Vulva, AGC, AIS, Uterine Corpus, & Ovarian Malignancies Flashcards
what is vulvar intraepithelial neoplasia (VIN)? what types of lesions?
VIN = premalignant condition of vulva (non-HPV)
Refers to squamous lesions
VIN LSIL is associated with what disease? VIN HSIL is associated with what disease? Differentiated VIN is associated with what disease?
VIN LSIL is associated with low oncogenic HPV types
VIN HSIL is associated with high oncogenic HPV types
Differentiated VIN is associated with lichen sclerosus
what are the risk factors of vulva HSIL (VIN HSIL)?
HPV infection, cig smoke, immunodeficiency or immunosuppression
what is the clinical presentation of VIN?
Vulvar pruritis, vulvar lesion
what tests do you do to evaluate VIN lesions?
Colposcopy and bx
what is the criteria to do Colposcopy when suspect VIN?
visible vulvar lesions, persistent symptoms, persistent abnormal cervical cytology
what is the GOLD STANDARD management for vulvar HSIL with a lesion?
Surgical excision (wide local excision or vulvectomy)
when would you do ablative therapy for pt with vulvar HSIL with a lesion?
done if pt doesn’t want surgery or isn’t candidate
what medication can you use in the treatment of vulvar HSIL with a lesion?
Topical tx with Imiquimod
management for vulvar HSIL without a lesion?
ablative therapy
what is the management for differentiated VIN?
surgical excision
risk factors for recurrence of VIN after tx?
immunosuppression, multifocal/multicentric disease, positive margins
risk factors for progression of VIN to malignancy?
histologic type (high-grade > low-grade)
co-existant VIN and carcinoma at dx
how can you prevent VIN?
HPV vaccine, smoking cessation
follow-up for pts with VIN?
follow-up every 6 months for 5 years, then annualy
vulvar cancer is most frequently in what women?
post-menopausal women
risk factors for vulvar cancer?
vulvar or cervical intraepithelial neoplasia, prior hx of cervical cancer (HPV), vulvar lichen sclerosus
what is the main factor to vulvar carcinogenesis occurring?
Mucosal HPV infection
clinical manifestations of vulvar cancer?
vulvar lesion (vulvar plaque, ulcer, or mass), pruritus
how do you evaluate pt for vulvar cancer?
colposcopy and bx
vulvar cancer dx, is what type of dx and made based upon what?
histologic dx made based upon a vulvar bx
75% of vulvar cancer are what type of cells?
squamous cell carcinomas
if pt with vulvar cancer has no mets, what is the standard tx?
surgery with adjuvant therapy
if pt with vulvar cancer has locally advanced disease/unresectable or has distant mets, what is the tx?
chemo or radiation if locally advanced disease/unresectable
chemo with combo of carboplatin and paclitaxel plus restaging exams with CT of chest, abdomen, and pelvic every 3 cycles for distant mets
atypical glandular cells are classified as?
AGC - endocervical, endometrial, NOS (not otherwise specified)
Atypical glandular cells, favor neoplastic (not normal cells)
Endocervical adenocarcinoma in situ (AIS)
Adenocarcinoma (full blown cancer)
endocervical and endometrial atypical cells are of what origin?
glandular cell origin
what is cervical adenocarcinoma in situ (AIS)?
a premalignant glandular condition
what is the only known precursor to cervical adenocarcinoma?
cervical adenocarcinoma in situ (AIS)
risk factors for cervicl adenocarcinoma in situ?
HPV infection (subtypes 16 and 18)
is it easy to distinguish AIS from cervical invasive adenocarcinoma?
NO!!! cytologically, they look the same, but histologally there is no invasion for AIS -> NEED BX
sx’s of AIS?
asymptomatic
what is the preserved management for AIS? what if you want to preserve fertility?
preferred management = hysterectomy
to preserve fertility = endocervical curetage
dx of AIS?
colposcopy-direct bx, endocervical curettage, conization
what is the definition of endometrial hyperplasia?
proliferation of endometrial glands
endometrial hyperplasia is a precursor to what?
to endometrial cancer
endometrial hyperplasia always results from?
unopposed chronic estrogen stimulation
what is the WHO CLASSIFICATION of endometrial hyperplasia?
- hyperplasia without atypia
- atypical hyperplasia (endometrial intraepithelial neoplasm: EIN)
endometrial hyperplasia risk factors?
