Gyne: Cervical, Endometrial, Ovarian, Vaginal, Vulva

What is the primary etiology of cervical cancer?

HPV p16 and p18

What are 4 risk factors for cervical cancer?

HPV 16/18, multiple sexual partners, early sexual intercourse, smoking

What is the most common histology for cervical cancer?

SCC

What are 4 common presenting symptoms of cervical cancer?

Post-coital bleeding, irregular vaginal bleeding/discharge, back pain, pelvic pain

What is the screening method protocol for cervical cancer?

PAP smear every 3 years from age 21
HPV testing every 5 years from ages 30-65

How is cervical cancer diagnosed?

Punch biopsy for visible leasions
Colposcopy for abnormal pap smears or high risk patients

Most common metastasis for cervical cancer?

Lung, liver, bone

Common side effects of RT cervical treatment?

Bowel changes, cystitis, vaginal stenosis (managed with dilators, 5 min 3-5x/week)

What is the treatment method for locally advanced cervical cancer?

Concurrent chemorads with cisplatin
(45/25 EBRT + 28/4 Brachy (Ir-192))

What is point A in cervical brachy?

Point A describes the 2 cm superior from cervical os and 2 cm lateral isodose lines from midline. It represents the dose to paracervical tissue.

What is Point B is cervical brachy?

2 cm superior and 5 cm lateral from midline. Represents dose to pelvic wall.

What intracavity applicators are used for cervical brachy?

Tandem and ring
Tandem and ovoids

Briefly describe the FIGO staging for cervical cancer.

Stage 1 (1A-1B) = extent of invasion from cervix microscopically to visible invasion confined to cervix/uterus

Stage 2 (2A-2B) = extension into upper 2/3 vagina, parametrial extension

Stage 3 (3A-3B) = extension into lower 1/3 vagina, pelvic wall involvement

Stage 4 (4A-4B) = Extension in bladder or rectum, distant mets

MNEMONIC: CVPBD (Cervix→Vagina→Pelvic Wall→Bladder/rectum→Distant)

What is the most common gyne cancer?

Endometrial cancer

What is the typical age of diagnosis for endometrial cancer?

55+ postmenopausal

What is the main risk factor for endometrial cancer?

Unopposed estrogen, most common in obesity

What are 5 risk factors for endometrial cancer?

Nulliparous, unopposed estrogen, late menopause/early menarche, diabetes, lynch syndrome

What is a common clinical presentation of endometrial cancer?

postmenopausal bleeding

What are some clinical presentations of advanced endometrial cancer?

Hematuria, hematochezia, lower extremity edema

What are the 3 layers of endometrial cancer?

Serosa→myometrium→endometrium (out to in)

What is the standard surgical procedure for endometrial cancer?

Total hysterectomy + bilateral

salpingo-oophorectomy (BSO) ± lymphadenectomy + omentectomy.

What are RT dose fractions for endometrial cancer?

21/3 brachy
45/25 EBRT

What are common RT side effects for endometrial cancer?

cystitis, diarrhea, frequency, urgency, cramping

What is the most common histology for endometrial cancer?

Adenocarcinoma

What rank is ovarian cancer among cancer deaths in women?

5th most common cause of cancer

death in women.

Name the hereditary syndromes linked to ovarian cancer.

BRCA1/2 (hereditary breast-ovarian cancer syndrome) and Lynch syndrome (hereditary non-polyposis colorectal cancer — HNPCC).

Which reproductive factors increase ovarian cancer risk?

Nulliparity, early menarche, late menopause, Hormonal replacement therapy, endometriosis.

What factors are PROTECTIVE against ovarian cancer?

Oral contraceptive pills, and breast feeding

What are 3 histological types of ovarian cancer? What is the most common type?

Epithelial (most common), Germ cell, Stromal

What is the most common subtype of epithelial ovarian cancer?

Serous adenocarcinoma

What are common clinical presentations for ovarian cancer?

Pelvic/abdominal pain, bloating, urinary frequency, difficulty eating, unintentional weight loss.

What gyne cancer is considered the silent killer?

Ovarian due to late and subtle presentations

What tumor marker is used in ovarian cancer work up?

CA-125 (cancer antigen 125)

Describe the FIGO staging for ovarian cancer

1 → in ovary
2 → in pelvis
3 → in abdomen/peritoneal nodes
4 → distant mets

What is the standard surgical procedure for ovarian cancer?

TAH (total abdominal hysterectomy) + BSO (bilateral salpingo-oophorectomy) + omentectomy.

What is the standard chemotherapy regimen for ovarian cancer?

Platinum-based combination — carboplatin or cisplatin + paclitaxel.

What is the role of RT in ovarian cancer?

Limited role. Whole abdomen RT was used historically (now largely replaced by chemo). EBRT may be used for isolated recurrence.

How common is primary vaginal cancer?

Rare. Most vaginal malignancies are metastatic (from cervix

or endometrium). Mean age 60+.

What are the risk factors for vaginal cancer?

HPV infection, prior hysterectomy, prior pelvic RT.

What histologic type occurs in the UPPER ⅔ of the vagina?

SCC

What histologic type occurs in the LOWER ⅓ of the vagina?

Adenocarcinoma.

What are the symptoms of vaginal cancer?

Vaginal discharge, postcoital bleeding, pelvic pain.

Outline FIGO staging for vaginal cancer.

Stage I: Confined to vaginal wall
Stage II: Paravaginal extension (subvaginal tissue)
Stage III: Extends to pelvic wall
Stage IVA: Involves bladder or rectum

Stage IVB: Distant metastases

What is the primary treatment for vaginal cancer?

Primary RT ± brachytherapy (surgery often not preferred due to anatomy/function preservation).

What brachytherapy approach is used for UPPER ⅔ vaginal lesions?

Intracavitary brachytherapy using a vaginal cylinder.

What brachytherapy approach is used for LOWER ⅓ vaginal lesions?

Interstitial brachytherapy + EBRT (needles placed through perineum to reach lower vagina/vulva region).

What is the standard dose for vaginal cancer?

45 Gy EBRT + brachytherapy boost.

What ranking does vulvar cancer hold among gynecologic cancers?

4th most common gynecologic

cancer.

Distinguish the etiology of vulvar cancer by age group.

- Younger women: HPV-related, VIN (vulvar intraepithelial neoplasia)
- Older women: Lichen sclerosus (chronic inflammatory condition)
- All ages: Smoking is a risk factor

What is the predominant histologic type of vulvar cancer?

SCC

Describe the lymphatic drainage of the vulva.

Inguinal lymph nodes FIRST (superficial inguinal → deep inguinal/femoral) → then pelvic (iliac) nodes.

What are the classic symptoms of vulvar cancer?

Pruritus (itching), visible mass/lesion, burning, bleeding, dysuria.

Summarize FIGO staging for vulvar cancer.

- Stage I: Confined to vulva,<2 cm
- Stage II: >2 cm, still confined to vulva
- Stage III: Lymph node involvement (inguinal)
- Stage IV: Adjacent structures (urethra, vagina, anus) or distant mets

What are the indications for adjuvant RT in vulvar cancer?

Positive surgical margins and/or positive lymph nodes (LN+).

What RT technique is preferred for vulvar cancer?

IMRT (intensity-modulated radiation therapy) — allows better sparing of bowel, bladder, femoral heads while covering inguinal nodes.

What is the dose range for vulvar cancer EBRT?

45–50 Gy EBRT ± boost to high-risk areas (gross disease, positive margins).