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Clin Med3: Womens Health > Gynecologic Oncology > Flashcards

Gynecologic Oncology Flashcards

(65 cards)

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1
Q

What are screenings for cervical cancer

A

Pap smear
HPV testing

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2
Q

how often should women 21-30 get PAP smears

A

every 3 years - if normal-risk

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3
Q

how often should women ages 30-65 get cervical cancer screenings

A

Cervical cytology alone every 3 years
OR
HPV testing alone every 5 years
OR
HPV and PAP every 5 years

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4
Q

what are the harms of screening

A

increase number of procedures - preterm labor, incompetent cervix
-many lesions would resolve on their own

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5
Q

when is no cytology screening recommended

A

under 21 or > 65 and previously screened

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6
Q

when is colposcopy + acetic acid stain used

A

ASCUS and + HPV
any CIN (-3)

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7
Q

when is cryosurgery used

A

small, non-invasive lesions

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8
Q

when is CO2 laser used

A

large visible lesions

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9
Q

when is the LEEP procedure used

A

excisional biopsy for lesions fully visible
in office, local anesthesia

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10
Q

what is Conization

A

surgical removal of entire transformation zone
CIN III or carcinoma in situ

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11
Q

when is cervical cancer most commonly diagnosed

A

between 35-44 years of age

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12
Q

What does CIN stand for

A

cervical intraepithelial neoplasia

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13
Q

what does ASCUS stand for

A

atypical squamous cells of undetermined significance

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14
Q

what are high risk factors for cervical cancers

A

HPV infection (types 16 and 18) - high number of sexual partners, early age at first intercourse, history of other STIs
HIV infection
Immunosuppression
Smoking
Exposure to DES in utero
previous tx for CIN 2 or CIN 3

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15
Q

What is CIN III

A

pre-cancerous stage
predominantly women ages 25-40

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16
Q

what are the different cervical carcinomas

A

Squamous cell carcinoma
adenocarcinomas
adenosquamous
arise primarily int he transitional zone

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17
Q

what are common symptoms of cervical cancers

A

metrorrhagia, postcoital spotting, cervical ulcerations
later stages: bladder and bowel dysfunction; fistulas

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18
Q

what is the definitive diagnosis for cervical cancer

A

biopsy

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19
Q

what imaging can be used for staging and treatment planning of cervical cancer

A

CT (primarily evaluates kidneys)
MRI (assesses uterine and paracervical extension)
US

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20
Q

what are the stages of cervical cancer

A

0-4

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21
Q

what is the treatment of choice for carcinoma in situ

A

total hysterectomy

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22
Q

what is the treatment for carcinoma in situ if the patient wishes to preserve childbearing abilities

A

removal of cervix and surrounding structures + lymph node dissection with retention of uterus
cervical conization, laser ablation, cryosurgery (all with close follow up)

