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Clin Med- P > female GU tumors > Flashcards

female GU tumors Flashcards

1
Q

two main risk factors for female GU cancer?

A

Multiparous

45-55 years of age

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2
Q

most significant early warning symptom of female gu cancer?

A

Post coital bleeding

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3
Q

5 early symptoms of female gu cancer?

A
  1. Thin watery discharge, blood tinged
  2. Intermittent painless metrorrhagia
  3. Post coital bleeding
  4. Bleeding becomes more frequent and increase in amount and duration
  5. Bleeding ultimately becomes continuous
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4
Q

4 late symptoms of female gu cancer?

A
  1. Flank pain and leg pain due to pelvic tumor
  2. Involving the uterus, pelvic wall or sciatic nerve
  3. Lower extremity swelling due to lymphatic blockage
  4. Massive hemorrhage and uremia and weight loss
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5
Q

3 types of cervical cancer treatment

A
  1. Surgery – Radical Hysterectomy
  2. Radiation
  3. Chemotherapy
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6
Q

2 txts for recurrent cervical cancer

A

Chemotherapy

Pelvic Exenteration

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7
Q

what is pelvic exenteration?

A

when ALL female organs are removed from the pelvis

including vagina and bladder/urethra

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8
Q

women who took DES have an increased risk of what? what about their daughter?

A

moms: breast cancer
Daughters: clear cell adenocarcinoma of the vagina and cervix and of breast cancer; fertility problems

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9
Q

many (20%) pts with DES exposure have ______ ______

A

cervical adenosis

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10
Q

most of the female GU cancers are of what type?

A

primarily squamous on histology

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11
Q

invasive cancer of the vagina- what are the symptoms?

A

typically asymptomatic , most common complaint is post-menopausal bleeding, post-coital bleeding

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12
Q

Dx of invasive cancer of the vagina. how is staging done?

A

biopsy using colposcopy, staging- FIGO or CIN

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13
Q

Over __% of patients with vaginal tumors have metastatic lesions. why is this significant?

A

80%

means they tend to not show up early, have already metastasized.

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14
Q

who does FIGO staging?

A

The FIGO staging systems are determined by the International Federation of Gynecology and Obstetrics

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15
Q

txt of vaginal cancer (maybe weeds)

A
  1. Surgical excision
  2. if primary vaginal cancer, use radiotherapy
  3. For clear cell lesions, radical hysterectomy, and vaginectomy or radiation therapy is effective
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16
Q

are benign tumors of the uterus common?

A

yes!

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17
Q

Smooth muscle benign tumor; most common benign uterine neoplasm. what is this?

A

fibroid (aka leiomyoma)

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18
Q

symptoms of fibroids

A

usually asymptomatic .. some women may have irregular periods, pelvic pain and infertility

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19
Q

what can change the size of fibroids?

A

Hormonally dependent (estrogen)- change throughout the cycle; shrink with menopause

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20
Q

txt for fibroids

A
  1. observation
  2. myomectomy (“fibroidectomy”)
  3. hysterectomy
  4. GnRH agonists may reduce tumor size (suppress estrogen production)
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21
Q

which treatments for fibroids will maybe restore fertility? which could contribute to infertility?

A

all of them will help restore fertility EXCEPT GnRH agonists b/c, while taking them, they will suppress necessary hormones

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22
Q

what is adenomyosis ?

A

Migration of glands from the basal layer of endometrium into the myometrium
-globular enlargment of uterus

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23
Q

older woman with cyclic pain… what might this be?

A

adenomyosis

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24
Q

what is the typical presentation of adenomyosis?

A

middle aged and parous women with severe dysmenorrhea and menorrhagia and having a symmetrically enlarged uterus

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25
Q

Dx of adenomyosis

A

US

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26
Q

Txt of adenomyosis (3)

A

NSAIDs for pain, hysterectomy, GnRH agonists

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27
Q

for adenomyosis, its hard to treat symptoms and maintian ____

A

fertility (b/c you need GnRH agonists for symptoms relief)

28
Q

what is the greatest risk for adenocarcinoma of the uterus?

A

unopposed estrogen effect on endometrium

29
Q

POST- MENOPAUSE BLEEDING IS _______ ______UNTIL PROVEN OTHERWISE

A

endometrial cancer

30
Q

what two things can decrease risk of adenocarcinoma of the uterus?

A

Oral contraceptives & smoking (maybe b/c less obesity in these women)

31
Q

risk factors for adenocarcinoma of the uterus? (5)

A
  1. obesity
  2. nulliparity + infertility (estrogen suppressed in pregnancy) & late menopause
  3. DM & HTN
  4. Caucasian
  5. tamoxifen use (an estrogen-like drug)
32
Q

adenocarcinoma of the uterus: overall more ______ ______ = higher risk

A

estrogen exposure

33
Q

most common symptoms of adenocarcinoma of the uterus. what else may you have?

A

postmenopausal bleeding

.. can have pelvic pain/cramping/bloating

34
Q

Dx of adenocarcinoma of the uterus

A

Ultrasound – “endometrial stripe” thickness > 5 mm

35
Q

if its early enough, what can you do for treatment of adenocarcinoma of the uterus?

