Cervical Cancer, Endometrial Cancer, Vulvar/Vaginal Cancer, Ovarian Cancer, Moles

Question 1

Cervical cancer patient?

Answer 1

Reproductive age, caught on asymptomatic screen or with post-coital bleeding.

Question 2

What causes cervical cancer?

Answer 2

HPV, inflammation, squamous cell carcinoma

Question 3

How to diagnose cervical cancer

Answer 3

Pap, colpo, stage by exam or CT

Question 4

How to treat cervical cancer

Answer 4

Asgus? Watch and wait
Endocervical lesion? Cone biopsy
Exocervical lesion? LEEP

Question 5

Treatment for stage 2a or better? For 2b or worse?

Answer 5

Resection.

Debulking plus chemo+radiation.

Question 6

Risk factors for cervical cancer?

Answer 6

Numerous partners and previous STDs

Question 7

Characterization of dysplasia/CIN 1

Answer 7

Cell in basement membrane

Question 8

Characterization of carcinoma in situ or CIN 2

Answer 8

Cells fill epithelial layer

Question 9

Squamous cell carcinoma

Answer 9

Cells break through basement membrane and cause lesions

Question 10

Goal of cervical screening?

Answer 10

To catch dysplasia

Question 11

Stage I cervical cancer

Answer 11

Involves cervix only

Question 12

Stage 2a cervical cancer

Answer 12

Involves part of vagina

Question 13

Stage 2b cervical cancer

Answer 13

Involves part of vagina and cardinal ligament

Question 14

Stage 3a cervical cancer

Answer 14

Involves all of the vagina

Question 15

Stage 3b cervical cancer

Answer 15

Involves all of vagina and pelvic sidewall

Question 16

Stage 4a cervical cancer

Answer 16

Involves bowel and bladder

Question 17

Stage 4b cervical cancer

Answer 17

Distant mets

Question 18

Screening algorithm

Answer 18

Asymptomatic screen with pap. Can be normal, abnormal or ASGUS. If asgus, do a HPV DNA or repeat in 12 months.
If abnormal do a colposcopy. If exocervical, do a leep. If endocervical do a cone biopsy

Question 19

Endometrial cancer pathogenesis

Answer 19

Unopposed estrogen exposure

Question 20

Patient with endometrial cancer

Answer 20

Postmenopausal bleeding, dysmenorrhea in younger, or young with granulosa-theca cell tumor.

Question 21

How to diagnose endometrial cancer

Answer 21

Endometrial sampling

Question 22

How to treat endometrial cancer

Answer 22

Progesterone, followed by TAH and BSO if severe

Question 23

Risk factors for endometrial cancer

Answer 23

Nulliparity, early menarche, late menopause, obesity, PCOS, HRT

Question 24

Patient presentation with vulvar cancer

Answer 24

Black and itchy, or red and itchy.

Question 25

How do diagnose vulvar cancer?

Answer 25

Biopsy.

Question 26

How to treat vulvar cancer

Answer 26

Vulvectomy and lymph node dissection if SCC or Melanoma, local resection if paget's disease.

Question 27

What type of cancer does DES exposure cause?

Answer 27

Vaginal adenocarcinoma

Question 28

Three major types of ovarian cancers?

Answer 28

Germ cell, epithelial cell, stromal cell

Question 29

Types of germ cell tumors

Answer 29

Dysgerminoma- LDH Choriocarcinoma- BHCG Endodermal sinus tumor (yolk sac)-AFP Dermoid Cyst-Can cause struma ovarii

Question 30

How do patients with germ cell tumors present?

Answer 30

Teenage girl with adnexal mass and weight gain. Benign, stage I only

Question 31

How to diagnose ovarian tumor?

Answer 31

Transvaginal ultrasound

Question 32

How to treat germ cell tumor

Answer 32

Unilateral salpingo-oopherectomy

Question 33

Types of epithelial cell tumors

Answer 33

Serous Mucinous Endometroid Brenner

Question 34

Pathogenesis of epithelial cell tumors

Answer 34

Trauma from ovulation, very malignant

Question 35

Patient with epithelial cell tumor

Answer 35

Older, post menopausal, nulliparious. Usually present at stage III or worse. Can be asymptomatic or can present with renal failure, SBO, ascites. Associated with BRCA1/2 or HNPCC

Question 36

How to diagnose epithelial cell tumors?

Answer 36

Transvaginal ultrasound, CT to stage, track with Ca-125

Question 37

How to treat epithelial cell tumors

Answer 37

TAH and BSO plus paclitaxel if 3b or worse

Question 38

What to do if patient BRCA positive to avoid ovarian cancer

Answer 38

Screen with TVUS yearly and do a CA-125, then do TAH and BSO at 35.

Question 39

Types of stromal cell tumors

Answer 39

Granulosa-theca tumor -- produces estrogen | Sertoli-leydig tumor- can virilize

Question 40

Complete mole pathogenesis

Answer 40

Completely molar (no fetal parts) Completely chromosomal (46 chromosomes) Completely spermal Fertilization is normal but there is a broken egg so only spermal DNA.

Question 41

How does a patient with a complete mole present?

Answer 41

Size-date discrepancy, very high BHCG which causes nausea and can cause hyperthyroidism, hyperemesis gravidarum, adnexal mass, grape-like cervix

Question 42

Why can high beta hcg cause hyperthyroidism

Answer 42

because the structure is very similar between TSH and HCG

Question 43

How to diagnose complete mole?

Answer 43

Ultrasound shows snowstorm appearance

Question 44

How to treat mole? Follow up?

Answer 44

Suction curretage. Follow B-HCG weekly, put on OCP for 1 year to make sure BHCG doesn't go up.

Question 45

Pathogenesis of incomplete mole

Answer 45

``` Incompletely molar (there are fetal parts) Incompletely chromosomal (69 usually) Created by egg and two sperm ```

Question 46

Choriocarcinoma pathogenesis

Answer 46

Cancer of gestational products, patient presents status post mole, miscarriage or normal pregnancy (which is the most severe). Rise in HCG

Question 47

How to diagnose choriocarcinoma

Answer 47

Ultrasound, then curretage for biopsy, CT to stage

Question 48

How to treat choriocarcinoma

Answer 48

Debulk, methotrexate, actinomycin, +/- cyclophosphamide (if mets to liver or brain, after a normal pregnancy, or if HCG>40K).