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cancer Flashcards

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1
Q

what are some different etiologies of OBGYN cancers

A

toxins, viruses (HPV), estrogen, ovulation

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2
Q

what is precancer

A

carcinoma in situ and dysplastic tissue

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3
Q

what is the job of the physician at the etiology phase?

A

identification of risk factors and prevention of development. we can use vaccines, or removal of risks.

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4
Q

what is the job of physician at the precancer phase?

A

screening or resection (cure)

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5
Q

what is physician’s job at the cancer phase?

A

diagnosis (staging) debulking, radiation or chemo

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6
Q

staging and prognosis?

A

the worse the stage, the worse the prognosis.

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7
Q

what do physicians worry about in the premenarchal stage for etiology?

A

usually only toxins, since the prepubescent female has no estrogen, is not ovulating, and usually is not sexually active and thus has reduced of acquiring viruses.

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8
Q

what do physicians worry about in the menarchal stage for etiology?

A

estrogen, viruses, ovulation. usually worry less about toxins.

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9
Q

what do physicians worry about in the postmenarchal stage for etiology?

A

lifetime of toxin exposure. lifetime of exposures for estrogen and ovulations.
This is why they have the most malignancies

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10
Q

what is the most complicated form of female cancer

A

ovarian due to the multiple cell types.

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11
Q

whart type of cancer is cervical cancer

A

squamous cell carcinoma

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12
Q

what type of cancer is vaginal cancer

A

squamous cell carcinoma

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13
Q

what type of cancer is vulver cancer

A

squamous cell carcinoma

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14
Q

what is the variant of vulvar cancer and why is it all important

A

pagets disease and its a red lesion.

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15
Q

what is the etiology of cervical, vulvar and vaginal cancers

A

HPV

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16
Q

what are the three cell types of ovary

A

germ, stromal, epithelial

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17
Q

what patient history could be indicative of cervical cancer?

A

post coital bleeding and black lesions that are puritic

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18
Q

what is the screen for vaginal and vulvar cancers?

A

There is none

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19
Q

What is the etiology of endometrial cancer

A

estrogen exposure

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20
Q

what is the precancerous lesion indicative of endometrial cancer

A

dysplasia, atypia

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21
Q

what is the typical cancer for endometrial cancer

A

adenocarcinoma

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22
Q

what patient history is a possible indicator for endometrial cancer

A

post-menopausal bleeder

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23
Q

what is the etiology of ovarian cancer

A

ovulation (ovarian epithelial cancer)

