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gyn neoplasms (10%) Flashcards

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1
Q

what is the MC type of vaginal ca

A 
squamous cell (95%)
clear cell if DES exposure in utero
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2
Q

what is the MC type of vulvar ca

A

90% squamous

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3
Q

RFs for vulvar ca

A

HPV 16, 18, 31

DES

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4
Q

sx of vulvar ca

A

pruritis MC
asx, postcoital bleeding, vaginal DC
red/white ulcerative, crusted lesions

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5
Q

dx of vulvar ca

A

bx vulvar lesions

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6
Q

2 MC types of breast ca

A

ductal or lobular

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7
Q

RFs for breast ca

A 
BRCA
1st deg relative
65yo+
inc # of menstrual cycles (nulliparity, 1st FT pregnancy >35yo, menarche <12yo, late menopause, never breastfed)
inc estrogen (PCOS, obesity, hRT, OCPs)
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8
Q

what % of breast ca pts have NO RFs

A

75%

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9
Q

stages of breast ca

A

0- preCA, DCIS, LCIS
I-III- w.i breast/regional LN
IV- distant mets

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10
Q

types of breast ca

A

ductal- infiltrative MC, carcinoma in situ

lobular- infiltrative or carcinoma in situ

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11
Q

what is infiltrative ductal carcinoma associated w

A

lymphatic mets

esp axillary

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12
Q

where is the MC position for breast ca lump

A

upper outer quadrant

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13
Q

what type of nipple discharge may indicate breast ca

A

bloody
purulent
green

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14
Q

where are the MC mets from breast ca

A

liver
lung
bone
brain

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15
Q

what does page’s disease of the nipple look like

A

chronic eczematous itchy, scaling rash on nipples + areola

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16
Q

what does inflammatory breast cancer look like

A

red, swollen, warm itchy breast often w nipple retraction + peau d’orange

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17
Q

what causes peau d’orange and what is the prognosis

A

lymphatic obstruction

poor prognosis

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18
Q

what do you usu see on mammogram in breast ca

A

microcalcifications

spiculated masses

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19
Q

when is US used to screen for breast ca

A

women <40yo

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20
Q

how do you dx breast ca

A

biopsy- fine needle, large needle, core, open

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21
Q

tx options for breast ca

A

lumpectomy +/- XRT
mastectomy

remove axillary LN!!!

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22
Q

when do you do XRT for breast ca

A

s/p lumpectomy or mastectomy

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23
Q

when do you do chemo for breast ca

A

stage II-IV, inoperable disease

especially if ER negative

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24
Q

what are the neoadjuvant endocrine treatments for breast ca

A

antiestrogens (tamoxifen)
aromatase inhibitors (letrozole, anastrozole)
monoclonal ab tx (trastuzumab/herceptin)

