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OB/GYN > cancer > Flashcards

cancer Flashcards

1
Q

what are some different etiologies of OBGYN cancers

A

toxins, viruses (HPV), estrogen, ovulation

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2
Q

what is precancer

A

carcinoma in situ and dysplastic tissue

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3
Q

what is the job of the physician at the etiology phase?

A

identification of risk factors and prevention of development. we can use vaccines, or removal of risks.

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4
Q

what is the job of physician at the precancer phase?

A

screening or resection (cure)

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5
Q

what is physician’s job at the cancer phase?

A

diagnosis (staging) debulking, radiation or chemo

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6
Q

staging and prognosis?

A

the worse the stage, the worse the prognosis.

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7
Q

what do physicians worry about in the premenarchal stage for etiology?

A

usually only toxins, since the prepubescent female has no estrogen, is not ovulating, and usually is not sexually active and thus has reduced of acquiring viruses.

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8
Q

what do physicians worry about in the menarchal stage for etiology?

A

estrogen, viruses, ovulation. usually worry less about toxins.

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9
Q

what do physicians worry about in the postmenarchal stage for etiology?

A

lifetime of toxin exposure. lifetime of exposures for estrogen and ovulations.
This is why they have the most malignancies

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10
Q

what is the most complicated form of female cancer

A

ovarian due to the multiple cell types.

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11
Q

whart type of cancer is cervical cancer

A

squamous cell carcinoma

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12
Q

what type of cancer is vaginal cancer

A

squamous cell carcinoma

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13
Q

what type of cancer is vulver cancer

A

squamous cell carcinoma

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14
Q

what is the variant of vulvar cancer and why is it all important

A

pagets disease and its a red lesion.

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15
Q

what is the etiology of cervical, vulvar and vaginal cancers

A

HPV

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16
Q

what are the three cell types of ovary

A

germ, stromal, epithelial

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17
Q

what patient history could be indicative of cervical cancer?

A

post coital bleeding and black lesions that are puritic

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18
Q

what is the screen for vaginal and vulvar cancers?

A

There is none

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19
Q

What is the etiology of endometrial cancer

A

estrogen exposure

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20
Q

what is the precancerous lesion indicative of endometrial cancer

A

dysplasia, atypia

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21
Q

what is the typical cancer for endometrial cancer

A

adenocarcinoma

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22
Q

what patient history is a possible indicator for endometrial cancer

A

post-menopausal bleeder

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23
Q

what is the etiology of ovarian cancer

A

ovulation (ovarian epithelial cancer)

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24
Q

what is the typical cancer of ovarian cancer

A

epithelial cancer

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25
Q

what is the screen for ovarian cancer

A

there is none

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26
Q

what patient history is possibly indicative of ovarian cancer

A

renal failure, small bowel obstruction ascites

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27
Q

what is the etiology of choriocarcinoma?

A

gestational trophoblastic disease

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28
Q

what is the typical cancer for choriocarcinoma?

A

Chorio

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29
Q

what is the screen for choriocarcinoma?

A

There is no official screen…but we can follow b-hCG while the patient is on oral contraceptive and if it rises then the cancer must be causing it.

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30
Q

what patient history could be indicative of choriocarcinoma

A

hyperemesis gravidum, hyperthyroid and size-date discrepancies.

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31
Q

are the rates of cervical cancer increasing or decreasing

A

rapidly decreasing

32
Q

what ages does cervical cancer arise

A

30s and 60s…bimodal

33
Q

what patient histories are indicative for cervical cancers in those bimodal age ranges?

A

30s –postcoital bleeding

60s –post-menopausal bleeding

34
Q

where does cervical come from?

A

HPV

35
Q

why dont we see Cervical cancers before menarche

A

because its caused by HPV and that is an STI. there usually is no sex before then

36
Q

what strains of HPV cause cancer

A

16/18k and the 30s

37
Q

what strains of HPV cause warts

A

6/11

38
Q

what is CIN now classified as?

A

Low-grade squamous intraepithelial lesion (LSIL)

39
Q

What are CIN2/3 classified as

A

High-grade squamous intraepithelial lesion (HSIL)

40
Q

Risk factors for cervical cancer

A

infections, HPV, smoking

41
Q

1a staging

A

microscopic

42
Q

Ib staging

A

macroscopic (see with naked eye) goes outward.