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24
Q

what is the typical cancer of ovarian cancer

A

epithelial cancer

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25
what is the screen for ovarian cancer
there is none
26
what patient history is possibly indicative of ovarian cancer
renal failure, small bowel obstruction ascites
27
what is the etiology of choriocarcinoma?
gestational trophoblastic disease
28
what is the typical cancer for choriocarcinoma?
Chorio
29
what is the screen for choriocarcinoma?
There is no official screen...but we can follow b-hCG while the patient is on oral contraceptive and if it rises then the cancer must be causing it.
30
what patient history could be indicative of choriocarcinoma
hyperemesis gravidum, hyperthyroid and size-date discrepancies.
31
are the rates of cervical cancer increasing or decreasing
rapidly decreasing
32
what ages does cervical cancer arise
30s and 60s...bimodal
33
what patient histories are indicative for cervical cancers in those bimodal age ranges?
30s --postcoital bleeding | 60s --post-menopausal bleeding
34
where does cervical come from?
HPV
35
why dont we see Cervical cancers before menarche
because its caused by HPV and that is an STI. there usually is no sex before then
36
what strains of HPV cause cancer
16/18k and the 30s
37
what strains of HPV cause warts
6/11
38
what is CIN now classified as?
Low-grade squamous intraepithelial lesion (LSIL)
39
What are CIN2/3 classified as
High-grade squamous intraepithelial lesion (HSIL)
40
Risk factors for cervical cancer
infections, HPV, smoking
41
1a staging
microscopic
42
Ib staging
macroscopic (see with naked eye) goes outward.
43
stage IA
only the cervix
44
stage IIA
only the upper 2/3 vagina
45
Stage IIIA
lower 1/3 vagina
46
Stage IIB
also involves the cardinal ligament
47
stage IIIB
involves the pelvic side wall
48
stage IV
distant metasteses.
49
stage IVA
adjacent organs
50
stage IV B
distant mets
51
How can we treat cervical lesions that are early
local ablative therapy. LEEP, freeze it off, and if endocervical use a cone biopsy.
52
what do the early stages look like
white lesions with a clear border, any abnormalities of the cervical, mosaicism.
53
when to begin pap
21 years old. continue every 3 years.
54
when to give paps when HIV positive
at diagnosis or when becoming sexually active. every year
55
How frequently pap if over 30 and HPV testing
then every 5 years
56
How frequently pap if over 65?
then can stop unless have a history of positive paps, or poor followup.
57
what happens with abnormal pap
colposcopy. if positive endocervical biopsy with follwup cone biopsy. if positive ecto and negative endo then local ablation therapy..
58
what happens when you have abnormal pap cells (atypical squamous cells of unknown significance (ASCUS).
Do paps in 6 months reflex the HPV DNA. If HPV DNA go to colpo. if at 6-12 months pap is ASCUS or worse then go to colpo. If ASCUS is positive and HPV is negative than normal resume 3 years. If ascus positive and repeats are normal than repeat 3 years.
59
If ecto lesion
LEEP/CRYO
60
If endo lesion
Cone
61
If IIA or better
Local ressection is generally curative
62
If IIB or worse
debulking chemo radiation and usually platinum based therapy
63
What does guardacil protect and who do we give to?
Vaccine to HPV. Recommended 11-26 girls. | Boys 11-21. can give as young as 9 and for boys as old as 21.
64
When do we see endometrial cancer?
estrogen has a cumulative effect. Reproductive age female with dysmenorrhea or in postmenopausal female with vaginal bleeding --bleeding after menopause is suspect!
65
What is the etiology of endometrial cancer
estrogen exposure.
66
Why are combined oral contraceptives protective against endometrial cancer?
because they contain progesterone and it PROtective against endometrial cancer because it blocks the effects of estrogen.
67
How does endometrial cancer form?
exposure to estrogen causes hyperplasia of endometrium (precancer) which gives way to adenocarinoma
68
what are the stages to get to adenocarcinoma
hyperplasia-cystic-adenomatous-atypical-adenocarcinoma
69
what causes excess estrogen exposure?
1) most potent annovulation (unopposed estrogen and lack of progesterone) 2) Age (older, longer exposure) 3) nullparity 4) obesity (peripheral conversion) 5) early menarche or late menopause 6) hormone replacement 7) tamoxifen
70
Is there a screen for endometrial cancer?
NO.
71
treatment for endometrial cancer
Total abdominal hysterectomy and bilateral oophorectomy this will remove the ovaries (source of estrogen) and the tumor in the uterus.
72
what is a stimulant for endos
estrogen
73
If patient has postmenopausal bleeding what do we do?
D and C or endometrial sampling.
74
If endomtrial sampling for postmeno bleeding is negative whats the diagnosis and treatment?
vaginal atrophy ---estrogen creams.
75
what are the four types of patients that present with endometrial cancers? how do all types present?
1) Old obese 2) Old and hormone replacement/tamoxifen 3) young annovulation (PCOS) 4) granulosa-thecal tumor Vaginal bleeding
76
How do we treat endometrial hyperplasia (especially in reproductive females)
Progesterone therapy.
77
If we diagnose endometrial cancer whats the treatment
total hysterectomy with bilateral oophorectomy with or without chemo and radiation.

OB/GYN (39 decks)

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