- resembles normal endo - increased gland to stroma - cribiform architecture - nuclear atypia

- papillary archi - high grade nuclear - macro nuleai

- clear cytoplasm - high nuclear grade - various architecture

1. myoinvasion 2. lymphovascular invasion 3. cervical invasion 4. mets

1. smoking 2. immunocompromise 3. OCP

- before bimanual - don't contam. with lube - collect before STD swabs - ensure visualization

GYN malignancy Flashcards by Seth Davis

what is endo CA

most common

- epithelial tumor

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2 types of edno CA

type 1 - E dependent

type 2 E indep

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risk factors for E dep

obesty
chronic anov (PCOS)
unopposed E use
tmoxifen
early menarche/late meno
Fam hx

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prevention

avopid risk factors

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screening for endo**

none

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3 warning signs for endo

post-meno bleeds
irreg vag. bleeds
abdo bloating, pain, bowel sx

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diagnostic test for endo ca

endo biopsy with pipelle instrument

- US is not appropriate replacement

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morphology of type 1

resembles normal endo
increased gland to stroma
cribiform architecture
nuclear atypia

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what is grading in endo

amount of solid area

- more solid area is worse

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what can be seen in E dependent before

precursor lesions

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4 types of lesions

simple vs. complex
with or without atypia
complex with atypia has 50% risk

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2 types of type 2

serous (papillary)
clear cell
- both are high grade

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morpho of serous

papillary archi
high grade nuclear
macro nuleai

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morpho of clear cell

clear cytoplasm
high nuclear grade
various architecture

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precursors for serous and clear cell

serous - endometrial intraepitheliam carcinoma

clear cell - none

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4 prognostic factors

myoinvasion
lymphovascular invasion
cervical invasion
mets

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mgmt of edno CA

surgical

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outcomes for 2 types

type 1 - usually found early and cured

type 2 - usually found late and poor

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etiology of cerv. CA

HPV- most only dev. sublincal infection

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3 cofactors

smoking
immunocompromise
OCP

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2 types of cerv. prevention

1ry - avoid HPV and cofactors

2ry - paps

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2 types of 2ry prevention

traditional - pap smear
liquid based cytology medium
- less false neg
- increase sens

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tips for collection

before bimanual
don’t contam. with lube
collect before STD swabs
ensure visualization

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what are challenges in cerv. screening

high false neg
less reduction in adenocarcinoma
is opportunitic - relies on pt and halthcare provider

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when to start screen

21 - long time to dev SIL and LSIL is transient

how often

annual is standard practice, but if have negs, can do every 2-3 years because of sig. lead time

when to stop

consider stopping at 65-70 or hysterectomy with normal pap Hx - continue if at risk - continure in hyterectomy if HSIL in past

what to do with abnormal result

colposcopic eval

*** bethesda classification

satisfactory vs. unsat | neg vs. epithelial cell abnormal

2 types of abnormal

1. squamous - ASC (us or H) - LSIL - HSIL - carcinoma 2. glandular - AGC atypical glandular cells - AGC favour neoplasia - adenocarcinoma

what is only one that doesn't need colposcopy

ASC-US | - up to 5%

option for ASC-US

1. immed. colposcopy 2. repeat smears q6mox3 3. HPV DNA test

5 alternative causes for abnormal smears

1. atrophic changes 2. inflamm/infection 3. regen after injury 4. CA of other source 5. previous radiation

what is pap test NOT

screening test, not a diagnostic test

4 types of squamous lesions

normal squam cell LSIL HSIL SCC

** what is cytopathology

koilocyte - HPV infected cell - enlarged nuc - irreg nuc - hyperchromasia - binucleation - cytopasmic halo

3 types of glandular leasion

normal endo glands adenocarcinoma in situ adenocarcinoma

what is done in colposcopy

look inside and biopsy if abnormal

2 options for lesions

1. exision - cone biopsy - general - LEEP - in office 2. ablation - no patho - laser - cautery - cryotherapy

5 warning signs of cerv CA

1. abnormal pap 2. abnormal bleeds - ESP post coital 3. pelvic pain/discharge 4. bowel or bladder 5. flank pain/sciatica/lower limb edema (terrible triad)