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23
Q

What is the treatment of early, small cell stage 1 cervical cancer

A

total hysterectomy alone

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24
Q

what is the treatment for cervical cancer stages I-IV

A

radiation and chemo (primarily cisplatin)
+/- total hysterectomy

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25
what are complications of cervical cancer stage II - IV
risk for vaginal hemorrhage -cause of death in 10-20% of pts with invasive cervical CA
26
what is the treatment of vaginal hemorrhage
ligation of uterine or hypogastric arteries hemostatic agents: acetone, monsel's solution vaginal packing radiation
27
what are the types of uterine cancer
endometrial adenocarcinomas (endometrial lining) Leiomyosarcomas (uterine smooth muscle)
28
what is the average age of diagnosis of leiomyosarcomas
50-52
29
what are risk factors of leiomyosarcomas
excess estrogen exposure tamoxifen use black patients prior pelvic radiation
30
what can reduce your risk of leiomyosarcomas
OCPs and Smoking
31
what is different with leiomyosarcomas than other uterine tumors
grow more quickly more aggressive metastasize more quickly poorer prognosis
32
what are the symptoms of leiomyosarcomas
abnormal vaginal bleeding (most common) pelvic or abdominal pain profuse foul smelling discharge +/- GI or urinary complaints
33
what is the most common type of uterine cancer
endometrium cancer
34
how is Leiomyosarcomas worked up
may be detected on endometrial biopsy or D&C MRI/CT Many diagnosed incidentally on operative histology
35
what is the treatment for leiomyosarcomas
total abdominal hysterectomy +/- radiation
36
how often should patients with leiomyosarcomas follow up
PE every 3 months for first 2 years 3rd year: every 6-12 months CT chest/abd/pelvis every 6-12 months
37
what is the average age at diagnosis of endometrial cancer
50-70yo
38
What are the two types of endometrial cancer
type 1: endometrioid (estrogen dependent) type 2: non-endometrioid
39
what is Lynch syndrome
hereditary non-polyposis colorectal cancer autosomal dominant condition
40
what is the most common symptom of endometrial cancers
irregular vaginal bleeding
41
what are the symptoms of pre-menopausal women with endometrial cancers
prolonged, heavy menstruation spotting between periods
42
what are the symptoms for post -menopausal women with endometrial cancers
any vaginal bleeding may present as abnormal vaginal discharge
43
what are the later signs stages of endometrial cancer
related to uterine enlargement or extrauterine extension pelvic pain or pressure bloating early satiety increased abdominal girth
44
what can be seen on PAP smear with endometrial cancer
benign endometrial ells on PAP in post-menopausal women atypical glandular cells on PAP
45
what is the mainstay of workup for endometrial cancers
endometrial biopsy D&C if insufficient sample of AUB persists
46
what is the treatment of choice for endometrial cancer
hysterectomy with bilateral salpingo-oophorectomy (BOS) +/- chemo/radiation
47
what is a tumor marker that can be related to endometrial cancer
CA-125
48
what is a precursor to vaginal cancer
vaginal intraepithelial neoplasia (VaIN)
49
what is the most common symptom of vaginal cancer
AUB may see pelvic pain or vaginal discharge urinary symptoms if involving anterior vaginal wall
50
what is the workup for vaginal cancer
often identified via pelvic exam gross lesions on speculum exam should be biopsies colposcopy if lesions suspected but not grossly identified CT to assess for metastasis
51
what is the treatment of stage 1 or 2 vaginal cancer
surgery or radiation; vaginectomy, hysterectomy, +/- lymphadenecotmy radiation: external beam +/- brachytherapy
52
what is the treatment of stage III vaginal cancer
typically radation + chemo (cisplatin)
53
what is the treatment of stage 4 vaginal cancer
systemic chemo +/- palliative care
54
what is a common association with vulvar cancer
HPV infection
55
what are risk factors for vulvar cancer
HPV infection increasing age HPV associated genital warts HSV infection smoking chronic immunosuppression Lichen Sclerosus
56
what is the most common vulvar cancer
squamous cell carcinoma
57
what are symptoms of vulvar cancer
primarily puritis and visible lesion may have pain, bleeding, ulceration and inguinal mass
58
how is vulvar cancer worked up
vulvoscopy with acetic acid staining - biopsy should preform colposcopy of vagina and cervix at same time dont forget perineal exam
59
what is the treatment of SCC vulvar cancer
local excision larger lesions: radical partial vulvectomy total vulvectomy + flap reconstruction chemo and or radiation
60
what are risk factors for ovarian cancer
nulliparity use of HRT/fertility tx obesity diet
61
what are protective for ovarian cancer
Multiparity use of OCPs use of ASA tubal ligation breast feeding
62
what are the histological types of ovarian cancer
epithelial cell (90%) germ cell stromal cell
63
what are the symptoms of ovarian cancer
primarily asymptomatic palpable mass identified on pelvic exam vague pelvic pain/pressure occasionally bloating, nausea, indigestions, early satiety (late stage) bowl/bladder changes (later stage) increasing abdominal girth (later stage)
64
what is the workup for ovarian cancer
tumor marker: CA-125 TVUS: to differentiate between benign and malignant masses open biopsy - for definitive dx
65
what is the treatment of ovarian cancer
sx removal of mass included total hysterectomy, BSO, removal of omentum and selective lymphadenectomy

Clin Med3: Womens Health (13 decks)

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