female GU tumors Flashcards
two main risk factors for female GU cancer?
Multiparous
45-55 years of age
most significant early warning symptom of female gu cancer?
Post coital bleeding
5 early symptoms of female gu cancer?
- Thin watery discharge, blood tinged
- Intermittent painless metrorrhagia
- Post coital bleeding
- Bleeding becomes more frequent and increase in amount and duration
- Bleeding ultimately becomes continuous
4 late symptoms of female gu cancer?
- Flank pain and leg pain due to pelvic tumor
- Involving the uterus, pelvic wall or sciatic nerve
- Lower extremity swelling due to lymphatic blockage
- Massive hemorrhage and uremia and weight loss
3 types of cervical cancer treatment
- Surgery – Radical Hysterectomy
- Radiation
- Chemotherapy
2 txts for recurrent cervical cancer
Chemotherapy
Pelvic Exenteration
what is pelvic exenteration?
when ALL female organs are removed from the pelvis
including vagina and bladder/urethra
women who took DES have an increased risk of what? what about their daughter?
moms: breast cancer
Daughters: clear cell adenocarcinoma of the vagina and cervix and of breast cancer; fertility problems
many (20%) pts with DES exposure have ______ ______
cervical adenosis
most of the female GU cancers are of what type?
primarily squamous on histology
invasive cancer of the vagina- what are the symptoms?
typically asymptomatic , most common complaint is post-menopausal bleeding, post-coital bleeding
Dx of invasive cancer of the vagina. how is staging done?
biopsy using colposcopy, staging- FIGO or CIN
Over __% of patients with vaginal tumors have metastatic lesions. why is this significant?
80%
means they tend to not show up early, have already metastasized.
who does FIGO staging?
The FIGO staging systems are determined by the International Federation of Gynecology and Obstetrics
txt of vaginal cancer (maybe weeds)
- Surgical excision
- if primary vaginal cancer, use radiotherapy
- For clear cell lesions, radical hysterectomy, and vaginectomy or radiation therapy is effective
are benign tumors of the uterus common?
yes!
Smooth muscle benign tumor; most common benign uterine neoplasm. what is this?
fibroid (aka leiomyoma)
symptoms of fibroids
usually asymptomatic .. some women may have irregular periods, pelvic pain and infertility
what can change the size of fibroids?
Hormonally dependent (estrogen)- change throughout the cycle; shrink with menopause
txt for fibroids
- observation
- myomectomy (“fibroidectomy”)
- hysterectomy
- GnRH agonists may reduce tumor size (suppress estrogen production)
which treatments for fibroids will maybe restore fertility? which could contribute to infertility?
all of them will help restore fertility EXCEPT GnRH agonists b/c, while taking them, they will suppress necessary hormones
what is adenomyosis ?
Migration of glands from the basal layer of endometrium into the myometrium
-globular enlargment of uterus
older woman with cyclic pain… what might this be?
adenomyosis
what is the typical presentation of adenomyosis?
middle aged and parous women with severe dysmenorrhea and menorrhagia and having a symmetrically enlarged uterus
Dx of adenomyosis
US
Txt of adenomyosis (3)
NSAIDs for pain, hysterectomy, GnRH agonists
for adenomyosis, its hard to treat symptoms and maintian ____
fertility (b/c you need GnRH agonists for symptoms relief)
what is the greatest risk for adenocarcinoma of the uterus?
unopposed estrogen effect on endometrium
POST- MENOPAUSE BLEEDING IS _______ ______UNTIL PROVEN OTHERWISE
endometrial cancer
what two things can decrease risk of adenocarcinoma of the uterus?
Oral contraceptives & smoking (maybe b/c less obesity in these women)
risk factors for adenocarcinoma of the uterus? (5)
- obesity
- nulliparity + infertility (estrogen suppressed in pregnancy) & late menopause
- DM & HTN
- Caucasian
- tamoxifen use (an estrogen-like drug)
adenocarcinoma of the uterus: overall more ______ ______ = higher risk
estrogen exposure
most common symptoms of adenocarcinoma of the uterus. what else may you have?
postmenopausal bleeding
.. can have pelvic pain/cramping/bloating
Dx of adenocarcinoma of the uterus
Ultrasound – “endometrial stripe” thickness > 5 mm
if its early enough, what can you do for treatment of adenocarcinoma of the uterus?
