Cancer

Question 1

Risk Factors for Endometrial Cx

Answer 1

• Early menarche
• Late menopause
• Obesity
• Nulliparous
• DM
• HTN
• Chronic anovulation
• Unopposed estrogen
• Estrogen secreting tumors
• Family hx (breast, ovarian)
• Age
• Hx infertility

Question 2

When to Suspect Endometrial Cx (+ work up)

Answer 2

If post-menopausal vaginal bleeding

• Transvaginal US may be used first; endometrial strip > 4 mm is considered abnormal
• Endometrial biopsy - office procedure
• If neg but stil suspicious due to risk factors then may do hysteroscope for direct visualization

Question 3

Cervical Cx Testing Principles

Answer 3

• Pap at 21 yr q 3 yrs; every 5 yrs if HPV co-testing
  
  • ASCUS, LSIL, HSIL
  • If HPV co-test is neg then may not do colposcopy in young woman w/ just ASCUS
• Abnormal pap –> colposcopy (use acetic acid so that cervical intraepithelial lesions turn white); biopsy the worst areas
  
  • CIN I, II and III
• If a woman presents w/ cervical mass then skip pap and go right to biopsy of mass
• If atypical glandular cells on pap then may be cervical, endometrial OR ovarian cancer - do colposcopy, endometrial biopsy and curettage
• If someone w/ cervical cancer has total hysterectomy - still get pap of vaginal cuff

Question 4

Cervical Cx Risk Factors

Answer 4

HIV, immunodeficiency, mult sexual partners, early age of sex

Question 5

Cervical Cx Presentation and Adv Sx

Answer 5

Often present w/ bleeding or post-coital spotting; if advanced may have CVA tenderness from hydronephrosis

Question 6

Cervical Cx Tx

Answer 6

• If contained to cervix - prefer hysterectomy

* If advanced stage - radiation and cis-platinum preferred (cryotherapy or external beams)

Question 7

Breakdown of Ovarian Tumor Types

Answer 7

• Teratomas (all 3 germ layers)
  
  • 95% are mature / benign
    
    • May be strums ovarii - thyroid tissue (hyperthyroid sx)
  • 5% immature / malignant; contain immature embryonic neural tissue
• Epithelial
  
  • Serous - most common; often bilateral
  • Mucinous - if rupture can lead to jelly belly w/ mucous in intra-abdominal cavity; can be very large
  • CA-125
  • Tx - surgical removal and staging +/- chemo
• Sex Cord Stromal (hormonally active)
  
  • Granulosa Cell - estrogen (juvenile type can cause precocious puberty)
  • Sertoli - Leydig - testosterone
  • Thecoma
  • Fibroma
  • Gyandroblastoma

Question 8

Mgt of Adenexal Mass by Age

Answer 8

Pre-pubertal - operative if > 2 cm

Reprod Age - if < 5 then observe; 5-10 cm then US (bad prognosis if solid components or septation), > 10 cm then operative

Post-Menopausal - > 5 cm then operative