Gyn Onc Flashcards by Emma F

GTN stage I or low risk (score <7) stage II and III treatment

Single agent chemo with either methotrexate or actinomycin D

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GTN high risk stage II/III (score 7 or more) or stage IV treatment

Multiagent chemo +/- surgery/radiotherapy

Etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine

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Scores 4 points on GTN staging (WHO)

13 or more months from antecedent pregnancy
Pretreatment serum hCG 1,000,000 or more
Liver, brain mets
>8 metastases
Previously failed two or more chemo drugs

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Recommended criteria for decision-making capacity

Communicates choice between treatment options
Understands treatment options
Understands the information leading to the decision
Understands consequences of treatment

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Should a patient with PMB on tamoxifen get a biopsy?

Yes, regardless of endometrial thickness

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Palliative option for treatment of large bowel obstruction in cancer patients

Colonic stent

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Breast cancer screening in BRCA1 and BRCA2

Annual MRI alternating with semiannual digital mammography starting at 25-30 years

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What do you do with a perimenopausal woman with low positive hCG?

1 week of OCPs and recheck hCG

If OCPs aren’t successful, do a CT chest/abd/pelvis

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Ovarian cancer debulking should…

remove all visible disease, including bowel resection, as safely as possible.

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Standard evaluation of all categories of AGC/AIS

ECC

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If AGC and +HPV, likely…

cervical disease

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AGC/AIS in women >35 (or younger with AUB or e/o chronic anovulation)

colposcopy + ECC + EMB

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Table for statistics

DISEASE +      DISEASE -
T      +        a                      b
E
S     -          c                      d
T

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Next step after surgery of stage IIIC1 uterine carcinosarcoma

Adjuvant chemotherapy

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Neutropenia < 1,500/mm3 on day of therapy

Delay until recovered
(if delay >7 days, reduce doses by 1 or add GCSF)
(if delay >14 days, reduce doses by 1 AND add GCSF)

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Platelets 75,000-150,000 on day of chemotherapy

Delay until recovered

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Platelets <75,000 on day of chemotherapy

Delay until recovered

If delay is >7 days, reduce doses by 1 level

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Immature teratoma, surgically resected, stage IA, grade 1 management

Surveillance

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Immature teratoma, surgically resected, stage IA, grade 2 or 3 management

Chemotherapy - bleomycin, etoposide, cisplatin

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First line treatment of hyperkalemia to stabilize myocardium

IV calcium

can also use insulin with glucose

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Greatest risk with oral conjugated equine estrogen use

Stroke

then DVT

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Ovarian luteoma

Causes gestational hyperandrogenism
Benign
Usually regress and disappear 2-3 weeks after delivery

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Risk of Ovarian Malignancy Algorithm

CA125
Human epididymis secretory protein 4
(In a woman with a pelvic mass)

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International Ovarian Tumor Analysis

Classification of adnexal masses

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Risk of Malignancy Index

CA125 Menopausal status Ultrasound findings (factors are multiplied together)

Risk of Ovarian Cancer Algorithm

Uses longitudinal increase in CA125 to determine risk

Ultrasound findings of pelvic mass consistent with malignancy

Irregular solid tumor Ascites At least four papillary structures Irregular multilocular tumor with largest diameter 100mm Very high color content on Doppler ultrasonography

After surgery for endometrial or colorectal cancer, first step to test for Lynch

Immunohistochemical TUMOR testing for MLH1, MSH2, MSH6, and PMS2 proteins

Ovarian cancer screening in BRCA1 or BRCA2

Periodic CA125 and transvaginal ultrasound starting at 30-35 or 5-10 years prior to earliest ovarian cancer diagnosis in the family

Prophylactic BSO in BRCA1 and BRCA2

Immediately after childbearing is complete or by 40

Managemnet of smooth muscle tumor of uncertain malignant potential

Surveillance for women desiring fertility | Hysterectomy for women not desiring fertility

Common prognostic prediction models use

Age Comorbidities Nodal status Tumor size

Factors associated with abnormal anal cytology in HIV individuals

CD4 count of less than 200cell/mm3 History of STD other than HPV Cervical cytology abnormality

Risk with St. John's wort

Induces cytochrome P450 activity (doubles its metabolic activity) (stop at least 5 days before surgery)

High risk patients with neutropenic fever

Neutropenia <100 cells/mm3 Anticipated duration of neutropenia >7 days Significant comorbid conditions (hypotension, pneumonia, new abd pain, neuro changes)

Broad spectrum antibiotics for neutropenic fever

Cipro and augmentin

Mutation associated with uterine papillary serous carcinoma

TP53 mutations

Side effect associated with switching from tamoxifen to aromatase inhibitor

Joint aches

Recommended treatment for advanced ovarian cancer that has been suboptimally cytoreduced

