Gyn Cancer Flashcards
FSH stimulates _____ cells to make _____.
sertoli/granulosa, estrogen
LH stimulates _____ cells to make _____.
leydig/theca, testosterone & progesterone
highest mortality for GYN cancers…
Ovarian > Endometrial > cervical
highest incidence of GYN cancers….
Endometrial > cervical > ovarian
highest incidence of cancer in women…
breast > lung > colon
highest mortality of cancer in women…
lung > breast > colon
Which GYN cancer is controlled with estrogen?
endometrial cancer
Which GYN cancer risk increases with ovulation?
ovarian(germ, stem & epithelial)
Which GYN cancers are you at increased risk for with HPV? which strains?
Cervical, vulvar, vaginal. HPV 16, 18, 45
Which strains of HPV are associated with warts?
6 & 11
which GYN cancer is most highly associated with post-coital bleeding?
cervical
which GYN cancer is most associated with post-menopausal bleeding?
endometrial
Cervical cancer staging…
1: at the cervix a is smaller than b.
2: just outside the cervix in vagina(a) or fallopian tubes(b)
3: further away from cervix than 2. if in vagina =a if in fallopian tubes = b.
4a = bowels, 4b = mets
pap smear screening
21q3
mamogram screening
40q2
how long does it take for cervical cancer to develop?
3-7 years
do a pap smear and it comes out showing ASCUS. what do you do?
ASCUS = atypical squamous cells of uncertin significance.
1. repeat pap q3 months untill resolves or do an HPV DNA screen.
- ASCUS and HPV + = Colposcopy
- ASCUS and HPV - = q3y
- ASCUS and +repeat = Colposcopy
- ASCUS and -repeat = q3y
Who gets vaccinated for HPV?
EVERYONE!
Female: 13-26
male: 12-21 or 26 still up for debate.
when does CIN become SCC?
CIN 1 = mild dysplasia; CIN 3 = full thickness dysplasia but once it breaks though the BM it bc SCC
What age group should you be considering for cervical, vaginal & vulvar cancers? why?
sexually active women! this is because its caused by HPV
what age group should you be considering for endometrial cancers? why?
post-menopausal women, these cancers are estrogen driven and increased exposure to estrogen will increase the chances of development
____ are protective against endometrial cancers.
OCPs
Risk factors for endometrial cancer.()
anovulation(PCOS) > Obesity(increased peripheral estrogen) > tamoxifen use >age > nulliparity >early menarche >late menopause
how do you dx endometrial cancer?
this will be seen in post meno women wiht abnormal bleeding = do endometrial sampling and a D&C, can also do pelvic ultrasound to see if thickness is <5mm.
do bx for endometrial sampling and you see hyperplasia tx? adenocarinoma tx?
hyperplasia = progesterone --| estrogen via blocking FSH Adenocarcinoma = TAH + BSO
*if there is mets tx w/Carboplatin & Paclitaxel
Tx of most GYN cancers w/mets?
Carboplatin & Paclitaxel
What will ovarian tumors present with? how do you f/u?
usually as an adenxal mass = do u/s if smooth w/o septations = simple cysts = do nothing. if complex w/septations = look at age and other sx! young = germ; old = epithelial
what are the 3 cell layers of the ovary? what tumors do you get from them?
- Stromal = sertoli-leydig & granulosa-theca
- germ cell = dysgerminoma, endodermal sinus, choriocarcinoma, teratoma
- epithelial = serous, mucinous, endometroid cystadenocarcinoma & brenner tumor
sx of sertoli-leydig tumor? what cell layer?
excess testosterone! from stromal layer
sx of granulosa-theca tumor? what cell layer?
excess estrogen! from stromal layer
sx of dysgerminoma tumor? what cell layer? age group? tx? assoc?
germ cell = young female; increased LDH, adenxal mass; unilateral oophorectomy or chemo!(very sensitive for pacitaxal)
sx of endodermal sinus tumor? what cell layer? age group? tx? assoc?
germ cell = young female; AFP, adenxal mass, unilateral oophorectomy
sx of teratoma tumor? what cell layer? age group? tx? assoc?
germ cell = young female; struma ovarrii, adenxal mass, unilateral oophorectomy
sx of choriocarcinoma tumor? what cell layer? age group? tx? assoc?
germ cell = young female; B-HCG elevation, often seen after pregnancy. dx w/u/s tx w/D&C. stage w/CT.
tx: D&C, TAH, Methotrexate then Actinomycin D(preserves fertility)
Types of Epithelial ovarian Cancers tumor? path? RF? Sx? Dx? Tx?
Serious, Mucinous, Endometroid Cystadenocarcinoma. due to repeated trauma of epithelium(ovulation) = see in older women/post meno.
RF: HNPCC/Lync, BRCA1 >BRCA2 =>having kids or 5yr OCP is protective.
spread by peritoneal seeding = renal failure, SBO, ascites.
dx: U/S then CT or MRI
Tx: TAH + BSO then Paclitaxel & Carboplatin since its usually late stage.
**monitor recurrence w/CA125
which mole has 69 chromosomes? pathogenesis?
incomplete mole, x2 sperm + 1 egg
which mole has 46 chromosomes? pathogenesis?
complete mole, 1 sperm + empty egg that duplicates.
Sx of a complete/incomplete mole?
elevated B-HCG, rapid increasing size compared to date, Hyperthyroidism(bhcg looks like TSH), Hyperemesis Gravidarum(severe, dehydrating morning sickness w/electrolyte abnormalities), snowstorm on pelvic U/S, grapelike mass
tx: D&C and give OCP to prevent pregnancy
MCC of Vulvar cancer? MC type?
SCC caused by HPV
sx of vulvar cancer…
pruritis! usually will be dark unless its pagents which will appear red/pink.
DES is associated wiht….
Adenocarcinoma of the vagina
how do you tx vaginal and vulvar cancers?
resect lesion and lymph node biopsy
