Study guide Flashcards
1
Q
optimal treatment of dermoid cyst
A
cystectomy with only inspection of contralateral ovary
2
Q
Most important prognostic factor for endometrial, cervical, vulvar and breast cancer is:
A
node status
3
Q
hydrops tubae profluens is a classic sign of :
A
fallopian tube carcinoma
4
Q
bleomycin MOA
A
inhibits synthesis of DNA; binds to DNA leading to single and double strand breaks
5
Q
topotecan
A
inhibits topoisomerase I - stabilizes the cleavable complex so that religation of cleaved DNA strand cannot occur - S phase of cell cycle
6
Q
5 fluorouracil MOA
A
pyrimidine analog antimetabolite that interferes with DNA and RNA synthesis - inhibits thymidylate synthetase
7
Q
5 fluorouracil adverse reaction
A
Neutropenia, mucositis, diarrhea, dermatitis
8
Q
carboplatinum adverse reaction
A
thrombocytopenia
9
Q
What is Meig’s syndrome
A
triad of ovarian fibroma, hydrothorax, ascites
10
Q
most common sites of ureteral injury
A
at cardinal ligaments and infundibulopelvic ligaments
11
Q
Vulvar stage IVb
A
pelvic nodes, distant mets
12
Q
Vulvar stage IIIc
A
with positive nodes with extracapsular spread
13
Q
most important predictor of local recurrence of vulvar cancer after resection
A
tissue margin (>8mm on fixed tissue)
14
Q
doxorubicin adverse effect
A
cardiotoxicity
15
Q
vicristine adverse effect
A
neurotoxicity
16
Q
How many stages in vulvar cancer?
A
Ia Ib II IIIa IIIb IIIc IVa IVb
17
Q
2 plant alkaloids
A
vincristine
vinblastine
18
Q
attributes of plain and chromic catgut
A
intense inflammation, absorbed quickly by phagocytosis
19
Q
methotrexate MOA
A
folate antimetabolite that inhibits DNA synthesis, repair, and cellular replication - inhibits dihydrofolate reductase - cell cycle specific for S phase
20
Q
dermoid with mostly thyroid tissue, benign
A
struma ovarii
21
Q
treatment for vulvar cancer if positive inguinal nodes
A
adjuvant pelvic radiation
22
Q
Lugol’s iodine MOA
A
glycogen stain; negative stain
23
Q
most superior and medial inguinal node, considered sentinel node for spread to pelvic nodes
A
Cloquet’s node
24
Q
BRCA2 on chromosome __
A
13
25
cisplatinum (cisplatin) MOA
inhibits DNA synthesis by formation of DNA cross-links, denatures double helix, covalently binds DNA
26
antidose to ifosfamide
mesna
27
treatment for vulvar cancer for well-lateralized lesions <2 cm
radical local excision of vulva with unilateral inguinal-femoral lymphadenectomy
28
chemo drug from the pacific Yew tree
Taxol
29
after transection the broad ligament, the ureter is where?
on medial leaf
30
cause of dyspereunia after radiation is usually:
atrophic vaginitis
31
paclitaxel (Taxol) adverse reaction
Alopecia, immediate hypersensitivity, neutropenia, bradycardia
32
carboplatinum MOA
alkylating agent - covalently binds to DNA, interstrand DNA cross-links; not cell-cycle specific
33
acetic acid MOA
dehydrate cells
34
Vulvar stage Ia
≤ 2 cm, ≤1 mm invasion, no nodes
35
heritability of BRCA mutations
autosomal dominant
36
Taxol is __ phase speicific
M phase
37
lymphatic drainage of uterus
iliac and paraaortic
38
cells found in Krukenburg tumors
signet ring cells
39
lymphatic drainage of upper vagina
iliac (pelvic)
40
p53 & Rb are examples of __ genes
tumor suppressor
41
cyclophosphamide MOA
alkylating agent -- prevents cell division by cross-linking DNA strands and decreasing DNA synthesis
42
BRCA1: __% risk of breast cancer and __% risk of ovarian cancer
85% risk of breast cancer and 40% risk of ovarian cancer
43
treatment for endometrial hyperplasia
TAH vs progestin therapy (any progestin will do); premalignant potential directly related to degree of cellular atypia and to a far less extent the degree of architectural complexity; microscopically has crowded glands but no invasion
44
Vulvar stage IVa
mucosa of bladder or rectum, urethra, bone bilateral inguinal nodes
45
plant alkaloids are __ phase specific
M phase
46
Which HPV strains linked to VIN & invasive SCC?
