Info
🌱 來自: Huppert’s Notes
GYN Malignancies🚧 施工中
GYN Malignancies
Ovarian cancer
• Epidemiology: Median age at diagnosis 63 yr, lifetime risk 1.3%. Risk factors: BRCA 1 or 2 mutation, older age, infertility, endometriosis, PCOS, cigarette smoking. Protective factors: OCPs, previous pregnancy, history of breastfeeding.
• Screening: No screening indicated; if high risk (e.g., ovarian cancer in first degree family member, BRCA mutation) can screen with CA-125, pelvic exams, and transvaginal ultrasounds, but little data
• Clinical features: Subacute presentation. Adnexal mass, ascites, early satiety, weight loss.
• Diagnosis: Transvaginal/abdominal ultrasound usually visualizes complex adnexal mass. Elevated CA-125. Pathologic diagnosis requires surgical exploration, as needle biopsy can rupture the mass and cause a worse prognosis.
• Treatment:
- If surgical candidate: Exploratory-laparotomy for surgical excision +/– intraperitoneal chemotherapy (survival benefit in patients with small amounts of residual disease confined to the peritoneal cavity following surgery)
- Adjuvant chemotherapy: Paclitaxel, carboplatin
- Surgical debulking improves survival in metastatic disease
• Surveillance: Obtain CA-125 before surgery. Following CA-125 longitudinally post-surgery may help identify recurrence, but has not been shown to impact overall survival.
Cervical cancer
• Epidemiology: Median age at diagnosis 50 yr. Risk factors: HPV, immunosuppression, HIV, smoking
• Screening: Pap smear (every 3 yr for women age 21–29 yr, then every 5 yr with HPV co-testing for women age -30 yr)
• Clinical features: Abnormal vaginal bleeding (post-menopausal, post-coital, intermenstrual)
• Diagnosis: Pap smear cervical cytology, cervical biopsy and colposcopy
• Treatment:
- Early (stage I): Loop electrosurgical excision procedure (LEEP) or cervical conization. After childbearing: Hysterectomy.
- Advanced (stage III–IV): Concurrent chemotherapy/radiation therapy (cisplatin-based regimen) or chemotherapy alone for metastatic disease
Endometrial cancer
• Epidemiology: Median age at diagnosis 60 yr. Risk factors: Excess estrogen (e.g., obesity, postmenopausal estrogen without progesterone opposition), tamoxifen therapy, nulliparity, diabetes, Lynch syndrome
• Screening: No routine screening recommended
• Clinical features: Postmenopausal/irregular bleeding
• Diagnosis: Transvaginal ultrasound with thickened endometrial stripe → perform endometrial biopsy
• Treatment: Surgical resection of the uterus, cervix, and adnexa in early stages; later stages may require chemotherapy/radiation therapy