Gyn Cancer Flashcards by Stephanie Hawks

FSH stimulates _____ cells to make _____.

sertoli/granulosa, estrogen

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LH stimulates _____ cells to make _____.

leydig/theca, testosterone & progesterone

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highest mortality for GYN cancers…

Ovarian > Endometrial > cervical

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highest incidence of GYN cancers….

Endometrial > cervical > ovarian

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highest incidence of cancer in women…

breast > lung > colon

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highest mortality of cancer in women…

lung > breast > colon

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Which GYN cancer is controlled with estrogen?

endometrial cancer

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Which GYN cancer risk increases with ovulation?

ovarian(germ, stem & epithelial)

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Which GYN cancers are you at increased risk for with HPV? which strains?

Cervical, vulvar, vaginal. HPV 16, 18, 45

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Which strains of HPV are associated with warts?

6 & 11

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which GYN cancer is most highly associated with post-coital bleeding?

cervical

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which GYN cancer is most associated with post-menopausal bleeding?

endometrial

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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

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pap smear screening

21q3

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mamogram screening

40q2

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how long does it take for cervical cancer to develop?

3-7 years

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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?

1. Stromal = sertoli-leydig & granulosa-theca 2. germ cell = dysgerminoma, endodermal sinus, choriocarcinoma, teratoma 3. 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