HPV 16,18, 31, 33
47
Vulvar stage Ib
> 2 cm or >1 mm invasion, no nodes
48
cyclophosphamide adverse effect
hemorrhagic cystitis
49
topotecan adverse reaction
profound neutopenia
50
most common tumor to metastasize to fetus
melanoma
51
Sentinal lymph node mapping in vulvar cancer
False negative rate is acceptably low (3.7%) such that patients can have SLN dissected and sent for frozen. If positive, full LN dissection on that side. Midline lesions need BILATERAL sentinel nodes.
52
the action of lasers is based on __
Water (cells heat and explode)
53
What is luteoma of pregnancy
solid, benign tumor requiring no treatment; regresses after pregnancy
54
What is the most common tumor in the broad ligament?
leiomyoma
55
cycle nonspecific alkylating agents
cyclophosphamide
chlorambucil
platinum compounds
56
doxorubicin MOA
inhibits topoisomerase II -- inhibition of DNA and RNA synthesis, inhibition of DNA repair
57
Lymph node spread of vulvar cancer
- first to ipsilateral inguinal nodes, then pelvic (late)
| - Well lateralized lesions ALWAYS spread to ipsilateral nodes before contralateral nodes
58
Main difference between tamoxifen and raloxifene is:
effect on endometrium (tamoxifen is proliferative)
59
bleomycin adverse effect
pulmonary fibrosis
60
methotrexate is __ phase specific
S phase
61
lymphatic drainage of cervix
iliac (pelvic)
62
paclitaxel (Taxol) MOA
inhibits microtubule disassembly, interfering with late G2 mitotic phase
63
metastatic tumore from stomach to ovary
Krukenburg tumors
64
ras, HER-2/neu are examples are __ genes
oncogenes
65
vincristine MOA
inhibits microtubule assembly - arrests cell at metaphase by disrupting formation of mitotic spindle (M & S phases)
66
BRCA1 on chromosome __
17
67
GROINS V Trial
False negative rate is acceptably low (3.7%) such that patients can have SLN dissected and sent for frozen. If positive, full LN dissection on that side. Midline lesions need BILATERAL sentinel nodes.
68
lymphatic drainage of vulva
inguinal
69
What are the steps of the cell cycle?
G1 - S (DNA replication) - G2 - M (mitosis)
70
lymphatic drainage of lower part of vagina
inguinal
71
Most likely histologies of vulvar cancer
1. Squamous cell cancer most common (~85% of all vulvar cancers)
2. melanoma (~9%)
3. Basal Cell Carcinoma (2%)
4. Paget’s disease, Bartholin’s adenocarcinoma, sarcomas, and neuroendocrine tumors all rare
72
cisplatin adverse reaction
nephrotoxicity, neurotoxicity, ototoxicity, emetogenic
73
Vulvar stage II
any size with adjacent spread (lower 1/3 vagina, lower 1/3 urethra, anus), no nodes
74
most important predictor of survival in vulvar cancer
+LN status (stage III disease)
75
methotrexate adverse reaction
Neutropenia, mucositis, nephrotoxicity
76
When doing omentectomy must ligate the __ arteries
gastroepiploic arteries
77
Vulvar stage IIIb
with 2 or more lymph node metastases (≥ 5 mm) OR 3 or more lymph node metastases (
78
attributes of PDS & Maxon
monofilament, highest tensile strength for absorbables
79
treatment for vulvar cancer for lesions >2cm or midline lesion
radical local excision of vulva with bilateral lymphadenectomy
80
predictors of lymph node spread in vulvar cancer
Tumor diameter, grade, depth of invasion into stroma (most important!) and LVSI
81
attributes of Nylon & Prolene
monofilament, highest tensile strength of all sutures, nonabsorbable
82
Vulvar stage IIIa
with 1 lymph node metastasis (≥ 5 mm) OR 1–2 lymph node metastases (
83
attributes of Vicryl and Dexon
polyfilament, absorbed by hydrolysis
84
What is treatment for microinvasive squamous cell carcinoma of vulva?