** prototypical case

42 yo female heathy smoker no pap for a few years new onset coital bleeds

what is role for imaging

none- do a physcial

clinical mgmt plan

1. refer to gyn onc 2. determine stage 3. determine optimal ther

** what is special about staging of cervical

only one done clincally - with hands

what is mgmt

tailored to pt - advanced - chemorad - early - surg or chemo rad

2 most common histo types

SCC | endocervical adenocarcinoma

morpho of SCC

sheets of malignant cells | - sometimes keratinzation

morpo of adenocarcinoma

presence of atypical glands growing in disorganized fashion and invading cervial stroma

outcomes

early - cured with surg or chemorad | late- maybe cured with chemorad

SE of therapy

- loss of fert - meno - sexual dys - bowel bladder tox

3 parts of ovary and their potential neoplasms

1. primordial germ cells - germ cell tumors 2. sex cords - stromal tumors 3. epitheliom - carcinoma

epi of of germ cell tumors

the good - 10-15% - young females - typically curable even with mets

types of germ cell tumors and their effect

``` 1. mature teratoma (95%) - benign all the rest are malig 2. immature teratoima 3. dysgerminoma 4. yolk sac carc 5. embryonal carc. 6. choriocarc 7. gonadoblastoma ```

histo of teratoma

derivatives of any cell layer | - made up of mature adult type tissue

epi of stromal tumors

the bad (3-5%) - women of all ages - usually early stage and cured

epi of epithelial tumors

the ugly (80-85%) - 5 subtypes - each has it's own chars

5 subtypes

1. serous - most common 2. endometriod 3. mucinous 4. clear cell 5. transitionnal

histo of serous

often bilateral ovaries | - solid and cyctic mass with papillary projections

histopath of serous

- pap archi - high nuclear grade - macronuleaoli - abundant mitosis - psammoma bodies

histopath of mucious

- mucin producing - large, unilateral - atypia varies - pools of mucin

endometrioid histopath

unilat - often hemmoragic - morpho ident to endo CA

histpath of clear cell

unilat - solid and cystic mass - may be hemorragic

2 risk factors for epithelial ovarian Ca

1. incessant oviualtion - nulliparity - early menarche/ late meno - not on OCP 2. genetics

3 related familial sysndromes

1. site specific familial ovarian cancer syndrome 2. BRCA 3. lynch 10% have gentic link

prevention/screening

1. avoidance of risk factors - OCP, childbearing 2. prophylactic surg in high risk women 3. no good screening - US is NOT good

screening for women at high risk (BRCA)

1. transvag US q6 months 2. mammography 3. colonoscoly 4. prophylactic surg

warning signs

often asymptomatic 1. abdo bloating 2. abdo pelvic pain 3. bowel/bladder 4. vag bleeds

prototypical case

``` 60yo female - meno 8 years - 6 month sx On exam - fluid wave - omental cake - fixed irreg mass - cul-de-sac nodularity ```

4 diagnositc tests

1. pelvic transvag US 2. tumor markers 3. CT 4. CXR, barium enema

what is only type with no tumor markers

immature teratoma

tumor marker for epi, germ cell, stroma

epi - CA-125 germ - LDH, AFP, B-hCG stromal - inhibin

limitations of CA-125

premeno - low spec., affected by benigh conditions post-meno - very hiogh PPV - non-mucinous

*** what is involved in calculating risk of malig. index for adnexal masses

RMI = UxMxCA125

what is U

U = 1 (U/S 0 or 1) U = 4 (U/S 2-5) 1 point for presence of: multilocarity, bilateral, solid, ascites, mets

what is M

``` M = 4 for postmeno M = 1 for premeno ```

CA-125

absolute value

where is cutoff

RMI>200 - refer

main treatment

surg - unless too unwell

4 roles for surg

1. diagnosis 2. staging 3. debulking 4. adjuvant facilitation

what is role of debulking

relat. between amount of disease left and length of survival

3 prognostic factors

1. stage 2. optimal debulking 3. tumor biol

what is vulvar CA

skin CA of the vulva

epi of vulvar

- uncommon - 90% SCC - can often be a second primary malig (cervix/anus)

2 types of vulvar

1. type 1 - HPV related | 2. type 2 - non HPV

risks for type 1 (3)

HPV smoking immune suppress

risk for type 2

chronic vulvar disease | - lichen sclerosis

prevention/screening

- avoid risk factors - no good screen - treat preinvasive lesions - surveillance colposcopy

warning sx

- vulvar itch - burning - irreg. bleeding - vulvar lesion - groin pain swelling - bowel/bladder pain in advanced

diagnostic tests

- physical exam - colposcopy if nothing visible on physical - skin biopsy

keys to surgical mgmt

- wide local margin - assess sentinal nodes - neoadjuvant chemorad for locally advanced disease

histopath

- most are SCC | - look at depth, tumor width, lymph invasion, status of margins

reasons behind sentinal LN

- mets to groin nodes - risk increases exponentially when depth >1mm - node dissection is morbin - do sentinal node instead and if clear leave the rest

what does sentinal LN allow

ultrastaging of this node and detection of small mets

outcomes for vulvar

depends on the stage

GYN malignancy Flashcards

(94 cards)