Test 3 Deck 3

Question 1

What are the first and second MC vulvar cancers?

Answer 1

Squamous cell MC (vestibule) then

Malignant melanoma (poor prognosis)

Question 2

Vulvar cancer in a person less than <55 is MC linked to what?

Answer 2

HPV

Question 3

Vulvar cancer in a woman 55+ is most like a NONSMOKER, and it linked to ___ ___.

Answer 3

Lichen sclerosis

Question 4

What two things make you much more likely to develop vulvar cancer?

Answer 4

Smoker + genital warts

Question 5

What is the presentation of early vulvar cancer?

Answer 5

Pruritis and visible lesion (pain bleeding, ulceration, inguinal mass)

Question 6

What is the evuaaltion procedure for vulvar cancer?

Answer 6

Vulvoscopy (4mm punch, acetowhite)

Question 7

Treatment for vulvar cancer?

Answer 7

Wide local excision (1A) good prognosis,

Radical vulvar resection (w/ inguinal lymphadenectomy + chemo)

Question 8

What is the follow up for vulvar cancer?

Answer 8

Q3 months 2 years, q6 months 5 years, annually

Question 9

What indicates very poor prognosis for vulvar cancer?

Answer 9

Recurrence

Question 10

Vaginal cancer is most commonly from where?

Answer 10

Somewhere else

Question 11

Very old 80+ year old woman presents w/ vaginal bleeding (MC), and dysuria, hematuria, urgency/ constipation. Dx__

Answer 11

Vaginal cancer, anterior wall for the urine stuff and posterior for the constipation

Question 12

What is the treatment for vaginal cancer?

Answer 12

Surgery, radiation, chemo

Question 13

Endometrial hyperplasia is a result of?

Answer 13

Anovulation

Question 14

What is the gold standard diagnosis for a woman w/ suspected endometrial hyperplasia?

Answer 14

Endometrial biopsy, but can use TVUS in a post menopausal woman

Question 15

POST menopausal woman w/ complaint of bleeding presents. You perform a transvaginal U/S and see thickened endometrium >4mm. What do you do?

Answer 15

Endometrial biopsy, looking for endometrial atypia

Question 16

What is the treatment for atypical endometrial hyperplasia in a post-menopausal woman?

Answer 16

Hysterectomy and BSO

Question 17

What is the treatment for atypical endometrial hyperplasia in a pre menopausal woman that wants to still give birth?

Answer 17

Progestins

Question 18

What is the treatment for a pre menopausal woman w/ hyperplasia and no atypia?

Answer 18

Progestins, or COC. F/U bx after treatment, if resolves continue treatment until menopause. If fails to resolve then refer for minimally invasive surgery

Question 19

What is the MC GYN in cancer in the US?

Answer 19

Endometrial cancer

Question 20

What is the treatment for endometrial cancer if you are not concerned w/ fertility?

Answer 20

Hysterectomy w/ BSO and lymph node staging. If advanced then chemo

Question 21

What are the two MC risk factors for endometrial cancer?

Answer 21

Obesity and unopposed estrogen

Question 22

What is the MC presenting symptom for endometrial cancer?

Answer 22

Irregular vaginal bleeding. In premenopausal woman it heavy or intermenstrual, post menopausal (any bleeding)

Question 23

Women w/ lynch syndrome are at an increase risk for ___. They receive an EMB every 1-2 years starting age __-__. MC endometrial cancer is the __ cancer. What do you offer to these patients in their mid 40’s?

Answer 23

Cancer (colon, endometrium, small bowel, renal pelvis, ovary), 30, 35, sentinel, prophylactic hysterectomy

Question 24

What are additional labs/ studies to perform for endometrial cancer?

Answer 24

CXR/ CT for metastasis, CA125 (to response)

Question 25

Treatment for endometrial cancer if you are attempting to retain fertility?

Answer 25

Evaluate to see if possible w/hysteroscopy and D&C. Then provide hormonal treatment w/ progestin and tamoxifen (unregulated progesterone)

Question 26

Woman that gets cancer following/ with pregnancy?

Answer 26

Gestational trophoblastic neoplasia

Question 27

Gestational trophoblastic neoplasia produces what?

Answer 27

B-hCG so follow the levels.

Question 28

What is the treatment for gestational choriocarcinoma?

Answer 28

Very responsive to chemo/ invasive mole

Question 29

What are some risk factors for ovarian cancer?

Answer 29

Fam hx breast/ovarian (BRCA), Nulliparity (more periods cause of the Fallopian tubes) Personal hx or breast cancer Postmenopausal hormone therapy (estrogen)

Question 30

What is the most deadly GYN cancer?

Answer 30

Ovarian cancer (epithelial MC)

Question 31

What are some protective factors for ovarian cancer?

Answer 31

Breast feeding Long term oral contraceptives Tubal ligation/hysterectomy Diet (high fiber)

Question 32

Large masses on pelvic exam tend to be __

Answer 32

Benign

Question 33

What are some common lab and exam findings in ovarian cancer?

Answer 33

Ascites, pleural effusion on pulm. Exam ``` Labs: CBC- thrombocytosis Hyponatremia CA-125 Human epididymal protein 4 tumor marker ```

Question 34

What is the most useful initial test for ovarian cancer and what may you see?

Answer 34

``` TVUS Multiloculated, solid, echogenic Large->5cm Thick septa w/ nodules Papillar projections/neovasularization ```

Question 35

Treatment for ovarian cancer?

Answer 35

Hysterectomy w/ BSO, lymph node Eval, very rarely would you consider performing fertility sparing because so deadly

Question 36

Size and treatement for premenopausal simple ovarian cysts?

Answer 36

<=3 normal <=5 nada >5/ <=7 TVS repeat 6-12 wks the yearly TVS if persistent >7 MRI/ surgery

Question 37

Pot menopausal treatment of simple cyst w/ benign qualities

Answer 37

<=1 normal <=5 CA125, if normal TVS 6-12 weeks, then years TVS if persistent >7 MRI surgery

Question 38

Treatment for cysts we/ indeterminate, but probably benign qualities pre/post menopausal?

Answer 38

Premenopausal: TVS reprinted in 6-12 weeks, if persistent MRI/surgery Post menopausal: surgery

Question 39

Treatment for cysts w/ qualities suggesting malignancy?

Answer 39

Surgical (thick (>3mm) irregular septations)(nodule w/ blood flow)

Question 40

Hemorrhagic ovarian cyst pre/post menopausal treatment?

Answer 40

Premenopausal <=3 norm <=5 nada 5-7 TVS repeated 6-12 weeks then MRI/surgery Early post menopause: CA125 (if normal) then TVS 6-12 weeks, if persistent MRI/ surgery Late menopause: surgery