wide local excision, NOT radical vulvectomy, NOT lymph node dissection
85
Define microinvasive squamous cell carcinoma of vulva
< 1 mm depth of invasion and <2 cm diameter - no risk of lymph node spread
86
In vulvar squamous cell carcinoma, if depth of invasion is 1.1 - 3 mm, likelihood of positive node is:
6 - 12% (need lymphadenectomy)
87
In vulvar squamous cell carcinoma, if depth of invasion is 3.1 - 5 mm, likelihood of positive node is:
15 - 20% (need lymphadenectomy)
88
second most common vulvar cancer
melanoma
89
survival with melanoma of vulva is related to:
Clark's or Brewlow's levels
90
treatment for melanoma of vulva with Clark level I or II (Breslow <1.5 mm)
wide local excision
91
treatment for melanoma of vulva with Breslow > 1.5mm
same as for squamous cell carcinoma, although nodes are only for prognosis
92
If nodes are positive in melanoma of vulva:
uniformly fatal
93
Paget's disease of vulva may represent underlying __
adenocarcinoma (15%)
94
Cake icing effect of vulva
Paget's disease
95
large clear cells at base of dermis
Paget cells
96
treatment of Paget's disease of vulva
Wide local excision with clear margins of 2 cm
97
treatment of bartholin gland carcinoma
treat like squamous cell carcinoma
98
treatment of verrucous carcinoma
radical local excision without node dissection
99
verrucous carcinoma: __ rather than __ borders
pushing rather than infiltrative borders
100
Borders of femoral triangle
sartorius laterally
adductor longus medially
inguinal ligament superiorly
101
Where are the inguinal nodes?
In the femoral triangle, between superficial fascia (Camper's) and deep fascia
102
Where are the femoral nodes?
In the femoral triage, deep to deep fascia
103
treatment for VIN I and II
observe
104
treatment for VIN III
wide local excision, CO2 laser ablation, Aldara (imiquimod)
105
most common symptom of VIN
pruritis
106
local recurrence __ after wide local excision of VIN III even with negative margins
20%
107
most common tumor in vagina
metastases from cervix or vulva, not primary vaginal cancer
108
most common histology of primary vaginal cancer
squamous cell carcinoma
109
lymphatic drainage of vaginal
upper: same as cervix
lower: same as vulva
110
vaginal cancer Stage I
mucosa
111
vaginal cancer Stage II
subvaginal/paravaginal tissue but not to sidewall
112
vaginal cancer Stage III
to pelvic sidewall
113
vaginal cancer Stage IVa
mucosa of bladder or rectum
114
vaginal cancer Stage IVb
distant mets
115
pelvic or inguinal lymph nodes in vaginal cancer mean stage __
stage III
116
treatment for vaginal cancer
Radiation for all stages: need external beam +/- brachy for lesions >2cm
Chemoradiation for locally advanced or metastatic
117
clear cell carcinoma of vagina is a subtype of __
adenocarcinoma
118
DES exposure in utero is associated with __
clear cell carcinoma of vagina
119
__% of patients with VaIN had or currently have either intraepithelial neoplasia or carcinoma of the cervix or vulva
50 - 90%
120
VaIN stage I
lower one third of epithelium
121
VaIN stage II
lower two thirds of epithelium
122
VaIN stage III
involves more than two thirds of epithelium
123
treatment of VaIN stage I
estrogen, follow; rare malignant potential
124
treatment of VaIN II/III
topical 5-FU, imiquomod, CO2 laser vaporization, partial vaginectomy, brachytherapy(Rare)
125
3 major risk factors for cervical cancer
1) age at first coitus
2) number of partners
3) Smoking
126
cervical cancer stage Ia1
cervix, diagnosed only by microscopy with invasion of <3 mm in depth and lateral spread <7 mm
127
cervical cancer stage Ia2
cervix, diagnosed with microscopy with invasion of >3 mm and <5 mm with lateral spread <7 mm
128
cervical cancer stage Ib1
clinically visible lesion or greater than Ia2, <4 cm in greatest dimension
129
How many cervical cancer stages are there?
