Week 4- Gynecologic Malignancies Flashcards
What are the two types of endometrial cancer?
Type 1:
- lower risk, more common
- lower age
- estrogen related (obesity, PCOS, T2DM…)
Type 2:
- higher risk, less common
- higher age
- not estrogen related
Staging of Endometrial Cancer
I: confined to uterus
II: cervix
III: adenexae, uterine serosa, vaginal lymph nodes
IV: bowel, bladder, distant
When can you use hormone therapy in the treatment of endometrial cancer?
In well differentiated cases..progestin works
What is the risk of other cancers to women who have been diagnosed with endometrial cancer?
2x risk of breast and 3-7 x risk of colorectal
What factors DECREASE your risk of endometrial cancer? What factors INCREASE your risk?
Decrease
- multiparity >3, OCP, exercise, SMOKING, coffee
Increase
- HNPCC (suggest prophylactic hysterectomy and oophorectomy ~ 40 y.o)
- Obesity (3-10x)
- DM (2-3X)
- Anovulatory cycles (e.g. PCOS)
- Tamoxifen (but still a low absolute risk 1/1000–> 2/1000)
What is tamoxifen?
A selective estrogen modulator - it is an antagonist in the breast and an agonist in the uterus
What are the acute and chronic effects of radiation therapy
Acute:
- entertitis
- cystitis
- dermatitis
- bone marrow suppression
- fatigue
Chronic
- ovarian ablation
- fibrosis, atrophy
- bleeding
- stricture/fistulae
False positive rate for pap?
< 1%
RIsk factors for cervical cancer
Risk factors for cervical cancer include: young age at first coitus, multiples sexual partners, young age at marriage, young age at first pregnancy, high parity (vs. low parity for endometrial cancer), divorce, lower socioeconomic status, smoking, sexual partner with multiple sexual partners. A woman who has been sexually active in her lifetime is always at risk of cervical cancer - even if she is not currently sexually active or has not been for a long time.
Is the pap more or less likely to miss an invasive cancer or a precursor lesion
Sooooo counterintuitive
Neoplastic cells are frequently obscured by inflammatory changes when invasive carcinoma is present. Therefore, nearly 50% of women with invasive cancer have false-negative smears. The error rate (false negative rate) of the Pap test to detect dysplasia is ranges from 15 - 30%.
Severe squamous dyskaryosis would show….
loss of cellular maturation on the surface
This question highlights the natural history of dysplasia if left untreated. Dysplastic lesions of the cervix will either regress, persist, progress to carcinoma in situ or progress to invasive disease. High-grade cervical dysplasia should be treated as this is a pre-malignant lesion. Most low grade lesions/CIN I will regress after 18 months. Persistent low-grade lesions should however by treated. High-grade lesions have a risk of progressing to invasive disease. The risk of CIN 2 progressing to invasion is around 5% and CIN 3 progressing is >12%.
LSIL vs. HSIL and CIN1 vs CIN2/3
LSIL and HSIL are based on cytology (= Bethesda system)
- LSIL= mild dyskaryosis, CIN1
- HSIL= severe dyskaryosis, CIN 3
The CIN grading is based on biopsy
- CIN1 is <1/3 of thickness (from basal up)
- CIN 2/3 is >2/3 of thickness (from basal up)=
What is gestational trophoblastic disease?
GTD: proliferative disorder of trophoblasts
- Hyatidiform mole
- complete= empty ovum + 2 sperm (*completely *sperm), no fetal tissue but *completely *covers uterus (snowstorm) and completely invades (…15-20%…)
- partial= normal ovum + 2 sperm, fetal tissue present
- Gestational trophoblastic neoplasia (can occur after ANY pregnancy, but more likely to occur after a molar pregnancy
- Invasive mole
- Choriocarcinoma (from villous trophoblasts)
- Placental site trophoblastic tumors