IV carboplatin and paclitaxel

RIsk factors for ovarian cancer

``` Increasing age Endometriosis Family history of breast or ovarian cancer Nulligravidity Infertility Early menarche Late menopause ```

Benefit of mechanical bowel prep

None

Treatment of IB1 cervical cancer in patient desiring fertility

Radical trachelectomy with pelvic lymphadenectomy

Contraindication to salvage products

Any solution mixed with blood that results in red cell lysis: Sterile water Hydrogen peroxide Alcohol

Indication for radical vulvectomy over wide local excision

Invasive carcinoma

Treatment of preinvasive lesions of the vulva

Wide local excision

Breast cancer risk reduction after 5 years of chemoprophylaxis with tamoxifen

50%

MLH1 immunohistochemical staining is absent, next test

Test sample for MLH1 methylation | 20-30% of cases of endometrial cancer with absence of MLH1 are due to methylation

Best surveillance for ovarian cancer with previous complete response to treatment

Physical exam

Nulligravid with microinvasive cervical cancer on biopsy (not excision)

Do cone or LEEP for further diagnostic evaluation

Treatment for HIT

Stop heparin/LMWH | Start another anticoagulant to treat VTE (argatroban or danaparoid)

ARDS clinical criteria

Respiratory symptoms within 1 week of inciting event Bilateral opacities on x-ray or CT that can't fully be explained by other cause Respiratory failure not explained by cardiac failure or fluid overload Impairment of oxygenation (PaO2/FiO2)

Ovarian cancer associated with endometriosis

Endometrioid or clear cell

Most common transfusion-associated infection in the US

Staphylococcus (gram + cocci)

Less than 25 years old with HSIL --> CIN2 --> ?

Repeat colposcopy and cytology at 6 months

Okay to use estrogen postoperatively in patients with endometrial cancer?

Controversial but yes, estrogen not shown to increase recurrence

Prognostic factors for success of exenteration

Time to recurrence Tobacco use Age >70 Primary site of disease

LEEP with AIS extending to margin?

Re-excise with cone

Most effective method to prevent gynecologic cancer risk in Lynch syndrome

Hysterectomy and bilateral salpingoophorectomy

Vulvar biopsy with large cells with prominent nuclei and coarse chromatin

Paget's disease

Management of vulvar Paget's

Cervical cancer screen, colonoscopy, and mammography

Cervical cancer stage if tumor is limited to cervix >4cm

IB2

Cervical cancer stage if involvement of upper third of vagina

IIA2

Cervical cancer stage if tumor involves lower third of vagina

IIIA

Are lymph nodes included in cervical cancer staging?

Highest risk factor for long-term sexual dysfunction after vulvectomy

Age

Treatment for vulvar basal cell carcinoma

Wide local excision (without lymphadenectomy)

Postoperative treatment for small cell cervical cancer (neuroendocrine)

Chemotherapy

Most compelling reason to convert to laparotomy for adnexal mass removal

Mural nodule Papillary projections Size greater than 10

Best method for contraception during molar pregnancy postoperative surveillance

OCPs | IUDs haven't been studied with regards to recurrences

Surveillance for first 2 years after IIIC high grade serous ovarian cancer surgery with no residual disease

History and physical CA-125 (not CT)

Risk factors for intraperitoneal catheter related complications

``` Timing of catheter insertion Hysterectomy Appendectomy Small bowel resection Ileocecal resection Left colon-rectosigmoid resection ```

Precludes candidacy for sentinel lymph node dissection in patients with vulvar cancer

Palpable lymph node

DCIS treatment

Breast sparing surgery + radiation

Best imaging modality for dense breast tissue

Digital mammography

Risk of laparoscopic resection of ovarian tumor

Port site metastasis

Prophylaxis for patients that are at high risk for VTE (age, cancer, extent of surgery)

LMWH for 4 weeks

General prerequisites for weaning from intubation

Secretions <2.5mL/hr Strong cough FiO2 <50%, PaOw/FiO2 of at least 150-200mmHg Manageable minute ventilation Acceptable pulmonary mechanics Alert No CHF, sepsis, acid-base abnormalities, severe electrolyte imbalances, vasopressor requirements, need for ongoing plasma expansion, no planned general anesthesia the same day, etc

What is the minimum ovarian pelvic radiation dosage that has no effect on the ovaries in females younger than 40

1.5 Gy

Immunohistochemical markers indicative of ovarian cancer

PAX8 CA125 WT1 KRT7

Treatment of choice for VAIN III

CO2 laser

LEEP showing CIN III with positive margins

Repeat cytology/ECC and colposcopy in 4-6 months

ASCUS in a 16 year old?

Repeat cytology 1 year

Least important intraoperative step for stage 1 ovarian cancer

Biopsy of the diaphragm

Best to determine prognosis of breast cancer

Stage

Tumor marker that’s most reliable in pregnancy

LDH

What to do for concern of increased intraabdominal pressure

Monitor intraabdominal pressures

Treatment for stage II invasive carcinoma of the vagina

Radiation

Pseudomyxoma peritonei can be fatal if left untreated due to what

Bowel obstruction

NOT a treatment for EIN

Nexplanon

What part of the cell does ionization radiation effect

Nucleus

If upper ur

Placenta site trophoblastic tumors most commonly develop following

Term pregnancies

What tumor marker is most elevated in endometrial cancer

Ça 125

Serum levels of which hormone can support a clinical impression of ectopic but can’t distinguish ectopic from IUP

Progesterone

Does prophylactic BSO reduce the risk of breast cancer in BRCA1?

Paget disease of the breast is what type of carcinoma

Ductal carcinoma

BRCA 1

Pancreatic Melanoma Breast Ovarian

Percentage of fibromas in miegs syndrome undergo malignant transformation

Late effects of radiation in women with gynecologic cancer

Fistulas Fibrosis stenosis of vaginal canal Intestinal obstructions Bladder stenosis

What can’t be treated with topical imiquimod?

VIN differentiated

Chemo that causes extravasation leading to skin necrosis and ulceration

Doxorubicin

Most favorable vulvar cancer

Basal cell