```
Ia1
Ia2
Ib1
Ib2
IIa1
IIa2
IIb
IIIa
IIIb
IVa
IVb
```
130
cervical cancer stage Ib2
clinically visible lesion, >4 cm in greatest dimension
131
cervical cancer stage IIa1
vaginal but no parametrial involvement
| involvement of the upper two-thirds of the vagina, <4 cm in greatest dimension
132
cervical cancer stage IIa2
vaginal but no parametrial involvement
| involvement of upper 2/3 vagina, >4 cm in greatest dimension
133
cervical cancer stage IIb
with parametrial involvement
134
cervical cancer stage IIIa
lower 1/3 vagina
135
cervical cancer stage IIIb
parametria to sidewall or hydronephrosis
136
cervical cancer stage IVa
mucosa of bladder or rectum
137
cervical cancer stage IVb
distant
138
cervical cancer staging and 5 year survival
I 90%
II 70%
III 30%
IV 10%
139
most common histology in cervical cancer
80% squamous cell carcinoma
| 20% adenocarcinoma – also HPV-related, tend to be endophytic and larger
140
cervical cancer treatment for stage Ia1
simple hysterectomy
141
cervical cancer treatment for stage Ia2 - IIa
radical hysterectomy and bilateral pelvic lymphadenectomy OR chemoradiation
-Surgery has higher immediate complication rate BUT better preservation of sexual fnx and ovarian fxn
-Radiation has fewer contraindications BUT long term complications
-They are equally effective
Worst is surgery then radiation
142
cervical cancer treatment for stage IIb and beyond
chemoradiation
143
most common complication after radical hyst and b/l pelvic lymphadenectomy
bladder atony
144
In radical hyster and b/l pelvic LA, uterine artery is taken at its origin from the __
hypogastric
145
Name 3 scenarios requiring chemoradiation in cervical cancer
1. Stage IIb and beyond
2. Bulky Ib (>3-4cm)
3. Adjuvant treatment following radical surgery (positive nodes, positive margins, parametrial involvement)
146
treatment for cervical cancer in first trimester of pregnancy
treat as usual; e.g. gravid radical hysterectomy and pelvic lymphadenectomy or radiation (fetus will die)
147
treatment for cervical cancer in second trimester of pregnancy
can wait for maturity or treat, depending on how early, patient preference
148
treatment for cervical cancer in third trimester of pregnancy
wait for maturity and treat (Cesarean delivery and then radiation, or Cesarean radical hysterectomy with pelvic lymphadenectomy)
149
Significance of microinvasion in cervical cancer:
is that there is no risk of lymph node metastasis
150
Cervical cancer microinvasion requires __ to diagnose
LEEP or cone bx
151
Definition of microinvasion in cervical cancer
less than 3 mm invasion with no lymphovascular space invasion (LVSI)
152
treatment for microinvasion in cervical cancer
TAH OR LEEP/cone bx
153
spread of cervical cancer
Locally
Pelvic lymph nodes - most common is obturator
Paraaortic lymph nodes
154
most common cause of death in cervical cancer
bilateral ureteral obstruction
155
treatment for cervical stump cancer
radiation or radical trachelectomy with nodes
156
Can stop cervical cancer screening at 65 if:
3 consecutive negative cytology tests or 2 consecutive negative co-tests within the previous 10 years, with the most recent test within the previous five years
157
bethesda system of glandular abnormalities of pap
AGUS (endometrioid v. endocervical)
adenocarcinoma in situ
adenocarcinoma
158
What kind of virus is HPV
double stranded DNA
159
E6 and E7 are HPV-encoded oncogenes whose protein products bind those of tumor suppressor genes __ and __, respectively
p53 and Rb
160
most common gynecologic cancer
endometrial cancer
161
risk factors for endometrial cancer
Estrogen excess - obesity, exogenous estrogen, chronic anovulation (type I)
162
How many stages of endometrial cancer are there?
```
Ia
Ib
II
IIIa
IIIb
IIIc1
IIIc2
IVa
IVb
```
163
endometrial cancer stage Ia
corpus, <1/2 invasion
164
endometrial cancer stage Ib
corpus, >1/2 invasion
165
endometrial cancer stage II
cervix, stromal invasion
166
endometrial cancer stage IIIa
adnexa or serosa
167
endometrial cancer stage IIIb
vagina or parametrial
168
endometrial cancer stage IIIc1
pelvic lymph nodes
169
endometrial cancer stage IIIc2
paraaortic lymph nodes
170
endometrial cancer IVa
bladder or bowel mucosa
171
endometrial cancer IVb
distant mets
172
3 scenarios in endometrial cancer requiring Adjuvant treatment with whole pelvic radiation OR vaginal brachytherapy
```
Deep invasion (>50%)
High grade (3)
Stage II (cervical involvement)
```
173
What studies showed that Radiation for endometrial cancer decreases local recurrences but does not improve survival?
