GYN: Neoplasms 10% Flashcards
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third most common type of cancer =
cervical cancer
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postmenopausal abnormal VAGINAL bleeding….think:
cervical carcinoma
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up to 80% of pts with cervical cancer present with
abnormal vaginal bleeding
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postcoital bleeding ddx should include
cervical carcinoma
“up to 80% of pts present with abnormal vaginal bleeding, mc postmenopausal…10% note postcoital bleeding”
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location of cervical carcinoma (location and name of zone)
squamocolumnar junction of the cervix
transformational zone
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80% of cervical carcinomas are what kind of cells?
squamous cells
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5 RF for cervical carcinoma
multiple sexual partners
early age at first intercourse
early first pregnancy
HPV positive
cigarette smoking association
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99% of the reason for cervical cancer
HPV
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what types of HPV cause cancer? which two especially?
16
18
31
33
especially 16 and 18
HPV 16 accounting for approximately 50% of cases and HPV 18 for 20%
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what physical exam finding is suspicious for cervical carcinoma?
friable
bleeding
cervical lesion on exam
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definitive means of diagnosis for cervical carcinoma
biopsy of gross lesions
colposcopically directed biopsies
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what is the treatment for cervical carcinoma?
resect
and/or
chemotherapy and radiation
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stage IA1 tx for cervical carcinoma
total hysterectomy, radical hysterectomy, conization
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Stage 2 tx for cervical carcinoma
chemo +/- radiation
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5-Year Survival rates for each of the 4 stages of cervical cancer
Stage 1: 85-90%
Stage 2: 65%
Stage 3: 29%
Stage 4: 21%
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who gets pap smear screening before the age of 21?
women who have HIV infection, at the time of initial intercourse
women who are on chronic immunosuppressive therapy for SLE or post organ transplantation, at the time of initial intercourse
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what kind of pap smear screening is done for women 30 yrs and older? and how often?
cytology + HPV testing
every 5 years
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who gets pap smear screening annually?
high-risk groups (HIV infection, immunosuppression, or in utero DES exposure)
women who have been treated in past for CIN 2, CIN 3, or cervical cancer
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ACOG recommendations for d/c of pap smear screening (two)
1 - no cytology screening after total hysterectomy if surgery for benign condition
2 - d/c screening at age 65 yrs for women who have had adequate recent screening
(3 consecutive negative cytology tests or two consecutive negative HPV/pap co-tests in 10 yrs before stopping, w/ most recent test w/in 5 yrs)
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three types of pathology found on pap screening report
ASC-US = Atypical Squamous Cells of Undetermined Significance
LSIL = Low-grade Squamous Intraepithelial Lesion (that is, mild dysplasia, CIN 1)
HSIL = High-grade Squamous Intraepithelial Lesion (that is, moderate to severe dysplasia, CIN II - III, carcinoma in situ)
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HPV types ___, ___, and ___ are risk factors for cervical dysplasia, which can lead to cervical CA.
16, 18, and 31
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what should be done for women with negative cytology and HPV POSITIVE on pap screening?
both tests repeated in 12 months
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ASCUS and up require ______
reflex HPV testing
if negative, can repeat in 12 months; if + then send for colposcopy
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ASCUS or LSIL, CIN-1 reflex HPV: what to do if +? what to do if -?
if positive and at least 25 yrs old =
colposcopy
if negative or under 25 yrs old =
retest in 1 year
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HSIL, CIN-2, CIN-3, CIS: next steps if outside cervix? if inside cervix?
colposcopy
outside cervix –> LEEP or cryotherapy
inside cervix –> cone biopsy
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squamous cell carcinoma found on pap…next steps?
resect
and/or
chemo and radiation
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which HPV vaccination is available in the US?
only the 9-valent
“in the United States, only the 9-valent vaccine is available”
(protects against 90% of warts, 73% of cervical cancers)
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what does quadrivalent HPV vaccine target?
6
11
16
18
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what does 9-valent HPV vaccine target?
6
11
16
18
31 33 45 52 58
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when is HPV vaccine recommeded for females and males? what’s earliest it can be administered?
11-12 yrs
9 yrs (it can be administered starting at 9 yrs of age)
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what are the recommendations for the HPV catch up vaccination?
catch up vaccination is recommended for females aged 13-26 yrs who have not been previously vaccinated or who have not completed the vaccine series
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HPV vaccination - what do clinicians do with adults 27 thru 45 yrs?
for adults ages 27 - 45 yrs, clinicians can consider discussing HPV vaccination with people who are most likely to benefit
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what is recommended for males for catch-up vaccination for HPV?
Among males 22 to 26 yrs old, catch-up HPV vaccination is recommended if they are
MSM
or
immunocompromised (including HIV)
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HPV vaccination dosing for <15 yrs old:
administer two-, rather than a three-dose vaccine series
in such pts, the two doses are administered at least 6 months apart
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dosing of HPV vaccination for pts >15 yrs old
HPV vac is administered in 3 doses at 0, at 1 to 2 months, and at 6 months
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how many doses of HPV vaccination do immunocompromised pts get?
three-dose series
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how common is vaginal cancer?
rare
1% of gynecological malignancies
(usually secondary to other cancer)
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most common cause of vaginal cancer?
squamous cell cancer represents 95%
caused by HPV
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MC location of vaginal carcinoma
upper one-third of posterior vaginal wall
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typical presentation of vaginal cancer
usually presents as changes in menstrual period
and/or
abnormal vaginal bleeding
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treatment of vaginal cancer
radiation therapy
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“what condition should be a pt be evaluated for when presenting with postcoital bleeding?”
“cervical cancer”
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“A 52 year-old obese patient with persistent heavy menses undergoes an endometrial biopsy and is diagnosed with atypical adenomatous hyperplasia. What is the next step in the management of this patient?”
total abd hysterectomy
“Atypical adenomatous hyperplasia contains cellular atypia and mitotic figures in addition to glandular crowding and complexity. This has a 20-30% risk of progression to endometrial cancer and the recommendation is hysterectomy.”
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management of STAGE 0 cervical cancer (carcinoma in situ)
EXCISION PREFERRED (LEEP, cold knife conization) or ABLATION
can consider total abd hysterectomy + bilateral salpingo-oophorectomy
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what is Paget disease of the vulva?
also known as extramammary Paget disease, is a rare vulvar malignancy most commonly seen in women aged 60 to 80
MC presenting s/s is vulvar pruritis
(well-demarcated, slightly raised, erythematous vulvar lesion with an eczematoid appearance)
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what is treatment for Paget Disease of the Vulva?
wide local excision with 2 cm margins or vulvectomy
