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Repro > Uterine/Ovary/Cervical CA, Gestational Trophoblastic Disease (docs) > Flashcards

Uterine/Ovary/Cervical CA, Gestational Trophoblastic Disease (docs) Flashcards

1
Q

What cell type is involved in uterine cervical carcinoma?

A

epithelial neoplasm, usually squamous cell carcinoma

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2
Q

Epidemiology of uterine cervical carcinoma?

A

common

12,000 cases/yr

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3
Q

Pathogenesis of uterine cervical carcinoma?

A

sexually transmitted HPV, especially 16 and 18

*only a tiny fraction of those infected get CA, and only after a long premalignant phase (as long as 20 years)

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4
Q

Pathology of CIN-I?

A

koilocytotic atypia (large nuclei with a halo) correlated with viral replication

**now called LSIL

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5
Q

Pathology of CIN-II?

A

pleomorphic atypia

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6
Q

Pathology of CIN-III?

A

carcinoma in situ

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7
Q

Symptoms/signs of uterine cervical carcinoma?

A

none, until late, when it starts bleeding

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8
Q

Colposcopy results of CIN?

A

white patches after application of acetic acid

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9
Q

Prognosis of uterine cervical carcinoma?

A

stage I: 85% 5-year survival
stage II: 75% 5-year survival
stage III: <50% 5-year survival

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10
Q

Dx of uterine cervical carcinoma?

A

screen with pap

dx with biopsy

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11
Q

HPV E6 gene product induces:

A

rapid degradation of p53 by ubiquitin-dependent proteolysis

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12
Q

HPV E7 gene product complexes with:

Which causes:

A

hypophosphorylated active form RB protein

proteoysis of RB protein, removing its inhibition of S-phase entry (via binding E2F transcription factor)

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13
Q

Colposcopy results of Invasive-type cervical ca?

A

fungating or flat or ulcerated,

commonly with highly abnormal vascular patterns

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14
Q

Invasive cervical cancer occurs in patients ages:

A

40-45

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15
Q

CIN III occurs in patients around age:

A

30

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16
Q

Trx of HSIL (CIN-II/III)?

A

cryotherapy, laser, loop electrical excision procedure (LEEP), cone resection

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17
Q

Trx of invasive cervical cancer?

A

hysterectomy and pelvic lymph node dissection

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18
Q

Prevention of cervical cancer?

A

vaccine

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19
Q

Ovarian carcinoma arises from:

A

surface of the ovary

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20
Q

3 most common types of Ovarian carcinoma?

A

serous (75%)
endometrioid (10%)
mucinous (10%)

21
Q

Epidemiology of Ovarian carcinoma?

A

common
slightly more common in whites
average age at dx = 63

*progressive four-fold rise in incidence between age 40-49 and age >70

22
Q

Prognosis of Ovarian carcinoma?

A

depends on stage: 85% 5-year survival if confined to ovary, but 25% if spread

23
Q

Treatment of Ovarian carcinoma?

A

surgery (excision if confined to ovary, “debulking” if spread)
+/- chemotherapy

24
Q

Diagnosis of Ovarian carcinoma?

A

radiology (US or CT), then surgery with biopsy

25
Q

When does dx of Ovarian carcinoma usually occur?

A

Commonly late, after already metastatic

26
Q

Screening tests for Ovarian carcinoma?

A

none very good!

US, +/- serum CA-125

27
Q

When are serum screening tests for Ovarian carcinoma commonly +?

A

when tumor = already stage 3

**half of patients with stage 1 ovarian cancer have a normal CA-125 level

28
Q

Signs of Ovarian carcinoma?

A 
*uncommon with early disease
pelvic or abd mass
abd ascites, tenderness
groin LAD
dec breath sound 
dullness to percussion over malignant pleural effusion
29
Q

Symptoms of Ovarian carcinoma?

A 
bloating 
abdominal enlargement 
urinary symptoms 
abd pain
pelvic pressure
\+++
30
Q

In ovarian carcinoma, ___% have symptoms before diagnosis.

A

93

31
Q

Pathology of Ovarian carcinoma?

A

> 60% distant metastases
~15% confined to 1’ at dx

typically 0.1-0.5 cm tumor nodules all over peritoneum and omentum

32
Q

Spread of Ovarian carcinoma?

A

first to peritoneum

then other ovary, regional lymph nodes, liver, lungs, etc

33
Q

Pathogenesis of Ovarian carcinoma?

A

accumulation of mutations in genes controlling cell proliferation (usually over many years)

34
Q

Risk factors for Ovarian carcinoma?

A
  • -age
  • -high exposure to gonadotropins
  • -high freq of ovulation (?)
  • -few or no pregnancies
  • -early menarche, late menopause
  • -family history (*BRCA mutation)
  • -smoking (mucinous type only)
35
Q

Conditions (risk factors) related to ovarian cancer?

A
  • -obesity (30% increased risk)

- -endometriosis (2.5 % lifetime risk)

36
Q

types of endometrial carcinoma?

A

type 1 = endometrioid (grade 1 or 2) **80%

type 2 = endometrioid (grade 3), serous or mucinous (etc) **20%

37
Q

Epidemiology of endometrial carcinoma?

A

US women have 2.6% lifetime risk

Average age at diagnosis = 61

38
Q

Pathogenesis of endometrial carcinoma?

A

type 1 = estrogen-responsive

type 2 = not estrogen-responsive

39
Q

Risk factors for type 1 endometrial carcinoma?

A 
age
obesity
unopposed estrogen
tamoxifen
nulliparity
DM
HTN
polycystic ovarian syndrome
40
Q

Genetic abnormalities in endometrial carcinoma?

A

Loss of PTEN function = early event

loss of p53 = 1’ genetic defect in non-endometrioid endometrial CA

41
Q

Pathology of endometrial carcinoma?

A

68% confined to uterus at dx
20% uterus + lymph nodes
8% + distant metastases

42
Q

Location of recurrences of endometrial carcinoma?

A

vaginal vault > pelvis > abdomen or lungs

43
Q

Symptoms of endometrial carcinoma?

A

abn uterine bleeding = cardinal symptom

44
Q

Signs of endometrial carcinoma?

A

typically none (uterus is usually not enlarged on exam)

45
Q

Dx of endometrial carcinoma?

A

can sometimes be made on cytology, but usually requires biopsy

46
Q

Treatment of endometrial carcinoma?

A

type 1: hysterectomy alone

type 2: hysterectomy +/- chemotherapy +/- radiation

47
Q

Prognosis of endometrial carcinoma?

A

cancer confined to uterus at dx = 96% 5-year survival

distant mets = 26% 5-year survival

48
Q

Most recurrences of endometrial carcinoma are in the first ___ years

A

three

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