1,2,3,4 Cancer--cervical, endometrial, ovarian Flashcards
Teratoma:
- difference between male and female
- Tx for female
- Male: malignant
Female: usu benign
- Cystectomy. Don’t remove an ovary since it can recur on the other side, and removing 2 ovaries does not allow girl to undergo puberty and have kids.
Your postmenopausal patient comes to clinic with vaginal bleeding. What are next steps/possible results/tx?
Suspect endometrial CA, although vaginal atrophy more likely.
Do endometrial sampling or D&C to get endometrial bx.
Possible results:
- Negative: vaginal atrophy. Tx with creams.
- Simple hyperplasia (not atypical): Precancer. Use Progesterone to protect from estrogen.
- Adenocarcinoma or Atypical hyperplasia: Cancer/advanced precancer. Do TAH/BSO. BSO removes estrogen source.
If there are Mets, add chemo.
cancer Screening main guidelines:
- colonoscopy
- mammograms
- pap smears
- age 50, then q10 y
- age 40, then q1 y
- age 21, then q3 (if all normal, stop screening at 65)
How does endometrial CA present in a reproductive-aged female?
Dysmenorrhea, menometrorrhagia
Cervical CA
What do stages mean?
1, 2a, 2b, 3a, 3b, 4a, 4b
stage 1: cervix only
2a: upper 1/3 vagina
3a: all of vagina
2b: spread to cardinal ligament
3b: spread to cardinal lig and pelvic sidewall
4a: bowel/bladder
4b: distant mets
- A pregnant woman is discovered to have cervical dysplasia after a routine Pap smear. Do/don’t do what?
Don’t do a cone biopsy during the pregnancy (can cause cervical insufficiency). You can wait until after pregnancy since it takes 3-7 years for precancer to become cancer.
You can still do a LEEP/cryo during pregnancy.
Ovarian CA, epithelial
- presenting symptoms to be aware of (3)
- what stage does it normally present
Remains asx while seeding peritoneally. Eventually, can present at Stage 3 with:
- Renal failure
- SBO
- Ascites
Ovarian CA:
3 main categories
- Epithelial–postmenopausal female
- Germ cell–teenage girl
- Stromal tumors–sertoli leydig, granulosa-theca
Describe Cervical CA screening.
- what changes at what years?
- what if pt is immunocompromised?
Start at age 21, then q3 years.
Age 21-29: q3 y
30-65: q3 or q5 Pap+ HPV testing
>65: can stop if no abnormal screens before
Immunocompromised: start Paps at onset of sex, even if <21
Why would a cervical cancer lesion be missed on pelvic exam?
The lesion may be an endocervical carcinoma (vs ectocervical carcinoma that can be seen).
Endometrial CA:
3 main risk factors
increased estrogen exposure
- nulliparity (estrogen shuts off during pregnancy)
- early menarche/late menopause
- obesity (peripheral conversion of estrogen)
BRCA 1/2 patients:
- increased risk of what GYN cancer? Which BRCA higher risk?
- how to screen
- how to ppx
- ovarian CA, epithelial. Increased incidence and also at younger age. Risk: BRCA 1>2
- CA-125 and transvag U/S, q1 year
- BSO at age 35.
Screening Pap smear results come back as abnormal. What does that mean, and what are the next steps and final treatments?
- Abnormal means any result that is not normal or ASCUS (atypical squamous cells of undetermined significance)
- Do Colposcopy to get 2 samples: ectocervical bx and endocervical curettage.
If ecto + and endo -, problem is on the outside. Do local destruction (LEEP, Cryo)
If ecto - and endo +, problem is in endocervix. Do cone biopsy (curative).
Endometrial CA:
-4 patient types/presentations to know:
- Fat and old (obese, postmenopausal), presenting with postmenopausal bleeding–most common pt. She now has loss of progesterone after menopause, but still estrogen from fat
- Thin and old, on hormone replacement. She’s taking SERM (eg Tamoxifen for breast CA), increasing risk for endometrial CA
- Young, with PCOS. Anovulation increases estrogen and prevents progesterone secretion.
- Granulosa-thecal cell tumor (secretes estrogen)–Rare
HPV types:
- high risk
- genital warts
- Which ones does Gardasil cover
- How about the new FDA approved Gardasil 9?
16,18,31,33
6,11
Gardasil: 6,11,16,18
New Gardasil 9: 6,11,16,18,31,33,45,52,58
