Neoplasms

Neoplasms-

-Endometrial Cancer-

-Endometrial Hyperplasia is the abnormal proliferation of both glandular and stromal elements showing altered histologic architecture

-Endometrial proliferation is an overabundance of endometrial whereas endometrial hyperplasia involves the structural elements.

-Different types of endometrial hyperplasia include cystic glandular hyperplasia, adenomatous hyperplasia, and atypical adenomatous hyperplasia

-Important concept is with continued estrogen stimulation through either endogenous or exogenous sources simple endometrial proliferation will lead to endometrial hyperplasia

-Risk factors for endometrial hyperplasia and endometrial carcinoma are anything that lead to an increase in estrogen in the environment.

-Diagnosis of endometrial hyperplasia or carcinoma is made by taking a sample.  Common ways to accomplish this are endometrial biopsy, D and C, or by removing of the uterus.

-The most common indication for endometrial sampling is abnormal bleeding especially those that are over 35.

-Most endometrial polyps are focal accentuated benign hyperplastic processes.

-Estrogen is implicated in antecedent hyperplasia; however, the actual stimulus to malignant degeneration to endometrial carcinoma is unclear

-Endometrial carcinoma usually occurs in women that are post menopausal

-Most primary endometrial carcinomas are adenocarcinomas

-Special consideration for endometrial sampling should be given to those with post menopausal bleeding that occurs after at least 6 months of amenorrhea.

-Endometrial carcinoma usually spreads throughout the endometrial cavity first and then begins to invade the myometrium, endocervical canal and eventually the lymphatics

-Once there is extrauterine spread to the abdominal and pelvic cavity, the spread can be similar to ovarian cancer

-Common histologic subtypes on endometrial carcinoma include:  papillary serous adenocarcinoma and clear cell adenocarcinoma

-The biggest prognostic factors is the histologic grade of endometrial cancer (Grading System is G1-G3)

-Surgical treatment is the cornerstone of therapy for endometrial carcinoma.  The abdomen pelvic cavity is explored and a TAHSO is performed

-Adjunctive therapy may include external beam radiation to reduce reoccurrence

-The first line treatment of recurrent disease is hormonal and includes progesterone at high doses.  Chemotherapy is also used

-Ovarian Neoplasms-

-The majority of primary ovarian tumors are partially cystic and derive from epithelial cells

-Ovarian neoplasms can also be from germ cells, sex cord stromal, and mixed types

-Leiomyoma (fibroid) is a neoplasm of smooth muscle that is benign that is usually from the uterus or broad ligament

-The majority of ovarian malignancies are from coelomic epithelium, with papillary cystoadenocarcinoma being most common

-The mean age at the time of diagnosis is 50 to 60 years old for ovarian cancer

-Presenting symptoms of ovarian cancer include dyspepsia, early satiety, anorexia, constipation, and bloating

-Patients may present with a pleural effusion with ovarian cancer

-Cervical Carcinoma-

-Cervical carcinoma is unique that there is a precursor lesion called  CIN (cervical intraepithelial neoplasia)

-CIN typically has a slow progression to frank cervical cancer

-Pap Smear is the non invasive screening test where samples are taken from the endocervix and exocervix

-Colposcopy is the follow up procedure for diagnosis on pap smears that are positive

-Treatments for precursor lesions CIN include cryotherapy, laser ablation, LEEP procedure (loop electrosurgical excision procedure), and cold knife cone biopsy with high cure rates

-Cervical cancer is now the second most common malignancy of women due to early detection

-Risk factors for development of cervical cancer:  early intercourse, multiple sex partners, early childbearing, male factors that are high risk, venereal infection, immune status, oral contraception, cigarette smoking, intrauterine DES exposure, and human papilloma virus exposure

-The area of metaplasia occurs for CIN between the old and new squamous columnar junction (SCJ)

-Ninety five percent of squamous intraepithelial neoplasia occurs in an area called the transformation zone

-Types of HPV associated with cervical carcinoma include types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, or 58

-Pap smears are recommended at age of first sexual intercourse or age of 18.

-The average age of invasive cervical carcinoma is 50

-The mainstays of treatment for invasive cervical carcinoma are radical surgical therapy and/or pelvic radiation

-Dysplasia (Cervical)-

-Cervical dysplasia is abnormal growth of precancerous cells on the surface of the cervix

-Cervical dysplasia is classified as high grade or low grade determined by the extent of the cell growth

-Cervical dysplasia is associated with HPV

-Surgical removal of abnormal tissue is the treatment of choice for cervical dysplasia

-Breast Cancer-

-Globally, Breast cancer is the most frequently diagnosed cancer and leading cause of cancer death in women

-In the US, breast cancer is the most common diagnosed cancer and the second most common cause of cancer death in women.

-Patients are staged via the TNM staging system

-Early stage includes stage I, IIa or a subset of II B

-Locally advanced includes a subset of patients with clinical stage II B and stage IIIA to IIIC disease

-Early stage breast cancer undergo primary surgery (lumpectomy or mastectomy) to the breast and regional nodes with or without radiation

-Following local treatment, systemic treatment may be offered based on primary tumor characteristics, tumor size, grade, status of estrogen receptors, progesterone receptors, and the human epidermal growth factor 2 (HER 2 ) receptor

-Locally advanced breast cancer is best managed with mutimodality therapy including systemic and local regional therapy

-Vaginal/Vulvar Neoplasms-

-Vaginal neoplasms are the rarest of all gynecologic neoplasms

-Carcinoma in Situ (CIS) occur mostly in the third decade of life.

-Over one half of the patients with CIS will have an antecedent or coexistent neoplasm of the lower genital tract

-Treatment options include laser ablation, local excision, and chemical treatment with 5 FU.  Total or partial vaginectomy with application of a split full thickness skin graft is usually reserved for treatment failures

-Invasive vaginal cancer is usually of the squamous cell carcinoma type (95%)

-Radiation therapy is the mainstay of treatment for patients with invasive vaginal cancer.   Radical hysterectomy combined with upper vaginectomy and pelvic lymphadectomy being used for upper vaginal lesion