cancer Flashcards
what are some different etiologies of OBGYN cancers
toxins, viruses (HPV), estrogen, ovulation
what is precancer
carcinoma in situ and dysplastic tissue
what is the job of the physician at the etiology phase?
identification of risk factors and prevention of development. we can use vaccines, or removal of risks.
what is the job of physician at the precancer phase?
screening or resection (cure)
what is physician’s job at the cancer phase?
diagnosis (staging) debulking, radiation or chemo
staging and prognosis?
the worse the stage, the worse the prognosis.
what do physicians worry about in the premenarchal stage for etiology?
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.
what do physicians worry about in the menarchal stage for etiology?
estrogen, viruses, ovulation. usually worry less about toxins.
what do physicians worry about in the postmenarchal stage for etiology?
lifetime of toxin exposure. lifetime of exposures for estrogen and ovulations.
This is why they have the most malignancies
what is the most complicated form of female cancer
ovarian due to the multiple cell types.
whart type of cancer is cervical cancer
squamous cell carcinoma
what type of cancer is vaginal cancer
squamous cell carcinoma
what type of cancer is vulver cancer
squamous cell carcinoma
what is the variant of vulvar cancer and why is it all important
pagets disease and its a red lesion.
what is the etiology of cervical, vulvar and vaginal cancers
HPV
what are the three cell types of ovary
germ, stromal, epithelial
what patient history could be indicative of cervical cancer?
post coital bleeding and black lesions that are puritic
what is the screen for vaginal and vulvar cancers?
There is none
What is the etiology of endometrial cancer
estrogen exposure
what is the precancerous lesion indicative of endometrial cancer
dysplasia, atypia
what is the typical cancer for endometrial cancer
adenocarcinoma
what patient history is a possible indicator for endometrial cancer
post-menopausal bleeder
what is the etiology of ovarian cancer
ovulation (ovarian epithelial cancer)
what is the typical cancer of ovarian cancer
epithelial cancer
what is the screen for ovarian cancer
there is none
what patient history is possibly indicative of ovarian cancer
renal failure, small bowel obstruction ascites
what is the etiology of choriocarcinoma?
gestational trophoblastic disease
what is the typical cancer for choriocarcinoma?
Chorio
what is the screen for choriocarcinoma?
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.
what patient history could be indicative of choriocarcinoma
hyperemesis gravidum, hyperthyroid and size-date discrepancies.
are the rates of cervical cancer increasing or decreasing
rapidly decreasing
what ages does cervical cancer arise
30s and 60s…bimodal
what patient histories are indicative for cervical cancers in those bimodal age ranges?
30s –postcoital bleeding
60s –post-menopausal bleeding
where does cervical come from?
HPV
why dont we see Cervical cancers before menarche
because its caused by HPV and that is an STI. there usually is no sex before then
what strains of HPV cause cancer
16/18k and the 30s
what strains of HPV cause warts
6/11
what is CIN now classified as?
Low-grade squamous intraepithelial lesion (LSIL)
What are CIN2/3 classified as
High-grade squamous intraepithelial lesion (HSIL)
Risk factors for cervical cancer
infections, HPV, smoking
1a staging
microscopic
Ib staging
macroscopic (see with naked eye) goes outward.
stage IA
only the cervix
stage IIA
only the upper 2/3 vagina
Stage IIIA
lower 1/3 vagina
Stage IIB
also involves the cardinal ligament
stage IIIB
involves the pelvic side wall
stage IV
distant metasteses.
stage IVA
adjacent organs
stage IV B
distant mets
How can we treat cervical lesions that are early
local ablative therapy. LEEP, freeze it off, and if endocervical use a cone biopsy.
what do the early stages look like
white lesions with a clear border, any abnormalities of the cervical, mosaicism.
when to begin pap
21 years old. continue every 3 years.
when to give paps when HIV positive
at diagnosis or when becoming sexually active. every year
How frequently pap if over 30 and HPV testing
then every 5 years
How frequently pap if over 65?
then can stop unless have a history of positive paps, or poor followup.
what happens with abnormal pap
colposcopy. if positive endocervical biopsy with follwup cone biopsy.
if positive ecto and negative endo then local ablation therapy..
what happens when you have abnormal pap cells (atypical squamous cells of unknown significance (ASCUS).
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.
If ecto lesion
LEEP/CRYO
If endo lesion
Cone
If IIA or better
Local ressection is generally curative
If IIB or worse
debulking chemo radiation and usually platinum based therapy
What does guardacil protect and who do we give to?
Vaccine to HPV. Recommended 11-26 girls.
Boys 11-21. can give as young as 9 and for boys as old as 21.
When do we see endometrial cancer?
estrogen has a cumulative effect. Reproductive age female with dysmenorrhea or in postmenopausal female with vaginal bleeding –bleeding after menopause is suspect!
What is the etiology of endometrial cancer
estrogen exposure.
Why are combined oral contraceptives protective against endometrial cancer?
because they contain progesterone and it PROtective against endometrial cancer because it blocks the effects of estrogen.
How does endometrial cancer form?
exposure to estrogen causes hyperplasia of endometrium (precancer) which gives way to adenocarinoma
what are the stages to get to adenocarcinoma
hyperplasia-cystic-adenomatous-atypical-adenocarcinoma
what causes excess estrogen exposure?
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
Is there a screen for endometrial cancer?
NO.
treatment for endometrial cancer
Total abdominal hysterectomy and bilateral oophorectomy this will remove the ovaries (source of estrogen) and the tumor in the uterus.
what is a stimulant for endos
estrogen
If patient has postmenopausal bleeding what do we do?
D and C or endometrial sampling.
If endomtrial sampling for postmeno bleeding is negative whats the diagnosis and treatment?
vaginal atrophy —estrogen creams.
what are the four types of patients that present with endometrial cancers?
how do all types present?
1) Old obese
2) Old and hormone replacement/tamoxifen
3) young annovulation (PCOS)
4) granulosa-thecal tumor
Vaginal bleeding
How do we treat endometrial hyperplasia (especially in reproductive females)
Progesterone therapy.
If we diagnose endometrial cancer whats the treatment
total hysterectomy with bilateral oophorectomy with or without chemo and radiation.