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25
tamoxifen uses and MOA
ER positive tumors | MOA- bind + block estrogen receptor in breast
26
aromatase inhibitors uses
letrozole, anastrozole | good in postmenopausal ER-positive tumors
27
monoclonal Ab use + ADRs
``` trastuzumab/herceptin HER2 positive (human epidermal growth factor receptors) ADR = cardiotoxic ```
28
mammogram screening guidelines
ACOG- q1yr starting at 40yo
29
clinical breast exam guidelines
q3yrs starting at 20yo --> q1yr after 40yo
30
breast self exam guidelines
monthly after 20yo | immediately after menstruation or on days 5-7
31
breast ca prevention in high risk pt
SERMs (tamoxifen or raloxifene) or aromatase inhibitors (letrozole, anastrozole) high risk = postmenopausal or 35yo+ with high risk (BRCA) usu done for 5yrs
32
which SERM is preferred for breast ca ppx, why and what are the cons of it
tamoxifen- more effective, more DVT + endometrial CA risk
33
what causes endometrial hyperplasia
unopposed estrogen (chronic anovulation, PCOS, perimenopause, obesity)
34
dx of endometrial hyperplasia
TVUS endo stripe >4 | definitive = bx
35
type of endometrial hyperplasia
gland proliferation | gland proliferation with cytologic atypic (pre-CA)
36
tx of endometrial hyperplasia
w/o atypia- progestin, repeat bx in 3-6mo w atypia- hysterectomy, progestin if not surgical candidate/wants fertility
37
what is the MC gyn malignancy in US
endometrial ca
38
MC age group to get endometrial ca
50-60yo
39
what is the MC result of endometrial bx in endometrial ca
adenocarcinoma | sarcoma is less common
40
tx of endometrial ca
I- hysterectomy, +/- XRT II-III- TAH-BSO + LN removal +/- XRT IV- systemic chemo
41
what is one protective factor against endometrial ca
combo OCPs
42
what percent of ovarian neoplasms are benign
90%
43
what is a dermoid (mature) cystic teratoma
MC benign ovarian neoplasm | germ cell tumor
44
what does dermoid cyst look like
cystic, calcification, fat, sebaceous tissue, hair + teeth
45
tx/prognosis of dermoid cyst
do not resolve spontaneously | associated w torsion if >5cm
46
what are the 2 types of cystadenoma
serous- benign, commonly 40-50yo, MORE COMMON mucionous- can be large, filled w mutinous material, 20-40yo
47
what is a cystadenofibroma
rare, benign surface epithelial tumor
48
when are cystadenofibromas MC
15-65yo
49
appearance of cystadenofibroma
complex cystic to solid appearing mass | resembles malignant tumor
50
what is the 2nd MC gyn ca
ovarian
51
what gyn ca has highest mortality
ovarian
52
what age is ovarian ca MC
40-60yo
53
presentation of ovarian ca
``` usu asx until late (extensive mets) abd fullness, distension, back/abd pain early satiety, constipation urinary frequency irreg menses, menorrhagia, postmeno bleeding ```
54
how do you screen for ovarian ca
TVUS in all high risk pts
55
what is the definitive dx of ovarian ca
biopsy 90% epithelia germ cell MC in <30yo
56
tx of ovarian ca
TAH-BSO + LN excision | chemo- paclitazel + cisplatin or carboplatin
57
what marker can be used to monitor progress of tx of ovarian ca
CA-125
58
what are the RFs for ovarian ca
``` famhx inc # of ovulatory cycles (infertile, nulliparous, 50yo+, late menopause) BRCA peutz-jehgers turners syndrome ```
59
protective factors for ovarian ca
OCPs high parity TAH
60
what is the 3rd MC gyn ca
cervical
61
what age is cervical ca MC
45yo
62
which HPV viruses are high risk
16, 18, 31
63
what is the MC sx of cervical ca
post-coital bleeding/spotting
64
what type of discharge is present with cervical ca
watery
65
if pt is >25yo and has normal pap cytology but HPV positive what are the future screening options
retest in 12mo OR genotype for HPV 16, 18, 31
66
what % of ASCUS regresses at 24mo
70%
67
if pt with ASCUS is 25yo+ what are the future screening options
HPV testing- if negative repeat pap in 3yrs, if positive --> colposcopy w bx OR repeat pap in 1yr
68
if pt with ASCUS is 21-24yo what are the future screening options
repeat pap in 1yr OR HPV testing
69
if pt with ASCUS is <21yo what are the future screening options
repeat pap in 1yr
70
what is ASC-H
atypical squamous cells can't exclude HSIL higher chance of ca than ascus
71
what future screening should be done if pt is ASC-H
colposcopy
72
what is LSIL
MC transient HPV infection includes CIN I
73
what % of LSIL regresses in 24mo?
50%
74
what future screening should be done if pt is 25-29yo and LSIL
colp w bx
75
what future screening should be done if pt is 30+yo and LSIL
HPV negative- repeat pap in 1yr | HPV positive- colp w bx
76
what is HSIL
includes CIN II, CIN III, Carcinoma in situ
77
what future screening should be done if pt has HSIL
colp w bx in all ages
78
what does CIN stand for
cervical intraepithelial neoplasm
79
what is CIN I
mild dysplasia, contained to basal 1/3 of epithelium
80
what is CIN II
moderate dysplasia, includes 2/3 thickness of basal epithelium
81
what is CIN III
severe dysplasia- >2/3 or full thickness of basal epithelium | if full thickness = carcinoma in situ
82
what is preinvasive cervical ca
severe dysplasia that is full thickness + has invaded the basement membrane
83
what should be done for CIN I
observe- if <20yo excise- LEEP or cold knife cervical connotation +/-ablation
84
what should be done for CIN II
excise (LEEP, cold knife cervical connotation) or ablation (cryocautery, laser cautery, electrocautery)
85
if pt has normal paps, how often should they be checked again
<25yo- q3yrs, no HPV testing 25-29yo- q3yrs w HPV testing 30yo+ - co-testing q5yrs, pap q3yrs

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