Gyn malignancy

Question 1

Cervix CA- Eti

Answer 1

• Persistant HPV
• STI, smoking, sex at young age, immunosupression
• Low SES
• 2nd most leading cause of CA death worldwide
• Progressive dysplasia leads to invasive

Question 2

Cervix CA- sx

Answer 2

• Abd pain
• Bleeding after intercourse
• Grossly abn cervix- yellow- tan course tissue
• Enlarged uterus
• Fixed, sticky uterus

Question 3

Cervix CA- Dx

Answer 3

• Punch & ECC visible lesions

- Check endocervical canal

Question 4

Cervix CA- Tx

Answer 4

Surgery, radiation & chemo depending on stage

Question 5

Endometrial CA- Epi

Answer 5

• Most common gyn CA
• 4th most common
• 75% postmenopausal
• Obesity, estrogen, anovulation, PCOS, fam hx, tamoxifen
• Type 1- 80%, type II poorer prognosis

Question 6

Endometrial CA- Sx

Answer 6

• Frank vaginal bleeding
• Wt loss, anorexia & fatigue
• Enlarged uterus, cervical displacement

Question 7

Endometrial CA- Dx

Answer 7

• Endometrial biopsy- gold standard

- Ultrasound- stripe

Question 8

Ovarian CA- Eti

Answer 8

• Most often dx at late stage- deadly
• Ovulation suppression decreases risk
• Risks correlate with ovulation suppression
• Fam hx

Question 9

Ovarian CA- Sx

Answer 9

• No early gyn sx
• Abd bloating, constipation, incontinence
• Heartburn, change in bowel pattern
• Ascites
• RUQ tenderness, adnexal mass
• Fatigue, unexplained wt loss

Question 10

Ovarian CA- Dx

Answer 10

• Transvaginal US
• CT scan
• CA125 on postmenopausal with pelvic mass

Question 11

Vulvar CA- Sx

Answer 11

• Pruritis
• Fleshy, nodular or warty lesion
• Benign appearing
• Melanoma

Question 12

Vulvar CA- Dx

Answer 12

• Biopsy

Question 13

Vulvar CA- Eti

Answer 13

• HPV mediated- dysplasia to CA in 60%

- Inflammatory/ autoimmune (lichen sclerosis) in 40%

Question 14

Vulvar CA- Tx

Answer 14

Resection or radiation

Question 15

Vaginal CA- Eti

Answer 15

• Rare
• Squamous cell, HPV mediated
• 60 yrs

Question 16

Vaginal CA- Sx

Answer 16

Vaginal, post coital bleeding

- Mass, plaque or ulcer

Question 17

Vaginal CA- Dx

Answer 17

Biopsy & pap

Question 18

Hydatiform mole- Eti

Answer 18

• Gestational trophoblasitc neoplasia
• Asians
• Risks: prior spontaneous abortion, hx of mole, age 35
• Cytogenic comp: 46, XX or paternal origin

Question 19

Hydatiform mole- Sx

Answer 19

• Excessive N/V
• Irregular uterine bleeding 6-16 wks
• Large uterus
• Beta hCG > 40,000
• Passage of grape like clusters per vagina
• No fetus or placenta

Question 20

Hydatiform mole- Dx

Answer 20

• Ultrasound

- B-hCG high

Question 21

Hydatiform mole- Tx

Answer 21

• MethotrexateIM or actinomycin IV

- Suction & curratge

Question 22

Choriocarcinoma- Eti

Answer 22

Presence of detectable B-hCG after mole evacuation

- Malignancy

Question 23

Choriocarcinoma- Sx

Answer 23

• Continued or recurrent bleeding
• Following mole, delivery, abortion or ectopic pregnancy
• Ulcerative vag. tumor, pelvic mass or distant METs

Question 24

Choriocarcinoma- Dx

Answer 24

• B-hCG elevation

- CXR for pulm mets

Question 25

Choriocarcinoma- Tx

Answer 25

-Chemo until zero hCG titer

Question 26

Breast CA- Eti

Answer 26

• 2nd common most CA
• 2nd common cause of CA death
• Risk increases thru 60, peaks at 70, declines
• whites
• Hereitable
• Alcohol, 1 preg > 30, contraceptive use

Question 27

Breast CA- Sx

Answer 27

• Painless lump
• Breast pain, discharge, erosion, retraction or enlarged nipple
• Asymmetry
• Axillary, supra/infraclvicular nodes

Question 28

Breast CA- Dx

Answer 28

• Mammography to Biopsy

Question 29

Breast CA- Tx

Answer 29

• Chemo, mastectomy, radiotherapy