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Clin Med3: Womens Health > Gynecologic Oncology > Flashcards

Gynecologic Oncology Flashcards

1
Q

What are screenings for cervical cancer

A

Pap smear
HPV testing

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2
Q

how often should women 21-30 get PAP smears

A

every 3 years - if normal-risk

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3
Q

how often should women ages 30-65 get cervical cancer screenings

A

Cervical cytology alone every 3 years
OR
HPV testing alone every 5 years
OR
HPV and PAP every 5 years

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4
Q

what are the harms of screening

A

increase number of procedures - preterm labor, incompetent cervix
-many lesions would resolve on their own

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5
Q

when is no cytology screening recommended

A

under 21 or > 65 and previously screened

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6
Q

when is colposcopy + acetic acid stain used

A

ASCUS and + HPV
any CIN (-3)

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7
Q

when is cryosurgery used

A

small, non-invasive lesions

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8
Q

when is CO2 laser used

A

large visible lesions

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9
Q

when is the LEEP procedure used

A

excisional biopsy for lesions fully visible
in office, local anesthesia

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10
Q

what is Conization

A

surgical removal of entire transformation zone
CIN III or carcinoma in situ

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11
Q

when is cervical cancer most commonly diagnosed

A

between 35-44 years of age

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12
Q

What does CIN stand for

A

cervical intraepithelial neoplasia

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13
Q

what does ASCUS stand for

A

atypical squamous cells of undetermined significance

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14
Q

what are high risk factors for cervical cancers

A

HPV infection (types 16 and 18) - high number of sexual partners, early age at first intercourse, history of other STIs
HIV infection
Immunosuppression
Smoking
Exposure to DES in utero
previous tx for CIN 2 or CIN 3

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15
Q

What is CIN III

A

pre-cancerous stage
predominantly women ages 25-40

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16
Q

what are the different cervical carcinomas

A

Squamous cell carcinoma
adenocarcinomas
adenosquamous
arise primarily int he transitional zone

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17
Q

what are common symptoms of cervical cancers

A

metrorrhagia, postcoital spotting, cervical ulcerations
later stages: bladder and bowel dysfunction; fistulas

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18
Q

what is the definitive diagnosis for cervical cancer

A

biopsy

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19
Q

what imaging can be used for staging and treatment planning of cervical cancer

A

CT (primarily evaluates kidneys)
MRI (assesses uterine and paracervical extension)
US

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20
Q

what are the stages of cervical cancer

A

0-4

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21
Q

what is the treatment of choice for carcinoma in situ

A

total hysterectomy

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22
Q

what is the treatment for carcinoma in situ if the patient wishes to preserve childbearing abilities

A

removal of cervix and surrounding structures + lymph node dissection with retention of uterus
cervical conization, laser ablation, cryosurgery (all with close follow up)

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23
Q

What is the treatment of early, small cell stage 1 cervical cancer

A

total hysterectomy alone

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24
Q

what is the treatment for cervical cancer stages I-IV

A

radiation and chemo (primarily cisplatin)
+/- total hysterectomy

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25
Q

what are complications of cervical cancer stage II - IV

A

risk for vaginal hemorrhage
-cause of death in 10-20% of pts with invasive cervical CA

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26
Q

what is the treatment of vaginal hemorrhage

A

ligation of uterine or hypogastric arteries
hemostatic agents: acetone, monsel’s solution
vaginal packing
radiation

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27
Q

what are the types of uterine cancer

A

endometrial adenocarcinomas (endometrial lining)
Leiomyosarcomas (uterine smooth muscle)

28
Q

what is the average age of diagnosis of leiomyosarcomas

A

50-52

29
Q

what are risk factors of leiomyosarcomas

A

excess estrogen exposure
tamoxifen use
black patients
prior pelvic radiation

30
Q

what can reduce your risk of leiomyosarcomas

A

OCPs and Smoking

31
Q

what is different with leiomyosarcomas than other uterine tumors

A

grow more quickly
more aggressive
metastasize more quickly
poorer prognosis

32
Q

what are the symptoms of leiomyosarcomas

A

abnormal vaginal bleeding (most common)
pelvic or abdominal pain
profuse foul smelling discharge
+/- GI or urinary complaints

33
Q

what is the most common type of uterine cancer

A

endometrium cancer

34
Q

how is Leiomyosarcomas worked up

A

may be detected on endometrial biopsy or D&C
MRI/CT
Many diagnosed incidentally on operative histology

