Clin Lab: Reproductive Disorders & Cancers Flashcards
Site of infection
- breast
- vulva
- vagina
- uterine
- intraabdominal
What are other symptoms of an intraabdominal infx?
- pain
- N/V
- fever
Can be an infection of the…
outer tissue or abscess formation
Lab workup for reproductive system infx? (7)
- CBC
- BMP/CMP
- ESR/CRP
- Lactic acid (sepsis)
- UA/urine culture
- Vaginal wet mount
- Blood cultures
Symptoms of PCOS
- Hirsutism
- Menstrual irregularity,
- Acne
- Central obesity (metabolic synd)
- infertility
(male-pattern hair loss & alopecia)
Imaging for reproductive system infx?
US or CT
What must be ruled out in PCOS? (think oral)
medications
- steroid & anti-epileptics
PCOS: Rotterdam Criteria
2 of 3 criteria met
- Oligo/anovulation
- Clinical or biochemical evidence of hyperandrogenism
- Polycystic ovaries on US
Can PCOS be a clinical Dx?
YES
How do you prove ovulation?
LH levels
What other hyperandrogenism causes must be ruled out before a dx of PCOS?
- thyroid dz
- hyperprolactinemia
- non-classical congenital adrenal hyperplasia
When should you do an initial workup for PCOS?
If pt has menstrual irregularity more than 2 years after menarche
What meds are confounding factors for PCOS?
Meds
- metformin
- OCPs
- spironolactone
Stop 4-6 wks before workup
What labs should you test initially if someone presents with possible PCOS? (6)
- CBC
- CMP
- TSH
- Prolactin
- HCG
- FSH
If testosterone is elevated, what should be done next?
screen for causes of hyperandrogenemia
- congential adrenal hyperplasia (17-hydroxyprogesterone 0- will be high)
- Adrenal carcinoma (DHEAS - will be high)
- Hyperprolactinemia - prolactin
- Cushing syndrome - cortisol
- Elevated growth hormone - IGF-1
PCOS workup includes:
- Total or free testosterone
- Transvaginal US
In PCOS, when should total or free testosterone be measured?
- between 8-10 AM
- days 4-10 of menstrual cycle (before ovulation)
Is a transvaginal US necessary to dx PCOS?
Not if other 2 dx criteria are met
- can help confirm dx
What are concerning features of breast cancer?
- irregular borders
- microcalcifications
Evidence of PCOS via transvaginal US?
12 or more cysts measuring 2-9mm in 1 ovary or incr ovarian volume
Does incidental finding of polycystic ovaries need a workup?
NO, if there are no signs/symptoms of PCOS
Additional testing after dx of PCOS include:
- BMI, waist circumference
–> Incr risk of metabolic synd - BP
- Lipid panel
- Oral glucose tolerance test
- Screening for sleep apnea
- Screening for depression
What are the 3 breast positioning for mammograms?
- Craniocaudal (CC)
- Mediolateral (ML)
- Mediolateral oblique (MLO)
How many views are usually gotten with mammograms?
TWO
Screening guidelines for breast CA:
- Age 40-49: depends on risk/benefit for each pt
- Age 50-74: every 1-2yrs
- 75+: depends on health / well-being of pt
Screening for breast CA includes:
- Mammogram
- Genetic testing
What is another type of mammogram what gives us better visualization of breast tissue?
breast tomosynthesis
What views are usually obtain for a mammogram?
- craniocaudal + mediolateral
- craniocaudal + mediolateral oblique
Describe a breast tomosynthesis test
Rotates the x-ray beam across several angles, more images
- Gives more 3D image w/o incr radiation exposure
What genes are assoc. w/ increased risk of breast CA?
- BRCA 1/ BRCA 2
- ATM
- CDH1
- CHEK2
- PALB2
- PTEN
- TP53
- STK11
Who gets tested for breast CA? (7)
- Breast CA at an earlier age (<60yo)
- Two or more different primary breast CAs
- Invasive ovarian CA
- Males w/ breast CA
- Metastatic prostate CA
- Ashkenazi Jew
- 1st degree relative w/ above gene(s)
If area of concern detected on screening mammogram, what testing is next?
a dx mammogram, +/- US FU, then biopsy
BRCA 1/BRCA 2 genes increase risk for which cancers
ovarian CA > breast CA
What 3 things should be done as an evaluation of a breast mass?
- Imaging
- Biopsy
- Receptor expression
Breast Mass Evaluation Imaging:
- Breast US (<30yo)
- Bilateral dx mammogram (>30 + mass)
- MRI
What are possible receptors that can be found on the surface of the breast mass?
- estrogen receptor (ER)
- Progesterone receptor (PR)
- Human Epidermal Growth Factor receptor (HER2)
Describe ER (+) markers?
prognostic marker & predictive of who would benefit from adjuvant endocrine therapy
What is a medication used to treat ER (+) breast CA?
tamoxifen
Describe HER2 (+) marker
- PROTEIN on surface of some breast CAs
- Higher levels – cells respond better to HER2 directed medications
What combination of markers has a better prognosis & response to tx?
ER+/PR+/HER2+
What combination of markers has a worse prognosis & response to tx?
ER-/PR-/HER2-
What are the two forms of cervical cancer?
- squamous cell carcinoma
- adenocarcinoma
What are something that can prevent/help the dx of cervical cancer?
- early detection/tx
- Gardasil vax
What are the pre-cancerous changes called in possible cervical cancer?
cervical intraepithelial neoplasia (CIN)
Cervical cancer is usually due to what type of infx?
