Cancers of female reproductive tract Flashcards
Reduce risk of cancer
-No smoking, alc in moderation
-Be active
-HPV vax
-Healthy diet
-Use condom w/ every sexual encounter
-Maintain healthy weight
-Mammogram q1-2y starting at age 40
-Pap smear q1-3y if sexually active, starting at age 21
-Cholesterol check q1y starting at age 45
-BP check q2y
-DM test if hypertensive or hypercholesterolemia
-Check for STIs if sexually active
Dx test
-Clinical breast exam: breast cancer
-Mammography: breast cancer
-Pap test: cervical cancer
-Transvaginal ultrasound: endometrial cancer
-CA-125: ovarian cancer
Gestational cancer
-New cancer dx during pregnancy or 1st year postpartum
-Tx of endometrial cancer is impossible d/t involvement of uterus
-Cervical cancer more common
-Tx for early-stage cancer and absence of nodal involvement is C-section
Ovarian cancer
-“Silent killer”
-Most receive dx during stage 3 or 4
-Long term survival is low
-No adequate screening test
-Women w/ BRCA1 or 2 mutations (determined thru DNA in WBCs) should have genetic counseling
-s/s: pelvic pain, urinary frequency and urgency, bloating, feeling full
-Routine screening not recommended
-Dx: laparoscopy
-Tx: hysterectomy, salpingo-oophorectomy, omentectomy, cydo-reductive surgery, chemo
-Mass on ovary after menopause is cancerous
-Reduce risk: oral contraceptives for 3 yrs or longer, having children before age 30, tube ligation
Endometrial cancer
-Hx of exposure to unopposed estrogen is primary cause
-Related to increased obesity rates
-Other high risk are DM and HTN
-Spreads to lungs, lymph nodes, liver, bones, brain, and vagina
-Early s/s: spontaneous bleeding
-Late s/s: myometrial invasion and growth toward cervix
-General s/s: note changes in uterus size and shape, vaginal discharge, thickness > 4 mm
-Type 1 carcinoma is most common and has good prognosis
-Endometrial thickness of 4 mm or less has extremely low risk
-Dx: in woman w/ postmenopausal bleeding and thick endometrium = sonohysterogram
-Tx: hysterectomy, salpingo-oophorectomy, follow up q3-4m for 1st 2 yrs
-Any episode of bleeding after menopause should be investigated for cancer
-Report: bleeding after sex, bleeding > 1 week, reappearance of bleeding after 6 m of no menses
Cervical cancer
-Caused by HPV, precursor is cervical dysplasia
-Dx: pap test (1st pap at age 21, age 21-29 q3y, age 30-65 q5y, age 65+ not pap), repeat pap in 4-6 m or refer for colposcopy, refer for HPV testing
-Colposcopy: lithotomy position, cervix is cleansed w/ acetic acid solution (makes abnormal cells appear white aka acetowhite)
-Strong link w/ smoking and obesity
-Tx: cryotherapy (use of liquid nitrogen, profuse watery vaginal discharge for 3-4 weeks after), cone biopsy (LEEP (removal w/ heated wire, mild cramping or bleeding for weeks after) or cold knife (scalpel is used, general anesthesia, cramping and bleeding after)), laser therapy, hysterectomy, radiation, chemo
-Suspect advanced cervical cancer in women w/ pelvic, back or leg pain, weight loss, anorexia, weakness, frxs
-Rest pelvis for 1 m after tx
-Primary prevention: gardasil 9 vax prevent HPV strains and works for 10 years, refrain from early sexual activity and having multiple partners, cervical cells, refrain from sex, avoid long-term use of OCs, no smoking
Pap smear prep
-Schedule test 1 week after menses ends
-No ssex for 48 hrs before
-No douching within 48 hrs
-Don’t use tampons, foams, creams, or jellies for 72 hrs before
-Cancel appt if bleeding occurs
Vaginal cancer
-Most commonly squamous cell carcinomas (SCCs)
-Tx: radiation, laser surgery, hysterectomy
-Risks: 60+, exposure to DES in utero, vaginal trauma, genital warts (HPV)
-Most women are as/s
-Those w/ s/s have painless bleeding after sex, abnormal vaginal discharge, painful sex, pelvic pain
-Dx: colposcopy
Vulvar cancer
-More common in age 60s-70s
-1st type: HPV, young women, common, classic VIN
-2nd type: not HPV, older women
-Most are SCCs (VIN)
-Classic VIN: common, HPV
