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GYN Flashcards

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1
Q

FIGO stage IA staging for cervix

A

Stage IA is microscopic disease, IA1: DOI<3mm, IA2: DOI>3mm but < 5mm

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2
Q

FIGO Stage II uterine

A

Invades cervical stroma but not extend beyond uterus.

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3
Q

Early dermatitis during vulvar RT is likely due to:

A

yeast infection, treat with diflucan

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4
Q

uterine high risk hisotlogy Stage IA

A

adj cht + VBT

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5
Q

IB G2

A

VBT but consider obs or consider EBRT depending on risk factors

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6
Q

T1a and T1b for vulvar cancer

A

T1a: confined to vulva/perineum <=2cm with stromal invasion <=1mm, T1b: >2cm OR any size with stromal invasion > 1mm

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7
Q

4 genomic classifications of endometrial cancer

A

POLE, MSI unstable, copy number low, copy number high (worst prognosis)

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8
Q

Management of cervix IB1

A

same as IA2 and IA1 with LVSI, radical hysterectomy instead of modified radical hysterectomy.

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9
Q

IB G3

A

EBRT

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10
Q

Management of vulvar cancer that is unresectable AND LND not feasible

A

CCRT + primary + inguinal/pelvic LN

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11
Q

How to treat a vaginal cuff recurrence of uterine

A

45 in 25 + VBT

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12
Q

IA, G3

A

VBT

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13
Q

FIGO Stage IIIA,IIIB,IIIC uterine

A

IIIA, serosa and/or adnexa, IIIB: Bagina or parametrial involvement, IIIC1: pelvic LN, IIIC2: PA LN involvement

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14
Q

d2cc bladder, rectum, sigmoid, bowel

A

80, 65, 70, 65 (90, 75, 75, 75)

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15
Q

VBT dose for monotherapy

A

6 Gy x 5 fractions to 5 mm depth

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16
Q

What dose to Primary, elective, and gross residual LN for postop vulvar

A

50 Gy to postop bed, if close or positive margin or ECE to 60 Gy, gross residual LN go to 66 Gy, 50 Gy to elective nodes

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17
Q

uterine high risk hisotlogy Stage IB-IV

A

adj cht +/-EBRT +/- VBT

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18
Q

Management of T1b vulvar

A

Modified radical vulvectomy, R0: observe, R1: re-resection v. CCRT, SLNB: if positive finish LND

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19
Q

What are the patients that could get postop RT without chemo (vulvar)

A

SLNB alone with 1 LN with < 2mm. Anyone with more LN gets LND and then anyone with 2+ LN gets adj CCRT.

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20
Q

When is a radical hysterectomy preferred over total hysterectomy in uterine cancer

A

with gross cervical involvement.( proximal third of vagina also taken)

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21
Q

Imaging needed for vulvar workup

A

CXR, MRI, PET CT

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22
Q

Management of IA1 cervix without LVSI

A

CKC with 3mm margin, R0: observe, R1: repeat CKC or simple trachelectomy. IF fertility not an issue, extrafaxscial hysterectomy.

