Gyn Onc Flashcards by Ned Jones

Management of early stage cervical cancer in general

Early stage cervical cancer.
Upfront surgery (cervical conization vs. modified radical vs. radial hysterectomy depending on stage)
***Adjuvant chemoradiation if path indicates intermediate or high-risk of recurrence

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Surgical management of stage I cervical cancer

IF IA1, conization w/ no further management if margins negative
IF IA2,
modified radical hysterectomy (removal of uterus, cervix, upper ¼ of vagina, and paramteria)
simple hysterectomy w/ lymphadenectomy (can get away with simple hysterectomy)
IF IB1, radical hysterectomy w/ lymphadenectomy
IF IB2, radical hysterectomy

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First line for MMR deficient advanced endometrial

carbo/taxol/durvalumab w/ maintenance durvalumab until progression (DUO-E - PFS HR 0.42 in dMMR, OS immature)
*or dostarlimab w/ maintenace dostarlimab

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Size threshold for surgery vs. CRT

4 cm (greater than 4 cm requires CRT)

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CRT for cervical

weekly cisplatin w/ EBRT + brachytherapy

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Indications for adjuvant chemoradiation in localized cervical

positive margins
node positive
parametrial invasion

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Metastatic cervical mgmt

IF PD-L1 positive, platinum/carboplatin + paclitaxel + pembro +/- avastin
IF PD-l1 negative, platinum/taxol and bev

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endometrial cancer presentation

pelvic pain
change in bowel habits
*vaginal bleeding
discharge

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endometrial cancer RF’s

obesity
HRT
tamoxifen
older age
infertility
*endometrial hyperplasia
*PCOS

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Management of complex atypical hyperplasia

hysterectomy

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Lynch recommended endometrial cancer screening

transvaginal US annually starting at age 30
*Risk reducing hysterectomy with BSO at 35 or after completing childbearing

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endometroid significance with endometrial

bread and butter, more common endometrial cancer
nonendometroid is higher risk

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Uterine serous cancer significance

aggressive, “serious”

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Stage 1A endometrial management in woman wishing to preserve fertility

IF G1-2, hormone therapy with medrestol (oral progestin) can be used to preserve fertility

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Stage II endometrial mgmt

upfront surgery / adjuvant full pelvic EBRT

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Stage III-IV endometrial mgmt

upfront surgery
adjuvant chemo
*CRT also an option followed by chemo for Stage III

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clear cell significance in endometrial

aggressively behaving, requires systemic therapy

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serous HER2+ endometrial cancer mgmt

add herceptin to carbo/taxol

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recurrent metastatic endometrial mgmt

IF treatment free interval of >6 months, retreat with carbo/taxol

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Systemic therapy for uterine carcinosarcoma

ifosfamide or platinum-based therapy or taxol

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low grade endometrial stromal sarcoma mgmt

hormonal therapy medregstrol

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leiomyosarcoma mgmt

surgery if resectable

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stage IB cervical cancer mgmt

surgery with adjuvant brachytherapy (not full pelvic EBRT)

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ovarian cancer presentation

bloating
pelvic or abdominal pain
early satiety
urinary symptoms

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ovarian cancer RF's

- obesity - estrogen exposure (later pregnancy after age 35) -

When germline BRCA testing is indicated in ovarian

All high grade ovarian

Ovarian cancer biomarker

CA-125

Stage I ovarian cancer mgmt

IF wishing to preserve fertility, salpingo-oophorectomy

general management of ovarian

upfront cytoreductive surgery w/ salpingo-oophorectomy and hysterectomy w/ adjuvant chemo

management of ovarian in nonsurgical patient

upfront systemic therapy

When adjuvant chemo is indicated in ovarian

1) Stage IC or higher (positive ascites or peritoneal washings) 2) G3 3) clear cell histology

Role of maintenance in ovarian

*Essentially PARP + avastin for anyone regardless of BRCA status if high risk for recurrence *PARP if not high risk for recurrence *So PARP maintenance for all and avastin if high risk for recurrence

niraparib SE

thrombocytopenia

Recurrent metastatic ovarian management

IF platinum sensitive, carbo/taxol +/- bev *second cytoreductive surgery if possible IF platinum resistant, liposomal doxorubicin + avastin IF no trial, alternative chemo - docetaxel, pemetrexed, doxorubicin

sensitivity to immunotherapy in ovarian

- not very effective

serous ovarian low grade management

- AI - MEK inhibitors

mucinous ovarian cancer mgmt

- GI regimens (platinum resistant), eg. mFOLFOX

ovarian dysgerminoma mgmt

- analogous to seminoma (BEP)

ovarian yolk sac (endodermal sinus) of ovary 1) characteristic path finding 2) mgmt