43
Q

stage IA

A

only the cervix

44
Q

stage IIA

A

only the upper 2/3 vagina

45
Q

Stage IIIA

A

lower 1/3 vagina

46
Q

Stage IIB

A

also involves the cardinal ligament

47
Q

stage IIIB

A

involves the pelvic side wall

48
Q

stage IV

A

distant metasteses.

49
Q

stage IVA

A

adjacent organs

50
Q

stage IV B

A

distant mets

51
Q

How can we treat cervical lesions that are early

A

local ablative therapy. LEEP, freeze it off, and if endocervical use a cone biopsy.

52
Q

what do the early stages look like

A

white lesions with a clear border, any abnormalities of the cervical, mosaicism.

53
Q

when to begin pap

A

21 years old. continue every 3 years.

54
Q

when to give paps when HIV positive

A

at diagnosis or when becoming sexually active. every year

55
Q

How frequently pap if over 30 and HPV testing

A

then every 5 years

56
Q

How frequently pap if over 65?

A

then can stop unless have a history of positive paps, or poor followup.

57
Q

what happens with abnormal pap

A

colposcopy. if positive endocervical biopsy with follwup cone biopsy.
if positive ecto and negative endo then local ablation therapy..

58
Q

what happens when you have abnormal pap cells (atypical squamous cells of unknown significance (ASCUS).

A

Do paps in 6 months
reflex the HPV DNA.
If HPV DNA go to colpo.
if at 6-12 months pap is ASCUS or worse then go to colpo.
If ASCUS is positive and HPV is negative than normal resume 3 years.
If ascus positive and repeats are normal than repeat 3 years.

59
Q

If ecto lesion

A

LEEP/CRYO

60
Q

If endo lesion

A

Cone

61
Q

If IIA or better

A

Local ressection is generally curative

62
Q

If IIB or worse

A

debulking chemo radiation and usually platinum based therapy

63
Q

What does guardacil protect and who do we give to?

A

Vaccine to HPV. Recommended 11-26 girls.

Boys 11-21. can give as young as 9 and for boys as old as 21.

64
Q

When do we see endometrial cancer?

A

estrogen has a cumulative effect. Reproductive age female with dysmenorrhea or in postmenopausal female with vaginal bleeding –bleeding after menopause is suspect!

65
Q

What is the etiology of endometrial cancer

A

estrogen exposure.

66
Q

Why are combined oral contraceptives protective against endometrial cancer?

A

because they contain progesterone and it PROtective against endometrial cancer because it blocks the effects of estrogen.

67
Q

How does endometrial cancer form?

A

exposure to estrogen causes hyperplasia of endometrium (precancer) which gives way to adenocarinoma

68
Q

what are the stages to get to adenocarcinoma

A

hyperplasia-cystic-adenomatous-atypical-adenocarcinoma

69
Q

what causes excess estrogen exposure?

A

1) most potent annovulation (unopposed estrogen and lack of progesterone)
2) Age (older, longer exposure)
3) nullparity
4) obesity (peripheral conversion)
5) early menarche or late menopause
6) hormone replacement
7) tamoxifen

70
Q

Is there a screen for endometrial cancer?

A

NO.

71
Q

treatment for endometrial cancer

A

Total abdominal hysterectomy and bilateral oophorectomy this will remove the ovaries (source of estrogen) and the tumor in the uterus.

72
Q

what is a stimulant for endos

A

estrogen

73
Q

If patient has postmenopausal bleeding what do we do?

A

D and C or endometrial sampling.

74
Q

If endomtrial sampling for postmeno bleeding is negative whats the diagnosis and treatment?

A

vaginal atrophy —estrogen creams.

75
Q

what are the four types of patients that present with endometrial cancers?
how do all types present?

A

1) Old obese
2) Old and hormone replacement/tamoxifen
3) young annovulation (PCOS)
4) granulosa-thecal tumor
Vaginal bleeding

76
Q

How do we treat endometrial hyperplasia (especially in reproductive females)

A

Progesterone therapy.

77
Q

If we diagnose endometrial cancer whats the treatment

A

total hysterectomy with bilateral oophorectomy with or without chemo and radiation.

OB/GYN (39 decks)

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