Lynch Syndrome, endometrial exposure to unopposed estrogen
clinical presentation of endometrial hyperplasia and endometrial cancer?
abnormal uterine bleeding
diagnostic evaluation for endometrial hyperplasia?
endometrial sampling
what is the management for endometrial hyperplasia but NEGATIVE endometrial sampling?
if negative endometrial sampling, but still have persistent or recurrent bleeding, then repeat endometrial sampling
what is the management for endometrial hyperplasia, POSITIVE endometrial sampling?
follow-up of bx or curettage results
what is the most common Gyn malignancy in developed countries?
Endometrial Carcinoma
what is Type I tumors of endometrial carcinoma (comprise how much of endometrial carcinoma? prognosis? responsive to estrogen?)?
make up 80% of endometrial carcinomas, favorable prognosis, estrogen-responsive
what is Type II tumors of endometrial carcinoma?
only comprises 10-20% of endometrial carcinomas, high-grade tumors, poor prognosis, not associated with estrogen stimulation
what is the main risk factor for endometrial cancer?
Lynch syndrome
Lynch syndrome is a risk factor for what cancers?
Ovarian, Uterine, and Colon cancers
what are the cervical cytology findings for endocervical cancer?
adenorcarcinoma, atypical glandular cells, endometrial cells
endometrial cancer may be what type of finding?
an incidental finding
what bleeding patterns should you watch for in endometrial cancer?
Postmenopausal women -> any bleeding b/c should not have any bleeding if post-menopausal
Age 45-menopause -> any abnormal uterine bleeding
Younger than 45 years -> abnormal and persistent uterine bleeding
how do you evaluate a women with SUSPECTED endometrial cancer?
Pelvic US and endometrial sampling
what kind of dx is endometrial cancer?
a histologic dx
in what cases do you screen women for endometrial cancer?
women with lynch syndrome get screened for endometrial cancer
pre-treatment evaluation for endometrial cancer
look for Lynch syndrome (high risk factor), tumor markers (CA-125), contrast MRI
what is the standard initial tx to women with newly dx low risk endometrial cancer? what about women who want to preserve fertility?
surgical staging with total hysterectomy = GOLD STANDARD
women who desire fertility preservation should have MEDICAL THERAPY
what is the standard tx approach to women with recurrent or metastatic endometrial cancer?
radiation therapy if only in vaginal vault
surgery and/or radiation if only in pelvis
what cells is ovarian cancer derived from?
epithelial cells
what cancers are considered a single entity?
high-grade epithelial ovarian carcinoma, fallopian tubal, and peritoneal carcinomas
what are the risk factors for ovarian cancer?
Lynch syndrome, BRCA gene mutation, older age
the risk of ovarian cancer decreases in women with a history of what?
previous pregnancy, use of OCPs, breastfeeding
the risk of ovarian cancer is increased in women with a history of what?
infertility, endometriosis, polycystic ovarian syndrome, cig smoking
what are the acute presentations of ovarian cancer? what are they associated with?
pleural effusion and bowel obstruction
associated with advanced stages of ovarian cancer and need immediate tx
what are the subacute presentations of ovarian cancer?
adenexal mass, pelvic or abd pain, urinrary symptoms (urgency or frequency), bloating, GI sx’s
advanced epithelial ovarian cancer presents with what sx’s?
abd distention, nausea, anorexia, early satiety d/t to ascites and bowel mets
most women with epithelial ovarian cancer have what sx’s prior to dx?
pelvic or abd sx’s -> subacute sx’s
physical exam results of pt with epithelial ovarian cancer that leads you to their dx?
abd ascites, mass in mid-left upper abdomen, pleural effusion, groin or supraclavicular lymphadenopathy
lab and imaging studies for ovarian cancer?
transvaginal and transabdominal US exam and measuring the serum CA-125 (high CA-125 = ovarian cancer)
expert panels endorse theuse of ___ as a prompt for evaluation for ovarian cancer
use of symptoms
is routine screening recommended for ovarian cancer? who do you screen for ovarian cancer?
screening is NOT recommended for ovarian cancer unless the pt has LYNCH SYNDROME d/t it’s high association with ovarian cancer
what is the 2 phase process of evaluation for ovarian cancer?
- initial evaluation - if no indication for sugery (no adnexal mass, no sx’s, no elevated CA-125, or peritoneal carcinomatosis) -> evaluate for other etiologies
- if there is adexal mass and sx’s -> surgical evaluation - surgical evaluation
when do you refer premenopausal women with a pelvic mass to gynecologic oncologist?
if have very elevated CA-125 level, ascites, or evidence of abdominal or distant mets
when do you refer postmenopausal women with a pelvic mass to gynecologic oncologist?
if have elevated CA-125 level, ascites, nodular or fixed pelvic mass, evidence of abdominal or distant mets
