B19. Epidemiology, etiology, histology, staging, symptoms, and diagnosis of vulvar, vaginal, and ovarian tumours. Flashcards Preview

Oncology > B19. Epidemiology, etiology, histology, staging, symptoms, and diagnosis of vulvar, vaginal, and ovarian tumours. > Flashcards

Flashcards in B19. Epidemiology, etiology, histology, staging, symptoms, and diagnosis of vulvar, vaginal, and ovarian tumours. Deck (29):
1

Epidemiology and symptoms of ovarian cancer

-Highest mortality among gynecological tumors
-Has no early symptoms and cannot be screened (typically found to late)
-Second most common pelvic gynecological tumors
-high mortality

2

Etiology of ovarian tumors

-Average age is 65 (if it affects young women considered hereditary disease BRCA1 and 2)
-The more ovulation cycles you have, the higher the chance of having an ovarian tumor

3

Histology of ovarian tumor types

-germ cell tumors
-epithelial tumors
-sex cord stromal tumors
-high grade serous carcinomas
-low grade serous type
-endometrioid, clear cell, and transitional type

4

Young patients have which ovarian tumor type the most? In adults? Rarest?

Germ-cell tumor for young patients. Epithelial tumors are most common in adults. Sex cord stromal tumors are the rarest and originate in the connective tissue.

5

What makes up 70% of the ovarian cancers? What are they sensitive to?

High grade serous carcinomas make up 70%. They are sensitive to chemo, especially p53.

6

Low grade serous types of make up what percent of ovarian tumors? Is it also chemo sensitive like the high grade serous carcinomas?

Only 5% of the ovarian tumors and is chemo-resistant.

7

How does ovarian tumors tend to spread?

-They tend to spread lymphatically, but in advanced cases hematogenously.
-Transperitoneal and intraperitoneal dissemination is common

8

Transperitoneal and intraperitoneal dissemination can lead to?

Peritoneal carcinomatosis and ascites

9

FIGO stage involvement of ovarian cancer
1.)
2.)
3.)
4.)

FIGO stage involvement of ovarian cancer
1.) Growth limited to the ovaries
2.) Tumor involves one or both ovaries with pelvic extension
3.) Tumor involves one or both ovaries with peritoneal metastasis outside the pelvis and/or retroperitoneal or inguinal lymph node metastasis
4.) Distance metastasis (excludes peritoneal metastasis) including liver parenchyma or malignant pleural effusion, which must be cytologically positive

10

If there are symptoms of ovarian cancer, what would they be?

-abdominal issues
-bloating
-abdominal discomfort

11

What tumor marker is elevated in advanced stages of ovarian cancer

CA-125

12

Physical exam and imaging for ovarian tumor?

Douglas pouch examination and rectal exam.

Imaging
-US (easiest access)
-CT and MRI (peritoneum and lymph nodes)

13

Imaging in ovarian cancer should focus on the pelvis but also which part of the body?

-omentum
-liver
-flexures

14

What is done if; an unresectable ovarian tumor is found?

Core needle biopsy is required for primary tumor or metastasis around retro-uterine pouch

15

Epidemiology and etiology of vulvar cancer

-Vulvar cancer is rare
-Seen in older woman and chances of incidence increases with age
-Develops due to poor personal hygiene, chronic inflammation, HPV infections, oncogenes viruses (15-20% of cases)

16

Histology of vulvar tumors

90-95% of vulvar tumors is invasive planocellular cancer

17

What are the types of vulvar cancer types

1.) Keratinizing form (affects elderly women, well differentiated, and p53 positive)
2.) Non-keratinizing form (poorly differentiated, often basaloid and HPV associated)
3.) verrucous carcinoma

18

Does vulvar tumors metastasis?

No, not unless it is treated with radiotherapy which makes radiotherapy CI

19

Vulvar tumors invade which local structure?

-vagina
-anus
-urinary meatus
-pelvic bones
-superficial inguinal and femoral lymph nodes (if more extensive tumors, invades external and internal iliac artery)

20

Vulvar tumor TNM staging
T1-
T2-
T3-
T4-
N1-
N2-

Vulvar tumor TNM staging
T1-
A: is <2 cm diameter and microinvasion depth <1mm
B: is <2cm diameter and microinvasion depth >1mm
T2-Tumor diameter is >2cm
T3-Tumor invades the urethra and/or the vagina, perineum, anus, unilateral inguinal metastasis
T4-
A: involves rectum and/or bladder, the mucosa of the urethra, pelvic bone, bilateral inguinal lymph nodes
B: distant metastasis and abdominal lymph node positivity

N1-unilateral inguinal lymph nodes
N2-bilateral inguinal lymph nodes

21

Symptoms of vulvar tumors

Begin at the labia minor or major
Tumor may be superficial, exophytic, and can eventually be ulcerated.
Skin discharge, itching, and bleeding are the most common symptoms

22

Diagnosis of vulvar tumor

Palpation of the tumor and inguinal lymph nodes. Rectovaginal examination.
Staging is done with inguinal US and pelvic CT or MRI.

23

Vaginal cancer epidemiology and etiology

-1-2% of all gynecological tumors
-50% affect posterior wall of the upper third of vagina
Risk factors
-increasing age (60 years of age)
-early age of intercourse
-multiple sex partners
-smoking
-HIV
-Vaginal intraepithelial neoplasia (VAIN)

24

When does vaginal intraepithelial neoplasia occur? What is typically seen with it?

It is usually associated with HPV (vaccination decreases its incidence). Typically seen with vulvar and cervical lesions.

25

Vaginal cancer types includes

-Squamous cell carcinoma
-Adenocarcinoma
-Melanoma
-Sarcoma

26

Most common histological type of vaginal cancer

Squamous cell carcinoma

27

Stages of vaginal cancer
-Stage I
-Stage II
-Stage III
-Stage IVA
-Stage IVB

Stages of vaginal cancer
-Stage I: Cancer is limited to vaginal wall
-Stage II: Cancer has spread to tissue next to vagina
-Stage III: Cancer has spread further into the pelvis
-Stage IVA: Cancer has spread to nearby areas, such as bladder or rectum
-Stage IVB: Cancer has spread to areas away from vagina, such as liver

28

Symptoms of vaginal cancer

Early vaginal cancer may not cause any signs and symptoms
As it develops, symptoms include
-Unusual vaginal bleeding (after intercourse or menopause)
-Watery vaginal discharge
-A lump or mass in your vagina
-Painful urination
-Frequent urination
-Constipation
-Pelvic pain

29

Diagnosis of vaginal cancer

-Pelvic exam and pap test
-Inspect the vagina with a magnifying instrument (Colposcopy)
-Biopsy of vaginal tissue for testing
-Imaging test to detect spread (x-ray, CT, MRI, PET)