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What is the appropriate follow-up after treatment of endometrial cancer
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What is the overall prognosis for endometrial cancer
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5: Gynecologic Oncology
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What is the screening recommendation for the general population What is the screening recommendation for women with/at risk for HNPCC
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Screening is not warranted for women who are asymptomatic Annual endometrial biopsies by age 35
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UTERINE SARCOMA
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What is a uterine sarcoma How common is it and who does it affect A very aggressive tumor that arises from the myometrium It is a very rare cancer (3 4% of all uterine malignancies) and commonly affects women over age 40 History of pelvic radiation; Longterm use of tamoxifen Mixed m llerian tumors (carcinosarcoma); leiomyosarcoma; endometrial stromal sarcoma (ESS); undifferentiated sarcoma Abnormal uterine bleeding; rapidly enlarging uterus; malodorous vaginal discharge; pelvic pressure and pain; part of the tumor may protrude from the cervical os Uterine leiomyomas Endometrial biopsy; dilation and fractional curettage Exploratory laparotomy with a pathologic diagnosis Imaging studies cannot distinguish between a sarcoma or other uterine tumors A CT scan of the thorax is recommended because uterine sarcoma commonly metastasizes to the lung Staging is done surgically and is a modification of the system used for endometrial cancer TAH/BSO, pelvic/paraaortic lymph node dissection, and pelvic washings
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What is the major differential diagnosis of uterine sarcoma What preoperative examinations may help with the diagnosis of a uterine sarcoma How is the definitive diagnosis of uterine sarcoma made What is the role of imaging studies in uterine sarcomas
What is the staging system for uterine sarcomas What is the treatment for uterine sarcomas
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Section II: Topics in Gynecology
What is the role of adjuvant therapy What is the overall prognosis for sarcomas
Stage I and II pelvic radiation therapy Generally they have worse prognosis than endometrial cancers of a similar stage
Ovarian Cancer
INTRODUCTION
How common is ovarian cancer It is the second most common gynecologic malignancy, but the leading cause of mortality among women who develop a gynecologic malignancy, and the fifth most common cause of cancer-related female deaths in the United States The lifetime risk of developing ovarian cancer is 14% (1 in 70) Symptoms of early-stage ovarian cancer are ill-defined and many women will not seek medical attention Often, the cancer is detected at its advanced stages when it has spread beyond the ovaries Epithelial origin; germ cell tumors; sex cord-stromal tumors; cancer metastatic to the ovary (usually from primary tumors of the breast, GI tract, or genital tract) Epithelial (~90% of all ovarian tumors)
Why is ovarian cancer the leading cause of mortality among women with gynecologic cancers
How are ovarian tumors categorized
Which ovarian tumor is the most common
EPITHELIAL OVARIAN CANCER
What age group does EOC affect What is thought to be the underlying hypothesis in the development of EOC Predominantly postmenopausal women Median age is 62 years old It is not well understood, but one hypothesis is that repetitive ovulation where disruption and repair of the ovarian epithelium may allow opportunity for genetic mutation and malignant transformation
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5: Gynecologic Oncology
What are the risk factors for development of EOC
Family history of breast cancer or EOC; history of breast cancer; advanced age; obesity/high fat diet; infertility; nulliparity; talc; endometriosis OCPs; tubal ligation; breastfeeding (history of); pregnancy; multiparity 90% are sporadic; 10% are genetic predisposition The onset of ovarian cancer occurs 10 years earlier in hereditary syndromes 1 Breast and ovarian cancer (BOC): associated with BRCA-1 mutation (autosomal dominant), more susceptibility to BOC, higher frequencies in Ashkenazi Jews 2 Lynch II Syndrome (hereditary nonpolyposis colon cancer HNPCC): colorectal cancer is hallmark, also commonly found are endometrial, urogenital, and other GI primaries 3 Site-specific ovarian cancer: strong genetic link, autosomal dominant, usually two or more first-degree relatives have the disease 1 Prophylactic genetic screening 2 CA-125 and transvaginal ultrasound every 6 12 months beginning between ages 25 and 35 years Prophylactic oophorectomy who have completed childbearing or by age 35 Endometriosis (25%) Serous 75 80% Mucinous 10% Endometrioid 10% Clear cell <1% Transitional cell <1% Undifferentiated <10%
What factors are protective against development of EOC What percent of EOC develops sporadically What percent are because of genetic predisposition What is one feature that distinguishes hereditary ovarian cancer from a somatic cause With what hereditary syndromes has ovarian cancer been associated Describe them
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