PORTEC, GOG-99
174
Most common types of histology in endometrial cancer
Type 1: Most common is endometrioid endometrial carcinoma
Type 2: Clear cell, papillary serous carcinoma have poorest prognosis
Papillary serous - looks like ovarian (papillary serous), acts like ovarian (spreads intraperitoneally), treated like ovarian (chemotherapy)
175
normal endometrial stripe in postmenopausal women
<5mm
176
tamoxifen increases the risk of endometrial carcinoma by
2-4 fold
177
tumor marker for recurrence of endometrial cancer
CA125
178
Cancer incidence for endometrial hyperplasia: simple without atypia
1%
179
Cancer incidence for endometrial hyperplasia: complex without atypia
3%
180
Cancer incidence for endometrial hyperplasia: simple with atypia
8-10%
181
Cancer incidence for endometrial hyperplasia: complex with atypia
30-40%
182
treatment for endometrial hyperplasia, simple without atypia
progestins
183
treatment for endometrial hyperplasia, complex without atypia
progestins
184
treatment for endometrial hyperplasia, simple with atypia
surgery or progestins
185
treatment for endometrial hyperplasia, complex with atypia
surgery
186
What does simple endometrial hyperplasia look like
- glands are mildly crowded
- cystically dilated with only occasional outpouching
- Mitoses may or may not be present
187
What does complex endometrial hyperasia look like
- glands that are crowded (>50 percent gland to stromal ratio);
- disorganized and have luminal outpouching.
- Mitoses
- Not Grade I endo CA because residual endometrial stroma that separates all glands
188
What does atypia look like
nuclear enlargement, prominent chromatin
189
How many stages of uterine sarcoma are there?
```
Ia
Ib
IIa
IIb
IIIa
IIIb
IIIc
IVa
IVb
```
190
uterine sarcoma stage Ia
Tumor limited to uterus < 5 cm
191
uterine sarcoma stage Ib
Tumor limited to uterus > 5 cm
192
uterine sarcoma stage IIa
Tumor extends to the pelvis, adnexal involvement
193
uterine sarcoma stage IIb
Tumor extends to extra-uterine pelvic tissue
194
uterine sarcoma stage IIIa
Tumor invades abdominal tissues, one site
195
uterine sarcoma stage IIIb
Tumor invades abdominal tissues, more than one site
196
uterine sarcoma stage IIIc
Metastasis to pelvic and/or para-aortic lymph nodes
197
uterine sarcoma stage IVa
Tumor invades bladder and/or rectum
198
uterine sarcoma stage IVb
distant mets
199
risk factors for uterine sarcoma
prior radiation exposure, age, race, tamoxifen
200
treatment for uterine sarcoma
TAH/BSO; all adjuvant therapies unproven
201
ovarian stage Ia
tumor limited to one ovary or fallopian tube, surface not involved
202
How many stages of ovarian cancer are there?
```
Ia
Ib
Ic1
Ic2
Ic3
IIa
IIb
IIIa - IIIa1i , IIIa1ii , IIIa2
IIIb
IIIc
IVa
IVb
```
203
ovarian stage Ib
tumor limited to both ovaries or fallopian tubes, surface not involved
204
ovarian stage Ic1
tumor limited to one or both ovaries/fallopian tubes with intra-operative tumor rupture
205
ovarian stage Ic2
tumor limited to one or both ovaries/fallopian tubes with pre-operative tumor rupture OR tumor on the surface/capsule
206
ovarian stage Ic3
tumor appears limited to one or both ovaries/fallopian tubes with positive cytology from ascites or washings
207
ovarian stage IIa
extension to gynecologic tissues beyond the primary organ (uterus, mets to fallopian tube, contralateral adnexa)
208
ovarian stage IIb
extension to other pelvic intraperitoneal tissues (e.g. – bladder peritoneum, rectum, cul-de-sac)
209
ovarian stage IIIa
positive LN or microscopic peritoneal metastases outside the pelvis
210
ovarian stage IIIb
Macroscopic metastasis outside the pelvis within the peritoneal space ≤ 2 cm
211
ovarian stage IIIc
Macroscopic peritoneal metastasis beyond pelvis > 2 cm in greatest dimension (includes extension of tumor to capsule of liver and spleen without parenchymal involvement of either organ), with or without positive retroperitoneal lymph nodes
212
ovarian stage IVa
positive pleural cytology (effusion)
213
ovarian stage IVb
parechymal metastasis to liver, spleen or extra-abdominal spread (thoracic or supraclavicular LN, pulmonary solid mets, etc.)
