Female cancers Flashcards
What is the main presenting sign for endometrial cancer?
abnormal uterine bleeding is the presenting sign in 85% of women
What is the most common cause of postmenopausal bleeding?
endometrial atrophy
What treatment has the strongest association with reducing endometrial cancer risk?
combined hormonal contraception use - 50% reduction in risk and protection lasts for 10-15 years after discontinuation
What hormonal state increases risk of endometrial cancer?
states of prolonged unopposed estrogen - obesity (peripheral conversion by adipose tissue), nulliparity, PCOS, prolonged anovulation
Per ACOG, when should women be evaluated for endometrial cancer?
- AUB > 45 years old
- AUB < 45 years and have a history of unopposed estrogen exposure
Does Raloxifene (SERM) increase risk of endometrial cancer?
no, hasn’t been shown to
SOR A
Does tamoxifen (SERM) increase the risk of endometrial cancer?
Yes. Protective effect on breasts but increases endometrial CA risk
SOR A
What is the workup for painless postmenopausal bleeding?
- PAP +/- CBC
- STD testing
- TV-US –> if > 4 mm then biopsy. If < 4 mm atrophic endometrium
What is workup for premenopausal women who you suspect endometrial cancer?
- biopsy looking for atypia
Management of reproductive age woman with aUB with no cytologic atypia on endometrial biopsy?
progestin withdrawal for 1 - 6 months then rebiopsy
Management of reproductive age woman with aUB with atypia on endometrial biopsy?
high dose progestins, megestrol, or Depo-provera for 3 months then rebiopsy
Management of post-menopausal woman with aUB with atypia on endometrial biopsy?
hysterectomy
Workup when suspecting ovarian cancer
TVUS and CA-125 (> 200 in premenopausal women)
should you do PAP smear on woman with history of endometrial cancer?
No
What do you do in this scenario?
- cytology negative
- HPV positive
- HPV 16 or 18 +
Colposcopy
