Flashcards in Gyn-onc Deck (25)
Which 2 subtypes of HPV are the most prevalent in cervical cancer?
16 and 18
Screening for cervical cancer?
Pap smear, HPV DNA testing
What does HPV vaccination do?
Reduces the incidence of premalignant lesion development in the cervix, vagina, and bulbs in women. Reduces genital warts and anal cancer in men.
Treatment for FIGO stage IB1 cervical cancer (lesion
Radical hysterectomy and lymph node dissection. If positive lymph nodes, positive margins, positive parametria, consider adjuvant cisplatin-based chemoradiation.
For metastatic cervical cancer, the addition of bev to chemo:
Improved OR by 4 months.
Risk factors for cervical cancer?
HPV, smoking, immunocompromise, early coitarche, multiple sexual partners
What are the 2 types of endometrial cancer?
Type I: endometrioid, due to unopposed estrogen exposure. Type II: non-endometrioid such as papillary serious or clear cell, higher mortality rate.
Risk factors for endometrial cancer?
Unopposed estrogen, obesity, nulliparity, late menopause, complex atypical endometrial hyperplasia, and tamoxifen use, HNPCC. Combined OCP and smoking decrease the risk.
How is endometrial cancer staged?
Treatment of endometrial cancer?
Surgery alone for early stage, low risk (stage IS, grade 1 or 2) endometrial cancer. Adjuvant therapy for high-intermediate risk. Adjuvant chemo for completely resected stage III and IV cancer. For low-grade, recurrent and metastatic endometrial cancer, progestin-based therapy. For high-grade metastatic disease, chemo (platinum, paclitaxel, doxorubicin, and bevacizumab)
Treatment for uterine carcinosarcomas (mixed Mullerian rumors)?
Always adjuvant chemo after resection. Use a combination of two drugs (platinum, ifosfamide, paclitaxel)
Treatment for uterine leiomyosarcoma?
Resection then observation for non-metastatic disease. No adjuvant therapy. For metastatic disease, gem plus docetaxel with RR about 30%. Doxorubicin with or without ifos is also OK.
Risk factors ovarian cancer?
Advanced age, family history, BRCA1/2, HPNCC, white race, fatty diet, nulliparity, first birth after age 35, , involuntary infertility, late menopause, early menarche. OCP use is protective.
Risk factors for ovarian cancer?
Increasing age, family history, BRCA1/2, HNPCC, white race, fatty diet, nulliparity, first birth after age 35, late menopause, early menarche. COPs are protective.
Only 50% of patients with early stage ovarian cancer have elevated CA-125 levels. T or F?
Neoadjuvant chemo followed by surgical cytoreduction yields equivalent outcomes to surgery followed by chemo for patients with clinically advanced epithelial ovarian cancer. T or F?
Do patients with favorable-risk, early-stage ovarian cancer (stage IA or IB, grade 1-2) require adjuvant chemo after complete surgical staging?
Chemo for advanced ovarian cancer?
Platinum plus taxane. The addition of bev increases PFS but not OS. Patients with optimally cytoreduced, stage III cancer have better OS when receiving IP chemo. Consolidation with paclitaxel has modest PFS benefit but also more alopecia and neuropathy.
Data on second-look laparotomy at the completion of first-line chemo for advanced ovarian cancer?
Provides prognostic info but does not improve survival.
Treatment for recurrent ovarian cancer?
If more than 12 months since last chemo, try platinum doublet again. Between 6 and 12 months, single agent platinum or non-platinum. Less than 6 months, nonplatinum single agent, with RR of 10-20%.
Treatment for sex-cord stromal cell tumors of the ovary?
Often diagnosed at stage I. Surgical resection. No adjuvant chemo. Some patients have concurrent endometrial carcinomas.
Treatment of germ cell tumors of the ovary?
Half are dysgerminomas. After staging surgery, stage I dysgerminomas and stage I, grade 1 immature teratomas need no adjuvant therapy. All other nondysgerminomas and higher-stage dysgerminomas need 3 or 4 cycles of cis/etop/bleo.
Treatment of gestational trophoblastic disease?
Highly curable with chemo. Low risk: methotrexate. High risk: etop/methotrexate/dactinomycin alternating with cyclophosphamide/vincristine.
Treatment for stage IB2 (lesion > 4 cm) cervical cancer and higher stages?
Cisplatin-based chemoradiation. Palliative chemo for stage IVB (distant mets).