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CLINICAL YR: Womens Health > GYN: Neoplasms 10% > Flashcards

GYN: Neoplasms 10% Flashcards

1
Q

(SmartyPance)

third most common type of cancer =

A

cervical cancer

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2
Q

(SmartyPance)

postmenopausal abnormal VAGINAL bleeding….think:

A

cervical carcinoma

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3
Q

(SmartyPance)

up to 80% of pts with cervical cancer present with

A

abnormal vaginal bleeding

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4
Q

(SmartyPance)

postcoital bleeding ddx should include

A

cervical carcinoma

“up to 80% of pts present with abnormal vaginal bleeding, mc postmenopausal…10% note postcoital bleeding”

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5
Q

(SmartyPance)

location of cervical carcinoma (location and name of zone)

A

squamocolumnar junction of the cervix

transformational zone

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6
Q

(SmartyPance)

80% of cervical carcinomas are what kind of cells?

A

squamous cells

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7
Q

(SmartyPance)

5 RF for cervical carcinoma

A

multiple sexual partners
early age at first intercourse
early first pregnancy
HPV positive

cigarette smoking association

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8
Q

(SmartyPance)

99% of the reason for cervical cancer

A

HPV

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9
Q

(SmartyPance)

what types of HPV cause cancer? which two especially?

A

16
18
31
33

especially 16 and 18
HPV 16 accounting for approximately 50% of cases and HPV 18 for 20%

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10
Q

(SmartyPance)

what physical exam finding is suspicious for cervical carcinoma?

A

friable
bleeding
cervical lesion on exam

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11
Q

(SmartyPance)

definitive means of diagnosis for cervical carcinoma

A

biopsy of gross lesions

colposcopically directed biopsies

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12
Q

(SmartyPance)

what is the treatment for cervical carcinoma?

A

resect
and/or
chemotherapy and radiation

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13
Q

(PPP 361)

stage IA1 tx for cervical carcinoma

A

total hysterectomy, radical hysterectomy, conization

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14
Q

(SmartyPance)

Stage 2 tx for cervical carcinoma

A

chemo +/- radiation

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15
Q

(SmartyPance)

5-Year Survival rates for each of the 4 stages of cervical cancer

A

Stage 1: 85-90%

Stage 2: 65%

Stage 3: 29%

Stage 4: 21%

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16
Q

(SmartyPance)

who gets pap smear screening before the age of 21?

A

women who have HIV infection, at the time of initial intercourse

women who are on chronic immunosuppressive therapy for SLE or post organ transplantation, at the time of initial intercourse

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17
Q

(SmartyPance)

what kind of pap smear screening is done for women 30 yrs and older? and how often?

A

cytology + HPV testing

every 5 years

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18
Q

(SmartyPance)

who gets pap smear screening annually?

A

high-risk groups (HIV infection, immunosuppression, or in utero DES exposure)

women who have been treated in past for CIN 2, CIN 3, or cervical cancer

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19
Q

(SmartyPance)

ACOG recommendations for d/c of pap smear screening (two)

A

1 - no cytology screening after total hysterectomy if surgery for benign condition

2 - d/c screening at age 65 yrs for women who have had adequate recent screening
(3 consecutive negative cytology tests or two consecutive negative HPV/pap co-tests in 10 yrs before stopping, w/ most recent test w/in 5 yrs)

20
Q

(SmartyPance)

three types of pathology found on pap screening report

A

ASC-US = Atypical Squamous Cells of Undetermined Significance

LSIL = Low-grade Squamous Intraepithelial Lesion (that is, mild dysplasia, CIN 1)

HSIL = High-grade Squamous Intraepithelial Lesion (that is, moderate to severe dysplasia, CIN II - III, carcinoma in situ)

21
Q

(SmartyPance)

HPV types ___, ___, and ___ are risk factors for cervical dysplasia, which can lead to cervical CA.

A

16, 18, and 31

22
Q

(SmartyPance)

what should be done for women with negative cytology and HPV POSITIVE on pap screening?

A

both tests repeated in 12 months

23
Q

(SmartyPance)

ASCUS and up require ______

A

reflex HPV testing

if negative, can repeat in 12 months; if + then send for colposcopy

24
Q

(SmartyPance)

ASCUS or LSIL, CIN-1 reflex HPV: what to do if +? what to do if -?

