Gyn Oncology

Cervical:

Lifetime risk 0.76%. Mean age at diagnosis 48 yrs.

HPV:

High Risk types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 69, 82

Low Risk types: 6, 11, 40, 42, 43, 44, 54, 61, 72, 81

- AGC on pap - 3-4% have AIS, and 1-2% have cervical adenocarcinoma.

- Adenocarcinoma in situ to early invasion is at least five years.

Reasons for excision procedure (CKC or LEEP): AIS, AGC-favor neoplasm or AGC-NOS on cytology even with negative colpo biopsies or ECC. If AIS or suspicious of AIS, must do CKC before hysterectomy. (Green Journal 4-2020).

- If Neg margins on CKC for AIS, then simple hysterectomy. If positive margins, refer to Gyn Onc to determine simple vs radical hyst and possible lymph node dissection. (Paps for 25 yrs after hysterectomy).

- If neg margins, and pt desires childbearing, then delay hysterectomy until completed childbearing.

For persistent low grade abnormal paps in postmenopausal women - vaginal estrogen for 6-8weeks and re-pap...it may have resolved (Brader).

Vaginal:

Uterine:

- "Women in the US have a 2.8 percent lifetime risk of being diagnosed with uterine cancer [3]. The average age of diagnosis of uterine cancer in the US is 62 years old. Among new cases, 34.5 percent were in women ages 55 to 64 years." (UpToDate)

Most common: endometrial adenocarcinoma.

- Type I tumors include tumors of endometrioid histology that are grade 1 or 2; these comprise approximately 80 percent of endometrial carcinomas. These tumors typically have a favorable prognosis, are estrogen-responsive, and may be preceded by an intraepithelial neoplasm (atypical and/or complex endometrial hyperplasia).

- Type II tumors account for 10 to 20 percent of endometrial carcinomas. They include grade 3 endometrioid tumors as well as tumors of non-endometrioid histology: serous, clear cell, mucinous, squamous, transitional cell, mesonephric, and undifferentiated.

Ovarian:

- lifetime risk: 1.6% (ACOG PB 174)

Adnexal masses: (mostly from Brader and Daudi):

- Never get CA125 on a pre-menopausal woman with ovarian cyst and known/highly suspected endometriosis (CA125 can be in 100s with benign disease)

- Never uses OVA1, usually only CA125.

- Large complex cysts in younger women are often muscinous cystadenomas.

- Serous cystadenomas are less likely to look complex, but are most common large cysts.

*Masses suspicious for cancer on US: Don't get an MRI, get an abdominal/pelvic CT for better assessment of nodes/mets.

Referrals:

If you are able to get a tissue diagnosis before referring, that is helpful..especially if patient if in poor health, and not a surgical candidate, tissue diagnosis can expedite chemotherapy if indicated (Example: patient with adnexal mass and poss. lung met, use IR to biopsy lung mass for tissue diagnosis).

- If you order additional imaging other than US, get CT abd/pelvis, not pelvic MRI.

- If you get a paracentesis to assess ascites, just get cytology and albumin. Then compare ascites albumin to serum albumin to determine if it is ascites from portal hypertension or not.