35
Q

what is the treatment for leiomyosarcomas

A

total abdominal hysterectomy
+/- radiation

36
Q

how often should patients with leiomyosarcomas follow up

A

PE every 3 months for first 2 years
3rd year: every 6-12 months
CT chest/abd/pelvis every 6-12 months

37
Q

what is the average age at diagnosis of endometrial cancer

A

50-70yo

38
Q

What are the two types of endometrial cancer

A

type 1: endometrioid (estrogen dependent)
type 2: non-endometrioid

39
Q

what is Lynch syndrome

A

hereditary non-polyposis colorectal cancer
autosomal dominant condition

40
Q

what is the most common symptom of endometrial cancers

A

irregular vaginal bleeding

41
Q

what are the symptoms of pre-menopausal women with endometrial cancers

A

prolonged, heavy menstruation
spotting between periods

42
Q

what are the symptoms for post -menopausal women with endometrial cancers

A

any vaginal bleeding
may present as abnormal vaginal discharge

43
Q

what are the later signs stages of endometrial cancer

A

related to uterine enlargement or extrauterine extension
pelvic pain or pressure
bloating
early satiety
increased abdominal girth

44
Q

what can be seen on PAP smear with endometrial cancer

A

benign endometrial ells on PAP in post-menopausal women
atypical glandular cells on PAP

45
Q

what is the mainstay of workup for endometrial cancers

A

endometrial biopsy
D&C if insufficient sample of AUB persists

46
Q

what is the treatment of choice for endometrial cancer

A

hysterectomy with bilateral salpingo-oophorectomy (BOS)
+/- chemo/radiation

47
Q

what is a tumor marker that can be related to endometrial cancer

A

CA-125

48
Q

what is a precursor to vaginal cancer

A

vaginal intraepithelial neoplasia (VaIN)

49
Q

what is the most common symptom of vaginal cancer

A

AUB
may see pelvic pain or vaginal discharge
urinary symptoms if involving anterior vaginal wall

50
Q

what is the workup for vaginal cancer

A

often identified via pelvic exam
gross lesions on speculum exam should be biopsies
colposcopy if lesions suspected but not grossly identified
CT to assess for metastasis

51
Q

what is the treatment of stage 1 or 2 vaginal cancer

A

surgery or radiation; vaginectomy, hysterectomy, +/- lymphadenecotmy
radiation: external beam +/- brachytherapy

52
Q

what is the treatment of stage III vaginal cancer

A

typically radation + chemo (cisplatin)

53
Q

what is the treatment of stage 4 vaginal cancer

A

systemic chemo +/- palliative care

54
Q

what is a common association with vulvar cancer

A

HPV infection

55
Q

what are risk factors for vulvar cancer

A

HPV infection
increasing age
HPV associated genital warts
HSV infection
smoking
chronic immunosuppression
Lichen Sclerosus

56
Q

what is the most common vulvar cancer

A

squamous cell carcinoma

57
Q

what are symptoms of vulvar cancer

A

primarily puritis and visible lesion
may have pain, bleeding, ulceration and inguinal mass

58
Q

how is vulvar cancer worked up

A

vulvoscopy with acetic acid staining - biopsy
should preform colposcopy of vagina and cervix at same time
dont forget perineal exam

59
Q

what is the treatment of SCC vulvar cancer

A

local excision
larger lesions: radical partial vulvectomy
total vulvectomy + flap reconstruction
chemo and or radiation

60
Q

what are risk factors for ovarian cancer

A

nulliparity
use of HRT/fertility tx
obesity
diet

61
Q

what are protective for ovarian cancer

A

Multiparity
use of OCPs
use of ASA
tubal ligation
breast feeding

62
Q

what are the histological types of ovarian cancer

A

epithelial cell (90%)
germ cell
stromal cell

63
Q

what are the symptoms of ovarian cancer

A

primarily asymptomatic
palpable mass identified on pelvic exam
vague pelvic pain/pressure
occasionally bloating, nausea, indigestions, early satiety (late stage)
bowl/bladder changes (later stage)
increasing abdominal girth (later stage)

64
Q

what is the workup for ovarian cancer

A

tumor marker: CA-125
TVUS: to differentiate between benign and malignant masses
open biopsy - for definitive dx

65
Q

what is the treatment of ovarian cancer

A

sx removal of mass
included total hysterectomy, BSO, removal of omentum and selective lymphadenectomy

Clin Med3: Womens Health (13 decks)

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