Ch. 34 WS Flashcards
Cancers of what organs/structures are considered gynecologic cancers?
Cervix, uterus, ovaries, vulva, and vagina
What is the outermost portion of the female genitalia called?
Vulva
List the major parts of the vulva.
Labia majora, labia minora, clitoris, and vestibule.
Where is the perineum located in females?
Between the vagina and anus
Describe the Vagina and its location in relation to other organs/structures.
6-8 inch muscular tube (cervix to vulva). Surrounded by rectum, urethera, and bladder.
What are the three layers of the vaginal wall.
Mucosa, muscularis, and adventitia.
What are the three layers of the wall of the uterus
Inner endometrium (mucous membrane), middle myometrium (smooth muscles), and the outer perimetrium (parietal peritoneum).
What is the parametrium?
The connective tissue that is immediately lateral to the uterine cervix
What is the endocervix and the exocervix?
Endocervix is the part of the cervix closest to the body of the uterus. Exocervix is part of the cervix closes to the vagina.
What is the cervical os?
The opening of the cervix (vaginal end)
What is the vaginal fornices?
A circular sulcus where the cervix projects through the vaginal wall.
What are the two main parts of the uterus?
Cervix and body (fundus)
Where does squamous cell carcinoma of the cervix usually originate?
At the squamocolumnar junction (transformation zone), squamous cells of the exocervix.
What are the two main parts of the uterus?
two main parts body (fundus) and cervix but other texts separate the body and the fundus. So probably best to know/recognize at least 3 parts (fundus, body, and cervix)
What is the best screening tool for cervical cancer?
Pap Smear guidelines recommend one every 3 years starting age 21
What is the most common presenting symptom in cervical cancer?
Abnormal vaginal bleeding
What are the two most common histological types of cervical cancer?
Squamous Cell Carcinoma 80%-90% , Adenocarcinoma 10%-20%
Which histology of cervical cancer has the worst prognosis?
Adenocarcinoma has the worst prognosis (arise in the endocervical mucus-producing gland cells)
What is the most common type of gynecologic malignancy?
Endometrial
What is the most common histological type of endometrial cancer?
Adenocarcinoma
What are the risk factors for cervical cancer?
- Multiple sexual partners,
- sexual intercourse at an early age,
- sexually transmitted diseases, specifically herpes simplex type 2 and HPV (strains 16 and 18). HPV is responsible for nearly 99% of cervical cancers.
- Also oral contraceptives with estrogen alone (no progesterone),
- smoking,
- hormonal factors,
- obesity,
- low socioeconomic status,
- nulliparity, and
- immunosuppression are also risk factors
List the clinical symptoms of cervical cancer.
Early stages are asymptomatic then abnormal vaginal discharge, pelvic or back pain, painful urination, and hematuria or hematochezia
What staging system is used for cervical cancer?
FIGO
What are the most common distant site involved in cervical cancer?
Lungs, liver, & bone
What structures become directly invaded by cervical cancer?
Uterus, vagina, parametrium, abdomen, pelvis, rectum, bladder
What are the risk factors for endometrial cancers?
A high cumulative exposure to estrogen that is not hindered by progesterone. Estrogen replacement therapy and obesity increase estrogen exposure. Nulliparity, late menopause, early menarche, irregular menstruation, diabetes, a history of infertility and hereditary colon cancer also increased risks. Women taking tamoxifen are at increased risk
What is the most common presenting symptom of endometrial cancer?
Postmenopausal bleeding
. Is a Pap smear used to screen for endometrial cancer?
no
Why is there such a high mortality rate for ovarian cancer?
More than 70% are diagnosed at advanced stages due to very vague symptoms.
What is the relationship to BRACA1 and BRACA2 and to ovarian cancer?
Presence of mutated BRACA1 and BRACA2 genes increases the risk of ovarian cancer.
What tumor marker is associated with ovarian cancer?
CA125
Why is the cure rate for cervical cancer better than the cure rate for ovarian cancer?
Cervical cancer can be detected earlier through pap screenings. There is no recommended screening for ovarian cancer and ovarian cancers are mostly diagnosed at an advanced stage because the signs and symptoms are vague. The advanced stage at diagnosis leads to a poorer prognosis.
What are acute side effects of pelvic irradiation?
Fatigue, diarrhea, dermatitis, and dysuria
What is the benefit of treating the pelvis with a full bladder as it relates to management of treatment symptoms?
Less bladder in field which will lessen the side effects of dysuria. Pushes small bowel more out to the field.
What are the clinical signs of vulvar cancer?
Pruritus, a palpable mass on the vulva, painful urination, and vaginal bleeding. (labia is most common location)
Ovarian cancer most common in _____ year olds.
50-70
Is CA-125 blood test a screening tool for ovarian cancer?
no
What is the best treatment for ovarian cancer?
Surgery and chemo
How does vulvar cancers spread?
direct extension and regional lymph nodes.
Also hematogenous(rare)
The lymphatic spread of vulvar cancers is orderly first ______ nodes then ______nodes.
inguinal & pelvic
what are the two HPV subtypes that are responsible for most cervical cancers?
16 & 18
For cervical cancer a ______ is performed on women with abnormal pap smear results or that are high risk for developing cervical cancer
colposcopy
lymphatic spread of cervical cancer is usually orderly, involving the ______ nodes, followed by ______ nodes, _________ nodes, ________ nodes, and then even ______ nodes.
parametrial nodes, pelvic nodes, common iliac nodes, periaortic nodes, and superclavicular nodes.
define nulliparity
never given birth
the gold standard method for evaluating women with symptoms of endometrial cancer are?
fractional dilation and curettage
Lymphatic spread of endometrial cancer occurs initially to the _____ and _______ nodes.
internal and external iliac pelvic nodes
Ovarian cancer is typically spread though what?
direc extension of adjacent organs, peritoneal fluid (seeding), or lymph nodes
what lymph nodes are are most frequently involved in lymphatic spread in ovarian cancer?
pelvic or para-aortic nodes
what are the distant mets sites for ovarian cancer?
lung, liver, diaphragm, bladder, or colon
_______ portion of the vagina is most common location of vaginal cancer
Upper 1/3
Vulvar cancers are mostly what histology?
squamous cell carcinomas
TD 5/5: Rectum
6,000 cGy
TD 5/5: Bladder
6,500 cGy
TD 5/5: Small bowel
4,000 cGy
TD 5/5: Ovaries
200 cGy
TD 5/5: Vaginia
9,000 cGy
A narrowing of the vagina,often accompanied with dryness, loss of elasticity and resilience, and scar tissue
vaginal stenosis
Use of cold temperatures to treat a disease
cryotherapy
the closing of the top of the vagina normally associated with a hysterectomy
vaginal cuff
tests that involves the use of a magnifying microscope to examine the cervix for visible abnormalities
colposcopy
Squamous cell epithelium of the cervix connects with the columnar epithelium of the endocervix, which is called?
transformation zone
The part of the cervix closest to the body of the uterus is the ________
endoxervix
the part of the cervix closest to the vagina is the ______
exocervix
