02a: Gyn Malignancies Flashcards
Most common gyn cancer:
Endometrial cancer
1 “killer” of the gyn cancers
Ovarian
Type (X) endometrial cancer is more common (80%), with risk factors reflecting (excess/deficiency) of (Y).
X = I (endometrioid)
Excess
Y = estrogen (endometrial hyperplasia)
Post-menopausal woman presenting with bleeding is (X) diagnosis until proven otherwise.
X = endometrial cancer
Which two key risk factors/diseases put women at about 3x relative risk of endometrial cancer?
- PCOS/chronic anovulation
2. Obesity (2-4x)
List 3 risk factors in patient’s Hx that put women at 2x relative risk for endometrial cancer
- Nullparity
- Late menopause
- DM (II esp; linked to obesity)
Which drug can be given to decrease risk for endometrial cancer?
Progesterone
Type (X) endometrial cancer is less common (20%), with which risk factors?
X = II
- Multiparity
- Advanced age
- Black race
T/F: Endometrial cancer is characterized by hyperplasia of endometrium.
False - Type I is, but Type II arises from atrophic endometrium
Diagnosis of Type II endometrial cancer by:
Tissue pathology (histo)
Endometrial echo for abnormal bleeding: endometrial thickness (greater/less) than (X) mm is reassuring, because it suggests (Y) changes.
Less
X = 5
Y = atrophic (lining not thickened)
(X)% of endometrial cancers diagnosed at Stage I
X = 70
Women over age (X) with abnormal vaginal bleeding should be evaluated for endometrial hyperplasia/cancer.
X = 40
35 year old woman with abnormal uterine bleeding. Which finding(s) in her Hx would prompt you to test for endometrial hyperplasia/cancer?
- Morbid obesity
- Unopposed hormonal estrogen Rx
- HNPCC
T/F: Mean age of epithelial ovarian cancer is 70 y.o.
False - mid-50s
Most epithelial ovarian cancers present with (X) symptoms in early stages.
X = no
RFs for epithelial ovarian cancers:
- FHx (BRCA1/2)
- Nullgravity
- Infertility
- Early menarche/late menopause
Epithelial Ovarian Cancer has been shown to maybe start in which structure?
Fallopian tubes
List the 3 key factors that decrease risk for Epithelial Ovarian Cancer
- Bilateral Salpingectomy
- OCP use
- Tubal ligation
Rx for Epithelial Ovarian Cancer
Surgery and followup chemo
T/F: High parity is a RF for cervical cancer
True
Smoking is RF for (X) type of cervical cancer
X = squamous cell
Which part of HPV genome is oncogenic?
E6-E7
Non-sexual routes for HPV transmission
- Mother to newborn (rare)
2. Fomites (exam gloves, undergarments…? Maybe..)
T/F: 80% of HPV infections are transient in young women.
True - median duration is 8 months
Abnormal pap smear is followed up with:
Colposcopy (inspect cervix/vagina)
Coposcopy: (X) is applied and abnormal areas turn (Y) color.
X = acetic acid Y = white
Surgical Rx of High Squamous Intraepithelial Lesion (HSIL) of cervix typically involves:
Removing entire transition zone
9-valent HPV vaccine protects against which strains?
6, 11 (warts), 16, 18 (cancer), 31, 33, 45, 52, 58
Bivalent HPV vaccine protects against which strains?
16, 18
Most commonly reported STD in US
Chlamydia
Condyloma lata are indicative of:
Secondary syphilis
List the two types of Condyloma
- Condyloma lata
2. Condyloma accuminata
Condyloma accuminata indicative of:
HPV infection
Condyloma (lata/accuminata) are wart-like and (X) colored.
Accuminata
X = skin
Condyloma (lata/accuminata) are flat-topped (macules/papules/patches). They’re “velvety” and (X) colored
Lata
Papules
X = white-ish
(X) imaging modality is good for intramural uterine and ovarian lesions
X = US
Sonohysterogram is imaging modality similar to (X) but using (Y) injection
X = US Y = saline (to distend uterus)
(X) imaging modality is best for tubal patency
X = hysterosalpingogram (X-ray with intrauterine contrast injection)
(MRI/CT) is more commonly used/preferred for gyn purposes.
MRI
Perihepatic adhesions after pelvic inflammatory disease:
Fitz-Hugh-Curtis Syndrome
Endometriosis refers to:
Presence of endometrial glands/stroma outside endometrial cavity
List some postulated theories of endometriosis pathogenesis
- Retrograde menstruation
- Coelomic metaplasia
- Dissemination (via vessels/lymph)
- Altered immunity
- Over-expression of ER-beta (suppressing progesterone R levels)
Endometriosis is associated with (continuous/an-) ovulation
Continuous (incessant; like ovarian, not endometrial, cancer)
Endometriosis: (increased/decreased) risk with multiparity.
Decreased
Endometriosis: RF for (X) cancer
X = ovarian
T/F: Fibroids, like endometriosis, are estrogen-dependent
True - shrink at menopause
T/F: Fibroids have no familial predisposition.
False
Clinical findings of uterine fibroids
Menorrhagia, pelvic pressure/pain, reproductive dysfunction
Submucosal fibroids are best diagnosed by which exam/modality?
Hysterosalpingogram or sonoysterogram (dye/saline injected into uterus, so helps see submucosal fibroid projecting into cavity)
Uterine fibroid Rx:
- Surg (myomectomy or hysterectomy)
2. Uterine a embolization (causing fibroid infarction/size reduction)
Pt with uterine fibroids is getting prepped for surgery, but is experiencing heavy bleeding. How can you control the bleeding temporarily prior to procedure?
GnRH analogs (limited long-term efficacy though; rebound fibroids)
List some scenarios in which uterine fibroid embolization should be avoided
- Pedunculated/submucosal or very large fibroids
- Extensive adenomyosis
- Patients that want future pregnancy
Adenomyosis is:
Endometrial glands/stroma present within uterine muscle
Best imaging modality to inspect adenomyosis:
MRI
Adenomyosis is more common in (multi/nulli)-parous women.
Multiparous (and those with prior uterine surgery)
Adenomyosis Rx of choice:
Hysterectomy
Surg for adenomyosis can be delayed with which meds?
- Progestins (Mirena, IUD)
- GnRH analogs
- Aromatase inhibitors
Uterine Synechiae, aka (X) syndrome, arise as a result of:
X = Asherman
Uterine surg or curettage removes deep endometrial layers and destroys basal crypts/glands required for endometrial regeneration
Asherman syndrome clinical findings:
- Amenorrhea or hypomenorrhea
- Infertility/recurrent fetal loss
- Cyclic pelvic pain
Asherman syndrome best diagnosed by:
Hysterosalpingography, sonohysterography, hysteroscopy
Rx for Asherman syndrome:
Hysteroscopic resection