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23
Q

Stage IVA and IVB uterine

A

IVA: invasion of bladder and/or bowel mucosa, IVB: DM

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24
Q

What imaging is needed for uterine

A

Transvaginal US, MRI pelvis, CXR, CTCAP

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25
What chemo is given with RT for vulvar
Cisplatin 40mg/m2 weekly
26
Management of T1a vulvar
WLE, R0: observe vs risk-directed adj RT, R1: Re-resection
27
What are indications for adj rt to vulva after surgery for vulvar cancer
Positive margin, close margin <8mm, LVSI, DOI>5mm, Size > 4cm
28
bladder ebrt constraint for 45 Gy gyn
V45<35%
29
Management for medically inoperable uterine
EBRT 45/25 then BT 5x5 with Rotte Y applicator, GTV to 90 Gy, HR-CTV to 65 Gy(entire uterus, serosal surface, cervix and upper 1-2 cm vagina.
30
Small bowel dmax
55 Gy
31
What are the postop indications for RT for cervix
You have to have 2 of these: outer two-third cervical stromal invasion, size>4cm, LVSI
32
Staging IB-IVB for cervix
IB1: >5mm DOI and size < 2 cm, IB2: >2 but <4 cm, IB3: >=4cm, IIA: involvement of upper 2/3 of vagina, IIA1: size<4cm, IIA2: >=rcm, IIB: parametria involvement, IIIA: lower third of vagina, IIIB: pelvic side wall involvement and/or hydronephrosis, IIIC1: pelvic LN involvement, IIIC2: PA LN, IVA: into bladder or rectum, IVB: distant mets.
33
What surgery is needed for vulvar cancer
modified radical vulvectomy
34
Vaginal cuff brachy dose
6Gy x 3 to surface
35
T2, T3 for vulvar cancer
T2: involvement of lower third urethra, vagina, or anus, T3: involvement of upper two thirds urethra, vagina, bladder, rectum, or fixation to bone.
36
What are indications of postop radiation to nodal regions for vulvar cancer
2+ lnvolved (must have at least 12 taken out), >2mm focus, ECE: 60-66Gy, Gross residual LN: 60-70 Gy
37
Management of cervix IA2
same as IA1 with LVSI, radical trachelectomy + PLND or modified radical hysterectomy + PLND
38
N staging for vulvar cancer
N1a: 1-2 LN each < 5mm, N1b: 1 LN>=5mm, N2a: 3+ LN each <5mm, N2b: 2+ LN>=5mm
39
Management of cervix IA1 with LVSI
radical trachelectomy + PLND or modified radical hysterectomy + PLND
40
What labs are needed for uterine workup
CBC/CMP/CA-125
41
Screening guidelines for cervical cancer
age 21 q3yrs pap smear, age 30 pap smear/HPV cotesting q5yr or pap smear q3y, Age 65 no further screening if 3 negative pap within 10 years.
42
Uterine Stage IA, G1-2
Observe, consider VBT if LVSI, or age>=60
43
Rectal V40
<40%
44
Management of cervix IB2 or IIA1
radical hysterectomy + PLND
45
Bone marrow V40
V40<40
46
47
Upper vagina brachy max dose
120-140
48
Lower vagina brachy max dose
<90
49
bowel constriant
V45<195 cc
50
Brachy coverage goals
D90 HR-CTV>=85 Gy, D98 HR-CTV >=75 Gy, D98 GTV>= 95 Gy, D98 IR-CTV >=60 Gy, Point A >=65 Gy
51
Rectum constraint
V40<80%
52
What should be marked at sim in a vulvar case
vaginal introitus, anal verge, vulva/scars/suspicious LN
53
IB, G1
VBT, consider observation if no other risk factors
54
indications for ccrt in recurrent endometrial
large recurrence, high grade, LN involvement.
55
Postop management for uterine Stage II
EBRT + VBT
56
cervix postop chemoRT criteria
positive LN, positive margin, parametrial involvement
57
when is SLNB indicated in vulvar management
if DOI>1mm and unifocal T1-T2 disease<4cm. (more advanced needs LND)
58
What are indications for vaginal cuff brachy after hysterectomy for cervix cancer
Less than radical hysterectomy, close/positive margin, bulky tumor, extensive LVSI
59
what is your ctv for an intact cervix case
GTV and cervix and uterus and upper half of vagina (2/3 if involved), and parametrium
60
Bone marrow constraint
V10<90%
61
In whom can LND be omitted with uterine cnacer
Primary <=2cm, G1-2, <=50 MMI
62
Postop management for uterine Stage III
Adj CHT x 6 cycles + EBRT +/-VBT, consider CCRT then adj cht per PORTEC-3 for stage IIIC
63
N2c and N3 for vulvar
N2c: ECE, N3: fixed or ulcerated LN
64
What dose to Primary, elective, and gross LN for intact vulvar
Primary to 66 Gy, elective to 50 Gy, Gross disease to 66
65
Bladder constraint for vulvar
V45<35%
66
how far down presacral do you treat for cervix
S2/S3
67
Management of cervix IB3 or IIA2-IVA
concurrent chemoRT + brachy
68
Management of unresectable disease vulvar cancer
Perform inguinal LND, if positive CCRT to primary and bilateral inguinal/pelvic LN, if negative CCRT to primary +/- inguinal LN
69
What if biopsy is non-diagnostic for uterine
do Hysteroscopy with D&C
70
VBT dose after EBRT
6 Gy x 3 to surface
71
What path is needed in vulvar workup
primary excisional or incisional biopsy, FNA node, pap smear

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