A

Dilation and curettage (D&C) (scrape lining)

36
Q

what do you use for biopsy of adenocarcinoma? what will it show?

A

Use of Pipelle in office for EMB (endometrial biopsy)

–> complex hyperplasia with atypia

37
Q

what is the most common type of uterine cancer ?

A

endometrioid aka adenocarcinoma

38
Q

general txt guidlines for adenocarcinoma of the uterus? (4 options)

A

use Surgical staging to guide therapy

  1. Total Abdominal Hysterectomy (TAH)
  2. Bilateral salpingo-oophorectomy (BSO)
  3. pelvic lymph node dissection (PLND)
  4. Irradiation therapy
39
Q

txt for recurrence of adenocarcinoma of the uterus. how is it different if they don’t have a uterus?

A

high-dose progestins or anti-estrogens

need both if they have a uterus, only estrogen if no uterus

40
Q

symptoms of ovarian masses and cysts? (3)

A

bloating, fullness in pelvis, unilateral pain

41
Q

Dx of ovarian mass or cyst?

A

mass palpated on bimanual or abdominal exam (but this physical exam is not that helpful)
** ultrasound (best )

42
Q

“string of pearls” on ultrasound

A

ovarian cysts in PCOS

43
Q

which type of ovarian mass/cyst is most common? in what age women?

A

fluid filled cysts, mostly in younger women

44
Q

how do follicular/corpus luteal cysts present?

A

Pelvic pain, usually unilateral, may change with menses. pain helped by analgesics

45
Q

follicular/corpus luteal cysts are ____, and no surgery is necessary if identified via ______ in ______ ________. what happens to them?

A

Common, no surgery necessary if identified on Ultrasound in premenopausal woman
… most spontaneously drain and degenerate.

46
Q

what is do follicular/corpus luteal cysts look like on TVUS?

A

Anechoic unilocular fluid filled cysts with thin walls

47
Q

when can follicular/hemorrhagic cysts cause worry? what do you do?

A

Ruptured/hemorrhagic cysts can sometimes have significant bleeding, pelvic fluid/blood (can enter the abdomen)
- if bleeding stopped you can just observe, otherwise need hospital for blood loss

48
Q

adnexal mass with indication for surgery:

Ovarian cystic structure >___ cm that has been observed 
___- ___weeks without regression

A

> 5cm, 6-8wks

49
Q

4 most important indications for surgery of adnexal mass

A
  1. Any solid ovarian lesion
  2. Any ovarian lesion with papillary vegetation on the cyst wall
  3. Any adnexal mass >10 cm in diameter
  4. torsion or rupture suspected ( from doppler ultrasound)
50
Q

2 less important indications for surgery of adnexal mass (aka the ones hadley didn’t highlight)

A
  1. Ascites

2. Palpable adnexal mass in a premenarchal or postmenopausal patient

51
Q

Ovarian cysts: ___cm require only watchful waiting;

A

<5cm

52
Q

ovarian cancer: ____ most common CA in women

____ most common gynecological CA and has highest _______ _______.

A

5th most common CA in women
3rd most common gyn CA
highest mortality rate

53
Q

why does ovarian cancer have the highest mortality rate of all the gyn cancers?

A

it presents with late symptoms

54
Q

two most important risk factors for ovarian cancer?

A

white and nulliparous

55
Q

ovarian cancer: Most commonly diagnosed between ____-____ years old

A

40-60

56
Q

ovarian cancer:
Most often diagnosed in stage __
Most are derived from ______

A

3, epithelium

57
Q

what meds are protective against ovarian cancer?

A

long term oral contraceptives

58
Q

____ -____% of Malignant ovarian tumors seen in the US are Epithelial

A

85-90%

epithileal

59
Q

ovarian cancer: ___% of cases are sporadic (no genetic link- BRCA),___% are genetic

A

90% sporadic

10% genetic

60
Q

2 forms of hereditary ovarian cancer

A

A. breast and ovarian cancer syndrome (BOC) - BRCA mutation

B. hereditary nonpolyposis colorectal cancer syndrome (HNPCC)

61
Q

4 symptoms of ovarian cancer

A

Ascites (common)
Abdominal distention
Vague GI symptoms
Fixed mass in abd.

62
Q

Dx of ovarian cancer

A

Transvaginal or abdominal ultrasound

may be a role for BRCA1 gene testing and P53 testing as well

63
Q

ovarian cancer screening; what can we use and is it useful?

A

Combination of U/S and CA125 can detect early ovarian cancer, but finds many false positives… doest decrease mortality slightly (according to Hadley)

64
Q

The _______ recommends against screening for ovarian cancer in women

A

USPTF

65
Q

where does ovarian cancer often spread to? what does this mean for txt?

A

omentum, so you often must remove the entire greater omentum when trying to remove cancer

66
Q

txt for epithelial ovarian cancer (7)

A

TAH, BSO, peritoneal washings, pelvic lymph node dissection, omentectomy
AND
Chemo and
radiation

Clin Med- P (124 decks)

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