Dilation and curettage (D&C) (scrape lining)
what do you use for biopsy of adenocarcinoma? what will it show?
Use of Pipelle in office for EMB (endometrial biopsy)
–> complex hyperplasia with atypia
what is the most common type of uterine cancer ?
endometrioid aka adenocarcinoma
general txt guidlines for adenocarcinoma of the uterus? (4 options)
use Surgical staging to guide therapy
- Total Abdominal Hysterectomy (TAH)
- Bilateral salpingo-oophorectomy (BSO)
- pelvic lymph node dissection (PLND)
- Irradiation therapy
txt for recurrence of adenocarcinoma of the uterus. how is it different if they don’t have a uterus?
high-dose progestins or anti-estrogens
need both if they have a uterus, only estrogen if no uterus
symptoms of ovarian masses and cysts? (3)
bloating, fullness in pelvis, unilateral pain
Dx of ovarian mass or cyst?
mass palpated on bimanual or abdominal exam (but this physical exam is not that helpful)
** ultrasound (best )
“string of pearls” on ultrasound
ovarian cysts in PCOS
which type of ovarian mass/cyst is most common? in what age women?
fluid filled cysts, mostly in younger women
how do follicular/corpus luteal cysts present?
Pelvic pain, usually unilateral, may change with menses. pain helped by analgesics
follicular/corpus luteal cysts are ____, and no surgery is necessary if identified via ______ in ______ ________. what happens to them?
Common, no surgery necessary if identified on Ultrasound in premenopausal woman
… most spontaneously drain and degenerate.
what is do follicular/corpus luteal cysts look like on TVUS?
Anechoic unilocular fluid filled cysts with thin walls
when can follicular/hemorrhagic cysts cause worry? what do you do?
Ruptured/hemorrhagic cysts can sometimes have significant bleeding, pelvic fluid/blood (can enter the abdomen)
- if bleeding stopped you can just observe, otherwise need hospital for blood loss
adnexal mass with indication for surgery:
Ovarian cystic structure >___ cm that has been observed ___- ___weeks without regression
> 5cm, 6-8wks
4 most important indications for surgery of adnexal mass
- Any solid ovarian lesion
- Any ovarian lesion with papillary vegetation on the cyst wall
- Any adnexal mass >10 cm in diameter
- torsion or rupture suspected ( from doppler ultrasound)
2 less important indications for surgery of adnexal mass (aka the ones hadley didn’t highlight)
- Ascites
2. Palpable adnexal mass in a premenarchal or postmenopausal patient
Ovarian cysts: ___cm require only watchful waiting;
<5cm
ovarian cancer: ____ most common CA in women
____ most common gynecological CA and has highest _______ _______.
5th most common CA in women
3rd most common gyn CA
highest mortality rate
why does ovarian cancer have the highest mortality rate of all the gyn cancers?
it presents with late symptoms
two most important risk factors for ovarian cancer?
white and nulliparous
ovarian cancer: Most commonly diagnosed between ____-____ years old
40-60
ovarian cancer:
Most often diagnosed in stage __
Most are derived from ______
3, epithelium
what meds are protective against ovarian cancer?
long term oral contraceptives
____ -____% of Malignant ovarian tumors seen in the US are Epithelial
85-90%
epithileal
ovarian cancer: ___% of cases are sporadic (no genetic link- BRCA),___% are genetic
90% sporadic
10% genetic
2 forms of hereditary ovarian cancer
A. breast and ovarian cancer syndrome (BOC) - BRCA mutation
B. hereditary nonpolyposis colorectal cancer syndrome (HNPCC)
4 symptoms of ovarian cancer
Ascites (common)
Abdominal distention
Vague GI symptoms
Fixed mass in abd.
Dx of ovarian cancer
Transvaginal or abdominal ultrasound
may be a role for BRCA1 gene testing and P53 testing as well
ovarian cancer screening; what can we use and is it useful?
Combination of U/S and CA125 can detect early ovarian cancer, but finds many false positives… doest decrease mortality slightly (according to Hadley)
The _______ recommends against screening for ovarian cancer in women
USPTF
where does ovarian cancer often spread to? what does this mean for txt?
omentum, so you often must remove the entire greater omentum when trying to remove cancer
txt for epithelial ovarian cancer (7)
TAH, BSO, peritoneal washings, pelvic lymph node dissection, omentectomy
AND
Chemo and
radiation