214
most common ovarian cancer histology
high grade serous - most common and most aggressive
215
ovarian cancer with +AFP
Endodermal sinus tumor (aka Yolk Sac), +/- immature teratoma, +/- embryonal carcinoma
216
ovarian cancer with +hcg
ovarian choriocarcinoma (rare); +/- dysgerminoma
217
name 2 types of sex cord stromal tumors
granulosa cell tumors, sertoli-leydig cell tumors
218
tumor markers for granulosa cell tumors
inhibins, estradiol
219
tumor markers for sertoli-leydig cell tumors
androgens
220
breast cancer stage 1
< 2 cm without nodes
221
breast cancer stage 2
>2cm but < 5 cm with or without 1-3 ipsilateral nodes OR > 5 cm without nodes
222
breast cancer stage 3
Anything in between stage II and IV: direct extension to the chest wall and/or to the skin (ulceration or skin nodules), Inflammatory carcinoma
223
breast cancer stage 4
distant mets
224
underlying disease in Paget's disease of breast
underlying carcinoma is ALWAYS present (unlike vulva)
225
risk factors for endometrial cancer
obesity, nulliparity, tamoxifen, unopposed estrogen, Lynch, DM, gallbladder
226
tamoxifen increases endometrial cancer risk by __
2-3 fold
227
pharm category of tamoxifen:
SERM
228
most COMMON pathology that results from tamoxifen
polyps
229
What screening should you do in women taking tamoxifen?
None
230
Are premenopausal women taking tamoxifen at increased risk of cancer?
No
231
Call Exner bodies mean:
granulosa cell tumors
232
Tumor markers for granulosa cell tumors
inhibin (A or B)
233
Tumor marker for dysgerminoma
LDH
234
3 types of ovarian cancer
epithelial (90%), germ cell, sex cord stromal
235
risk factors for ovarian cancer
HNPPC, Peutz Jeughers, age, nulliparity, P1>35yo
236
protective factors for ovarian cancer
OCPs, salpingectomy, breastfeeding
237
Schillar Duval bodies mean:
endodermal sinus (yolk sac) germ cell cancer
238
Oncogenes for cervical cancer in HPV
p53: E6
Rb: E7
239
cutoff for elevated Ca125 in postmenopausal
>35
240
cutoff for elevated Ca125 in premenopausal
200
241
causes of elevated ca125 other than cancer
endometriosis, pancreatitis, hepatitis, diverticulitis, cirrhosis, menses, PID, pregnancy, fibroids
242
treatment for low risk GTN
methotrexate or dactinomycin (Act-D)
243
treatment for high risk GTN
EMACO
244
components of EMACO
etoposide, methotrexate, Act-D, cyclophosphamide, vincristine
245
cure rate for GTN with treatment
>80%
246
How do you diagnose persistent GTN?
HCG plateaus for 4 measurements over 3w
HCG >10% over 3 measurements over 2w
HCG still persistent after 6 months
247
If you are doing a hyst for hyperplasia with atypia, what is the likelihood of finding endometrial ca?
42%
248
Risks for progression to endometrial ca from hyperplasia:
simple: 1
complex: 5
simple w atypia: 10
complex w atypia: 25
249
risk factors for cervical cancer
smoking! HPV, immunocompromised, HIV, multiple partners, 3+ SVDs
250
When do you start paps when +HIV
when she becomes sexually active
251
When do you start paps for DES exposure hx
menarche
252
next steps for 35yo negative pap, +HPV
16 or 18: colpo
low risk HPV: cotest 1 year
no HPV type: cotest 1 year
253
oncogene in endometrial cancer
K-ras
254
tumor suppressor gene in endometrial cancer
PTEN
255
indications for risk reducing BSO
BRCA age >40, Lynch, strong family hx, hx breast cancer
256
risk of primary peritoneal cancer after BSO in +BRCA
0.2%
257
What HPV is associated with SCC
16
258
What HPV is associated with adeno
18
259
Stage: cervical cancer side wall w hydro
IIIB
