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Clin Med III exam III > Vulvar cancer > Flashcards

Vulvar cancer Flashcards

1
Q

Vulvar intraepithelial neoplasia is a ___ condition

A

premalignant

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2
Q

Three types of vulvar intraepithelial neoplasia

A
  • low grade
  • high grade
  • differentiated type
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3
Q

Low grade VIN is associated with ___

A

low oncogenic HPV tyes

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4
Q

High grade VIN is associated with ___

A

high oncogenic HPV types

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5
Q

Differentiated VIN is associated with ___

A

lichen sclerosus

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6
Q

Risk factors for high grade VIN

A
  • HPV
  • smoking
  • immunodeficiency
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7
Q

Clinical presentation of VIN

A
  • pruritus and discomfort

- vulvar lesion

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8
Q

Treatment of high grade VIN with a lesion

A
  • surgical excision
  • ablative therapy
  • topical imiquimod
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9
Q

Treatment of high grade VIN without a lesion

A

-ablative therapy

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10
Q

Treatment of differentiated VIN

A

surgical excision

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11
Q

What are the risk factors of recurrence of VIN after treatment

A
  • immunosuppression
  • multifocal/multicentric disease
  • positive margins
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12
Q

When do you follow with with a patient that had VIN after treatment

A

every 6 months for 5 years then anually

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13
Q

What population is vulvar carcinoma most frequently seen in

A

postmenopausal women

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14
Q

What are the risk factors for vulvar cancer

A
  • VIN/SIN
  • prior hx of cervial cancer
  • vulvar lichen sclerosus
  • smoking
  • immunodeficiency
  • northern european ancestry
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15
Q

What complaint is associated with most vulvar disorders

A

pruritus

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16
Q

Histologically what are most vulvar cancers? What else can they be?

A

most are squamous cell carcinomas

can also be melanoma

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17
Q

Treatment of vulvar cancer with no evidence of distant disease

A

surgery with adjuvent therapy

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18
Q

Treatment for vulvar cancer with locally advanced disease

A

chemo or radiation alone

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19
Q

Treatmetn of vulvar cancer with distant mets

A
  • chemo w/ carboplatin and paclitaxel

- restaging exams w/ CT of chest,abd, pelvis every 3 cycles

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20
Q

Origins of atypical glandular cells

A
  • enodcervial

- endometrial

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21
Q

Are atypical glandular cells associated with premalignant/malignant lesions

A

YES

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22
Q

relationship between risk of malignancy and age in women with AGC

A

risk of malignancy increases with age

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23
Q

How are atypical enodmetrial cells worked up

A

endometrial and endocervical sampling–> colposcopy if no endometrial pathology

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24
Q

How are all subcategories of AGC (except endometrial) worked up

A

colposcopy with endocervial sampling and endometrial sampling

25
Q

Adenocarcinoma in situ of the cervix is what

A

a premalignant condition

26
Q

Adenocarcinoma in situ is the only precursor to what

A

adenocarcinoma

27
Q

Cytology for adenocarcinoma in situ

A

atypical glandular cells resemble the same ones of cervical invasive adenocarcinoma

28
Q

How does a patient with adenocarcinoma in situ present

A
  • nearly always asymptomatic

- generally not visible on gross examination

29
Q

How do you diagnose adenocarcinoma in situ

A
  • colposcopy directed biopsy
  • endovervical curettage
  • conization
30
Q

Preferred management for adenocarcinoma in situ

A

hysterectomy

31
Q

Conservative management of adenocarcinoma in situ

A

if margins are negative after excision–> long term follow up

if margins are involved or ECC +—> re-excision is recommended or re-evaluate at 6 months

32
Q

What is endometrial hyperplasia

A

proliferation of endometrial glands

33
Q

Endometrial hyperplasia is typically a result from what

A

unopposed chronic estrogen stimulation

34
Q

WHO classification of endometrial hyperplasia

A
  • hyperplasia without atypia

- atypical hyperplasia (enodmetrial intraepithelial neoplasm)

35
Q

Risk factors for endometrial hyperplasia

A
  • HPV
  • smoking
  • exposure to estrogen
  • Lych syndrome
36
Q

Endometrial hyperplasia clinical presentation

A
  • abnormal uterine bleeding

- same as endometrial carcimona

37
Q

Diagnostic evaluation of endometrial hyperplasia

A
  • pelvic sonography

- enodmetrial sampling

38
Q

What are the two categories of endometrial carcinoma

A
  • type I tumors

- type II tumors

39
Q

Which endometrial carcinoma has the better prognosis

A

type I tumors

40
Q

Which type of endometrial carcinoma is estrogen responsive

A

type I tumors

41
Q

What may precede a type I endometrial carcinoma

A

intraepithelial neoplasm

42
Q

Are type I or type II endometrial carcinoma tumors more common

A

type I

43
Q

Cervical cytology findings with endometrial carcinoma

A
  • adenocarcinoma
  • aytpical glandular cells
  • endometrial cells
44
Q

Bleeding patterns in postmenopausal women that should make you think cancer. Age 45 to menopause. Younger the 45.

A

Postmenopausal: any bleeding

45 to menopause: any abnormal bleeding

Younger than 45: abnormal and persistent uterine bleeding

45
Q

If suspected endometrial cancer, what should be done?

A
  • physical exam (size, mobility and axis of uterus)
  • urine HCG
  • pelvic sonography
  • endometrial sampling
46
Q

Enodmetrial carcinoma is a ___ diagnosis based upon results of ____

A

histological diagnosis based on results of andometrial biopsy or hysterectomy

47
Q

When is routine endometrial cancer screenings preformed

A

in women with lunch syndrome

48
Q

Before treating someone for endometrial cancer what should be done

A
  • evaluation for hereditary cancer syndromes
  • serum tumor marker CA 125
  • contrast MRI
49
Q

Standard treatment for women with low risk endometrial cancer

A

Surgical staging

  • total hysterectomy
  • bilateral salpingo-oophroectomy
  • lymph node evaluation
50
Q

Standard treatment for women with recurrent of metastatic endometrial cancer

A

-if isolated to vaginal vault–>radiation

if limited to pelvis–> surgery and/or radiation

51
Q

The majority of ovarian malignancies are derived from ___

A

epithelial cells

52
Q

Risk factors for ovarian cancer

A
  • lynch syndrome
  • BRCA gene mutation
  • increasing age
  • hx of infertility
  • endometriosis
  • PCOS
  • smoking
53
Q

What factors can reduce a womens risk for ovarian cancer

A
  • previous pregnancy
  • use of OCP
  • breastfeeding
54
Q

Acute presentation of ovarian cancer. Subacute presentation.

A

acute- pleural effusion, bowl obstruction

subacute- adenxal mass, pelvic/abd pain, bloating, GI sx’s

55
Q

How does a patient with advanced ovarian cancer present

A
  • abd distension
  • nausea
  • anorexia
  • early satiety d/t acites or bowel mets
56
Q

When do you preform a surgical evaluation if ovarian cancer is suspected

A

if there is an adnexal mass is found

57
Q

When to refer premenopausal women with a pelvic mass to gyn onc

A
  • very elevated CA125 level
  • ascites
  • evidence of abdominal or distant mets
58
Q

When to refer postmenopausal women with a pelvic mass to gyn onc

A
  • elevated CA 125
  • ascites
  • nodular or fixed pelvic mass
  • evidence of abdominal or fixed mets

Clin Med III exam III (10 decks)

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