- schiller duval bodies - adjuvant BEP

immature teratoma of ovary mgmt

- adjuvant BEP

granulosa cell tumor of ovary of mgmt

- upfront surgery - BEP

sertoli-leydig tumor of ovary 1) presentation 2) mgmt

1) virilization (testosterone producing - opposite of male sertoli-leydig) 2) surgery w/ adjuvant BEP

Ethnicity with highest rising rate of endometrial cancer

Black

endometrial cancer RF's

obesity tamoxifen Unopposed estrogen therapy infertility *PCOS (increased estrogen production) Estrogen-producing ovarian tumors

Lynch genes mutated in majority of endometrial cancer pts

MLH1 + MSH2

Indication for MSI/MMR in endometrial cancer patients

All patients (universal screening)

Management of endometrial complex atypia

- treated as malignancy (high percentage have coexisting adenocarcinoma)

Management of endometrial in patients who aren't surgical candidates

XRT

Adjuvant management stage I endometrial management

- indicated for high grade disease - Brachytherapy vs. radiotherapy depending on depth of invasion (full pelvic if deep invasion)

Stage III endometrial mgmt

- cytoreductive surgery - adjuvant chemo +/- XRT

Management of endometrial with isolated vaginal/pelvic recurrence

XRT

Later line for endometrial post chemo

Lenvatinib + pembro

When VEGF addition is indicated in endometrial

p53 mutation in recurrent metastatic disease

Targetable mutation for first line endometrial

HER2 for Serous endometrial

Localized carcinosarcoma mgmt

Surgery with adjuvant carbo/taxol (noninferior to ifosfamide and better tolerated)

Management of endometrial stromal sarcoma

Hormonal therapy (megestrol acetate) - hormone sensitive

Gyn malignancy assocaited with diethylstilbestrol (DES) exposure in utero

clear cell adenocarcinoma of the vagina and cervix

Preferred firstline systemic therapy for low grade endometrial stromal sarcoma

- AI

Olaparib SE to know

pneumonitis

Rucaparib SE to know

hepatotoxic

Management of ovarian cancer pt in surveillance with rising CA 125

- PET or CT

Components of surgical staging for ovarian cancer

- omentectomy, peritoneal biopsies, + lymph node sampling

Molecular profiling of endometrial

- MSI/MMR *HER2

Status of HER2 in endometral

Added to systemic therapy in first line metastatic setting if HER2 positive

Management of stage II cervical cancer (extension beyond the uterus)

Concurrent chemoradiation (w/ EBRT), followed by brachytherapy

First line for low risk gestational trophoblastic neoplasm/choriocarcinoma

- single agent chemo with methotrexate or dactinomycin

first line for metastati uterine leiomyosarcoma

gemcitabine + docetaxel Doxorubicine + trabectedin (Preferred)

1) RF's for ovarian cancer 2) protective factor

1) Nulliparity and early menarche 2) OCP's

Cervical cancer screening

High risk HPV test q 5 yrs (preferred) starting at age 25 - HPV + cytology cotesting q 5 years also an option

Management of locally advanced small cell carcinoma of the cervix

- CRT with cisplatin and etoposide, followed by 2 additional cycles of cisplatin/etoposide *essentially the same as small cell of lung

Management of metastatic cervical with peritoneal carcinomatosis

- intraperitoneal cisplatin/taxol + IV taxol

Drug approved for ovarian with tumors expressing high levels of FOLR1

mivretuximab soravtansine

Tumor mutational profiling required for metastatic cervical cancer

PD-L1 (IO added to chemo for PD-L1 positive)

Gene mutation to know for granulosa cell tumors

FOXL2

Initial management of cervical cancer with pelvic wall extension and hydronephrosis

Concurrent CRT w/ platinum chemo followed by brachytherapy

Stage IA dysgerminoma management

Observation

Minimally invasive/robotic vs. open hysterectomy for small cervical tumors

open (minimally invasive associated with lower OS)

Recurrent metastatic cervical cancer management

same as de novo, platinum sensitivity doesn't apply (CONFIRM)

Gyn Onc Flashcards

(78 cards)