A

if positive and at least 25 yrs old =
colposcopy

if negative or under 25 yrs old =
retest in 1 year

25
Q

(SmartyPance)

HSIL, CIN-2, CIN-3, CIS: next steps if outside cervix? if inside cervix?

A

colposcopy

outside cervix –> LEEP or cryotherapy

inside cervix –> cone biopsy

26
Q

(SmartyPance)

squamous cell carcinoma found on pap…next steps?

A

resect
and/or
chemo and radiation

27
Q

(SmartyPance)

which HPV vaccination is available in the US?

A

only the 9-valent

“in the United States, only the 9-valent vaccine is available”

(protects against 90% of warts, 73% of cervical cancers)

28
Q

(SmartyPance)

what does quadrivalent HPV vaccine target?

A

6
11
16
18

29
Q

(SmartyPance)

what does 9-valent HPV vaccine target?

A

6
11
16
18

31
33
45
52
58
30
Q

(SmartyPance)

when is HPV vaccine recommeded for females and males? what’s earliest it can be administered?

A

11-12 yrs

9 yrs (it can be administered starting at 9 yrs of age)

31
Q

(SmartyPance)

what are the recommendations for the HPV catch up vaccination?

A

catch up vaccination is recommended for females aged 13-26 yrs who have not been previously vaccinated or who have not completed the vaccine series

32
Q

(SmartyPance)

HPV vaccination - what do clinicians do with adults 27 thru 45 yrs?

A

for adults ages 27 - 45 yrs, clinicians can consider discussing HPV vaccination with people who are most likely to benefit

33
Q

(SmartyPance)

what is recommended for males for catch-up vaccination for HPV?

A

Among males 22 to 26 yrs old, catch-up HPV vaccination is recommended if they are
MSM
or
immunocompromised (including HIV)

34
Q

(SmartyPance)

HPV vaccination dosing for <15 yrs old:

A

administer two-, rather than a three-dose vaccine series

in such pts, the two doses are administered at least 6 months apart

35
Q

(SmartyPance)

dosing of HPV vaccination for pts >15 yrs old

A

HPV vac is administered in 3 doses at 0, at 1 to 2 months, and at 6 months

36
Q

(SmartyPance)

how many doses of HPV vaccination do immunocompromised pts get?

A

three-dose series

37
Q

(SmartyPance)

how common is vaginal cancer?

A

rare
1% of gynecological malignancies
(usually secondary to other cancer)

38
Q

(SmartyPance)

most common cause of vaginal cancer?

A

squamous cell cancer represents 95%

caused by HPV

39
Q

(SmartyPance)

MC location of vaginal carcinoma

A

upper one-third of posterior vaginal wall

40
Q

(SmartyPance)

typical presentation of vaginal cancer

A

usually presents as changes in menstrual period
and/or
abnormal vaginal bleeding

41
Q

(SmartyPance)

treatment of vaginal cancer

A

radiation therapy

42
Q

(RR)

“what condition should be a pt be evaluated for when presenting with postcoital bleeding?”

A

“cervical cancer”

43
Q

(SmartyPance)
“A 52 year-old obese patient with persistent heavy menses undergoes an endometrial biopsy and is diagnosed with atypical adenomatous hyperplasia. What is the next step in the management of this patient?”

A

total abd hysterectomy

“Atypical adenomatous hyperplasia contains cellular atypia and mitotic figures in addition to glandular crowding and complexity. This has a 20-30% risk of progression to endometrial cancer and the recommendation is hysterectomy.”

44
Q

(PPP 361)

management of STAGE 0 cervical cancer (carcinoma in situ)

A

EXCISION PREFERRED (LEEP, cold knife conization) or ABLATION

can consider total abd hysterectomy + bilateral salpingo-oophorectomy

45
Q

(RR)

what is Paget disease of the vulva?

A

also known as extramammary Paget disease, is a rare vulvar malignancy most commonly seen in women aged 60 to 80

MC presenting s/s is vulvar pruritis

(well-demarcated, slightly raised, erythematous vulvar lesion with an eczematoid appearance)

46
Q

(RR)

what is treatment for Paget Disease of the Vulva?

A

wide local excision with 2 cm margins or vulvectomy

CLINICAL YR: Womens Health (9 decks)

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