CTgyn flashcards
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- Cardinal ligament contents
- The cardinal (Mackenrodt) ligaments contain the uterine artery and vein and provide lateral support to the uterus and cervix.
- Squamocolumnar junction
- The squamocolumnar junction is the border between the ectocervical squamous epithelium and endocervical columnar epithelium; it is the site of metaplasia and most cervical cancers.
- Ovarian lymphatic drainage
- Ovarian lymphatics follow the ovarian vessels to para-aortic nodes; some drainage goes to pelvic nodes via the broad ligament.
- Vulvar lymphatic drainage
- The vulva drains primarily to superficial inguinal nodes; the clitoris and anterior labia may drain directly to deep femoral or pelvic nodes.
- Endometrial functionalis and basalis
- The endometrial functionalis sheds during menses and is supplied by spiral arterioles; the basalis regenerates the endometrium and is supplied by straight arterioles.
- Most common gynecologic malignancy
- Endometrial cancer is the most common gynecologic malignancy in the United States, with obesity and unopposed estrogen as major risk factors.
- Ovarian cancer risk factors
- Nulliparity, early menarche, late menopause, BRCA mutations, and Lynch syndrome increase ovarian cancer risk; parity and oral contraceptives are protective.
- HPV types in cervical cancer
- High-risk HPV types 16 and 18 cause approximately 70% of cervical cancers; persistent infection is necessary for carcinogenesis.
- Vulvar cancer pathways
- Vulvar squamous cell carcinoma arises via HPV-associated (basaloid/warty) or HPV-independent (differentiated VIN, lichen sclerosus) pathways.
- Endometrial cancer diagnostic test
- Endometrial biopsy or dilation and curettage is required for diagnosis; transvaginal ultrasound is not diagnostic but can guide evaluation.
- Cervical cancer staging imaging
- MRI assesses local tumor extent; CT or PET/CT evaluates nodal and distant metastases; FIGO allows imaging findings in staging.
- Ovarian cancer workup
- Transvaginal ultrasound, CA-125, and CT of chest/abdomen/pelvis are used; tissue diagnosis requires surgery or biopsy.
- Sentinel lymph node biopsy
- Sentinel node biopsy with ultrastaging is standard for early vulvar cancer and increasingly used in endometrial cancer to detect micrometastases.
- Tumor markers in gynecologic cancer
- CA-125 for epithelial ovarian cancer, beta-hCG for gestational trophoblastic disease, AFP for yolk sac tumors, and inhibin for granulosa cell tumors.
- FIGO endometrial cancer stage I
- Stage I endometrial cancer is confined to the uterus: IA has less than 50% myometrial invasion; IB has 50% or more invasion.
- FIGO cervical cancer stage IB
- Stage IB cervical cancer is a measurable lesion confined to the cervix: IB1 ≤2 cm, IB2 >2 to ≤4 cm, IB3 >4 cm.
- FIGO ovarian cancer stage III
- Stage III ovarian cancer involves peritoneal metastases outside the pelvis or retroperitoneal lymph nodes; IIIA/B/C depend on size of residual disease.
- FIGO vulvar cancer stage III
- Stage III vulvar cancer includes tumors of any size with positive inguinal-femoral lymph nodes that are not fixed or ulcerated.
- Endometrial cancer prognostic factors
- Stage, grade, histologic subtype, myometrial invasion, and lymphovascular space invasion are key prognostic factors; p53 and POLE status are molecular markers.
- Ovarian cancer debulking goal
- Primary debulking surgery for ovarian cancer aims for no visible residual disease; residual disease is a strong prognostic factor.
- Radical hysterectomy
- Radical hysterectomy with pelvic lymphadenectomy is standard for early-stage cervical cancer (e.g., stage IB1–IB2); it removes the uterus, cervix, parametria, and upper vagina.
- Sentinel node ultrastaging
- Ultrastaging of sentinel lymph nodes uses step sectioning and cytokeratin immunohistochemistry to detect micrometastases and isolated tumor cells.
- Operative report essentials
- Operative reports should document tumor size, location, histology, grade, margins, lymphovascular invasion, and lymph node counts.
- Cervical cancer chemoradiation
- Concurrent cisplatin-based chemoradiation with brachytherapy is standard for locally advanced cervical cancer (stages IB3–IVA).
- PARP inhibitor maintenance
- PARP inhibitors are used as maintenance therapy for BRCA-mutated or HRD-positive advanced ovarian cancer after platinum-based chemotherapy.
- Endometrial cancer adjuvant therapy
- Adjuvant radiation is used for high-intermediate/high-risk endometrial cancer; chemotherapy is used for advanced or serous/clear cell histologies.
- Casefinding sources
- Casefinding for gynecologic cancers uses pathology reports, radiology reports, operating room logs, and tumor board lists to identify eligible cases.
- Data quality re-abstraction
- Re-abstracting a sample of cases and comparing with original data is a standard method to assess and improve cancer registry data quality.
- Survival analysis methods
- Kaplan-Meier estimates survival curves; Cox proportional hazards models assess the effect of prognostic factors on survival.
- Endometrial cancer follow-up
- Follow-up for endometrial cancer includes physical exam and symptom review every 3–6 months for 2–3 years, then annually; routine imaging is not recommended.
- Informed consent elements
- Informed consent must include diagnosis, treatment options, risks, benefits, and alternatives, and must be documented in the medical record.
- Multidisciplinary tumor board
- A multidisciplinary tumor board reviews cases to improve staging accuracy and treatment planning; documentation of the discussion is recommended.