Cervical Cancer, Endometrial Cancer, Vulvar/Vaginal Cancer, Ovarian Cancer, Moles Flashcards
Cervical cancer patient?
Reproductive age, caught on asymptomatic screen or with post-coital bleeding.
What causes cervical cancer?
HPV, inflammation, squamous cell carcinoma
How to diagnose cervical cancer
Pap, colpo, stage by exam or CT
How to treat cervical cancer
Asgus? Watch and wait
Endocervical lesion? Cone biopsy
Exocervical lesion? LEEP
Treatment for stage 2a or better? For 2b or worse?
Resection.
Debulking plus chemo+radiation.
Risk factors for cervical cancer?
Numerous partners and previous STDs
Characterization of dysplasia/CIN 1
Cell in basement membrane
Characterization of carcinoma in situ or CIN 2
Cells fill epithelial layer
Squamous cell carcinoma
Cells break through basement membrane and cause lesions
Goal of cervical screening?
To catch dysplasia
Stage I cervical cancer
Involves cervix only
Stage 2a cervical cancer
Involves part of vagina
Stage 2b cervical cancer
Involves part of vagina and cardinal ligament
Stage 3a cervical cancer
Involves all of the vagina
Stage 3b cervical cancer
Involves all of vagina and pelvic sidewall
Stage 4a cervical cancer
Involves bowel and bladder
Stage 4b cervical cancer
Distant mets
Screening algorithm
Asymptomatic screen with pap. Can be normal, abnormal or ASGUS. If asgus, do a HPV DNA or repeat in 12 months.
If abnormal do a colposcopy. If exocervical, do a leep. If endocervical do a cone biopsy
Endometrial cancer pathogenesis
Unopposed estrogen exposure
Patient with endometrial cancer
Postmenopausal bleeding, dysmenorrhea in younger, or young with granulosa-theca cell tumor.
How to diagnose endometrial cancer
Endometrial sampling
How to treat endometrial cancer
Progesterone, followed by TAH and BSO if severe
Risk factors for endometrial cancer
Nulliparity, early menarche, late menopause, obesity, PCOS, HRT
Patient presentation with vulvar cancer
Black and itchy, or red and itchy.
How do diagnose vulvar cancer?
Biopsy.
How to treat vulvar cancer
Vulvectomy and lymph node dissection if SCC or Melanoma, local resection if paget’s disease.
What type of cancer does DES exposure cause?
Vaginal adenocarcinoma
Three major types of ovarian cancers?
Germ cell, epithelial cell, stromal cell
Types of germ cell tumors
Dysgerminoma- LDH
Choriocarcinoma- BHCG
Endodermal sinus tumor (yolk sac)-AFP
Dermoid Cyst-Can cause struma ovarii
How do patients with germ cell tumors present?
Teenage girl with adnexal mass and weight gain. Benign, stage I only
How to diagnose ovarian tumor?
Transvaginal ultrasound
How to treat germ cell tumor
Unilateral salpingo-oopherectomy
Types of epithelial cell tumors
Serous
Mucinous
Endometroid
Brenner
Pathogenesis of epithelial cell tumors
Trauma from ovulation, very malignant
Patient with epithelial cell tumor
Older, post menopausal, nulliparious. Usually present at stage III or worse. Can be asymptomatic or can present with renal failure, SBO, ascites. Associated with BRCA1/2 or HNPCC
How to diagnose epithelial cell tumors?
Transvaginal ultrasound, CT to stage, track with Ca-125
How to treat epithelial cell tumors
TAH and BSO plus paclitaxel if 3b or worse
What to do if patient BRCA positive to avoid ovarian cancer
Screen with TVUS yearly and do a CA-125, then do TAH and BSO at 35.
Types of stromal cell tumors
Granulosa-theca tumor – produces estrogen
Sertoli-leydig tumor- can virilize
Complete mole pathogenesis
Completely molar (no fetal parts)
Completely chromosomal (46 chromosomes)
Completely spermal
Fertilization is normal but there is a broken egg so only spermal DNA.
How does a patient with a complete mole present?
Size-date discrepancy, very high BHCG which causes nausea and can cause hyperthyroidism, hyperemesis gravidarum, adnexal mass, grape-like cervix
Why can high beta hcg cause hyperthyroidism
because the structure is very similar between TSH and HCG
How to diagnose complete mole?
Ultrasound shows snowstorm appearance
How to treat mole? Follow up?
Suction curretage. Follow B-HCG weekly, put on OCP for 1 year to make sure BHCG doesn’t go up.
Pathogenesis of incomplete mole
Incompletely molar (there are fetal parts) Incompletely chromosomal (69 usually) Created by egg and two sperm
Choriocarcinoma pathogenesis
Cancer of gestational products, patient presents status post mole, miscarriage or normal pregnancy (which is the most severe). Rise in HCG
How to diagnose choriocarcinoma
Ultrasound, then curretage for biopsy, CT to stage
How to treat choriocarcinoma
Debulk, methotrexate, actinomycin, +/- cyclophosphamide (if mets to liver or brain, after a normal pregnancy, or if HCG>40K).