HPV infx
What are the 3 grades of CIN?
- CIN 1
- CIN 2
- CIN 3
Describe CIN 1
- abnl changes limited to < 1/3 total thickness of epithelial tissue
–> low risk of developing into CA – nonprogressive HPV strain & gets cleared by body
Describe CIN 2
abnl changes b/t 1/3 to 2/3 thickness
Describe CIN 3
abnormal changes > 2/3 thickness
–> Highest risk of developing into CA
What has happened that signified that cervical cancer is present?
invasion of basement membrane
–> progressed from epidermis into dermis
Why are screening test done for cervical CA?
determine risk for CIN 3
What do test can be done to screen for cervical cancer?
- pap smear
- HPV testing
Describe a pap smear
- Brush & swab samples obtained from outside & inside of cervix
- Smears examined under a microscope – epithelial & glandular cells are graded for level of dysplasia
Describe HPV testing
IDs presence of HPV strains assoc w/ cervical cancer
What are the USPSTF screening guidelines for cervical cancer?
< 21 yrs – no screening
21-29 yrs – Pap smear every 3 yrs
30-65 yrs – 3 possibilities
–> Pap smear every 3 yrs
–> HPV testing every 5 yrs
–> Pap smear + HPV testing every 5 yrs
> 65 yrs – no screening if no abnormal screening in last 10 yrs
What are the ACS screening guidelines for cervical cancer?
- HPV testing preferred over Pap smear
–> HPV test every 5 yrs b/t 25-65yo
What does a typical pap smear report include?
- Specimen type
- Description of specimen adequacy
- Interpretation of results
Interpretation of results for a pap smear could include…
- Negative for intraepithelial lesion or malignancy
OR - A description of epithelial cell abnormality
–> Squamous cell abnormalities and/or glandular cell abnormalities
Squamous cells abnormalities are reported as:
- Atypical squamous cells (ASC)
–> Unknown significance (ASC-US)
–> Cannot exclude lesion (ASC-H) - Low-grade squamous intraepithelial lesion (LSIL)
- High-grade squamous intraepithelial lesion (HSIL)*
- Squamous cell carcinoma in situ
Describe an atypical squamous cells (ASC) report on Pap smear.
doesn’t look right, but not cancerous
Describe an unknown significance (ASC-US) report on Pap smear.
little change, probably fine
Describe a cannot exclude lesion (ASC-H) report on Pap smear.
might become cancerous, close watch
Describe an low-grade squamous intraepithelial lesion (LSIL) report on Pap smear.
CIN 1 or early CIN 2
Describe a high-grade squamous intraepithelial lesion (HSIL) report on Pap smear.
- High CIN 2 or CIN 3
–> more likely to go on & become CA
Describe a squamous cells carcinoma in situ report on Pap smear.
THIS IS CANCER!
What is glandular cell abnormalities reported on a pap smear?
- Atypical – weird
- Atypical, favor neoplastic – weird probably CA
- Endocervical adenocarcinoma in situ - cancer
Describe the make up of HPV?
double-stranded DNA virus
Types of HPV testing
- DNA analysis (PCR/NAAT)
- RNA analysis
- PRO detection
What two PROs can be tested for in HPV?
- P16
- Ki-67
If HPV is detected, what is done next?
genotyping to ID if it’s a high risk stain
What is used to calculate risk of CIN 3+ to guide further follow up?
- results of current or prior abnl pap smear
AND/OR - HPV testing
What are the 6 different risk cervical CA recommendations possible?
Expedited tx (excisional) (risk > 60%)
Either expedited tx or colposcopy (risk 25-59%)
Colposcopy w/ biopsy (risk 4-24%)
Surveillance (repeat testing) at 1yr (risk 0.5-3.9%)
Surveillance at 3yrs (risk 0.15-0.5%)
Surveillance at 5yrs (risk < 0.15%)
Expedited treatment (excisional) risk % for cervical CA?
> 60%
Either expedited tx or colposcopy risk % for cervical CA?
25 - 59%
Colposcopy with biopsy risk % for cervical CA?
4 - 24%
Surveillance (repeat testing) at 1 year risk % for cervical CA?
0.5 - 3.9%
Surveillance at 3 yrs risk % for cervical CA?
0.15 - 0.5%
Surveillance at 5 yrs % for cervical CA?
< 0.15%
Describe how a colposcopy is done?
Acetic acid (vinegar) used to highlight abnl cells then…
Removal (excisional) vs biopsy (pinch)
Are there any screening test for ovarian cancer?
NO
What does the workup include for ovarian cancer?
- Imaging
- Markers
- Surgical Evaluation
What type of imaging can be done for ovarian cancer?
transabdominal or transvaginal US
What are the markers for ovarian cancer?
CA-125
What do we use the biomarker CA-125 for?
to evaluate tx effectiveness & screen for recurrence of ovarian CA
Are there any screening test for uterine cancer?
NO
Are there any biomarkers for uterine cancer?
NO
How do you dx uterine cancer?
endometrial biopsy
NOTE
Any postmenopausal women w/ spotting is concerning/high risk for endometrial CA
How do you dx menopause?
Clinical dx
–> can do labs to support dx
What hormones can be tested to confirm dx of menopause?
FSH & estradiol levels
Describe lab levels of FSH and estradiol in a pt w/ menopause?
High FSH & low estradiol
What is the FSH diagnostic level for menopause?
> 25
(or 12 consecutive months of no periods)
