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Women's health > gyn neoplasms (10%) > Flashcards

gyn neoplasms (10%) Flashcards

1
Q

what is the MC type of vaginal ca

A 
squamous cell (95%)
clear cell if DES exposure in utero
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2
Q

what is the MC type of vulvar ca

A

90% squamous

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3
Q

RFs for vulvar ca

A

HPV 16, 18, 31

DES

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4
Q

sx of vulvar ca

A

pruritis MC
asx, postcoital bleeding, vaginal DC
red/white ulcerative, crusted lesions

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5
Q

dx of vulvar ca

A

bx vulvar lesions

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6
Q

2 MC types of breast ca

A

ductal or lobular

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7
Q

RFs for breast ca

A 
BRCA
1st deg relative
65yo+
inc # of menstrual cycles (nulliparity, 1st FT pregnancy >35yo, menarche <12yo, late menopause, never breastfed)
inc estrogen (PCOS, obesity, hRT, OCPs)
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8
Q

what % of breast ca pts have NO RFs

A

75%

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9
Q

stages of breast ca

A

0- preCA, DCIS, LCIS
I-III- w.i breast/regional LN
IV- distant mets

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10
Q

types of breast ca

A

ductal- infiltrative MC, carcinoma in situ

lobular- infiltrative or carcinoma in situ

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11
Q

what is infiltrative ductal carcinoma associated w

A

lymphatic mets

esp axillary

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12
Q

where is the MC position for breast ca lump

A

upper outer quadrant

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13
Q

what type of nipple discharge may indicate breast ca

A

bloody
purulent
green

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14
Q

where are the MC mets from breast ca

A

liver
lung
bone
brain

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15
Q

what does page’s disease of the nipple look like

A

chronic eczematous itchy, scaling rash on nipples + areola

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16
Q

what does inflammatory breast cancer look like

A

red, swollen, warm itchy breast often w nipple retraction + peau d’orange

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17
Q

what causes peau d’orange and what is the prognosis

A

lymphatic obstruction

poor prognosis

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18
Q

what do you usu see on mammogram in breast ca

A

microcalcifications

spiculated masses

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19
Q

when is US used to screen for breast ca

A

women <40yo

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20
Q

how do you dx breast ca

A

biopsy- fine needle, large needle, core, open

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21
Q

tx options for breast ca

A

lumpectomy +/- XRT
mastectomy

remove axillary LN!!!

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22
Q

when do you do XRT for breast ca

A

s/p lumpectomy or mastectomy

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23
Q

when do you do chemo for breast ca

A

stage II-IV, inoperable disease

especially if ER negative

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24
Q

what are the neoadjuvant endocrine treatments for breast ca

A

antiestrogens (tamoxifen)
aromatase inhibitors (letrozole, anastrozole)
monoclonal ab tx (trastuzumab/herceptin)

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25
Q

tamoxifen uses and MOA

A

ER positive tumors

MOA- bind + block estrogen receptor in breast

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26
Q

aromatase inhibitors uses

A

letrozole, anastrozole

good in postmenopausal ER-positive tumors

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27
Q

monoclonal Ab use + ADRs

A 
trastuzumab/herceptin
HER2 positive (human epidermal growth factor receptors)
ADR = cardiotoxic
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28
Q

mammogram screening guidelines

A

ACOG- q1yr starting at 40yo

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29
Q

clinical breast exam guidelines

A

q3yrs starting at 20yo –> q1yr after 40yo

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30
Q

breast self exam guidelines

A

monthly after 20yo

immediately after menstruation or on days 5-7

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31
Q

breast ca prevention in high risk pt

A

SERMs (tamoxifen or raloxifene) or aromatase inhibitors (letrozole, anastrozole)

high risk = postmenopausal or 35yo+ with high risk (BRCA)

usu done for 5yrs

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32
Q

which SERM is preferred for breast ca ppx, why and what are the cons of it

A

tamoxifen- more effective, more DVT + endometrial CA risk

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33
Q

what causes endometrial hyperplasia

A

unopposed estrogen (chronic anovulation, PCOS, perimenopause, obesity)

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34
Q

dx of endometrial hyperplasia

A

TVUS endo stripe >4

definitive = bx

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35
Q

type of endometrial hyperplasia

A

gland proliferation

gland proliferation with cytologic atypic (pre-CA)

36
Q

tx of endometrial hyperplasia

A

w/o atypia- progestin, repeat bx in 3-6mo

w atypia- hysterectomy, progestin if not surgical candidate/wants fertility

37
Q

what is the MC gyn malignancy in US

A

endometrial ca

38
Q

MC age group to get endometrial ca

A

50-60yo

39
Q

what is the MC result of endometrial bx in endometrial ca

A

adenocarcinoma

sarcoma is less common

40
Q

tx of endometrial ca

A

I- hysterectomy, +/- XRT
II-III- TAH-BSO + LN removal +/- XRT
IV- systemic chemo

41
Q

what is one protective factor against endometrial ca

A

combo OCPs

42
Q

what percent of ovarian neoplasms are benign

A

90%

43
Q

what is a dermoid (mature) cystic teratoma

A

MC benign ovarian neoplasm

germ cell tumor

44
Q

what does dermoid cyst look like

A

cystic, calcification, fat, sebaceous tissue, hair + teeth

45
Q

tx/prognosis of dermoid cyst

A

do not resolve spontaneously

associated w torsion if >5cm

46
Q

what are the 2 types of cystadenoma

A

serous- benign, commonly 40-50yo, MORE COMMON

mucionous- can be large, filled w mutinous material, 20-40yo

47
Q

what is a cystadenofibroma

A

rare, benign surface epithelial tumor

48
Q

when are cystadenofibromas MC

A

15-65yo

49
Q

appearance of cystadenofibroma

A

complex cystic to solid appearing mass

resembles malignant tumor

50
Q

what is the 2nd MC gyn ca

A

ovarian

51
Q

what gyn ca has highest mortality

A

ovarian

52
Q

what age is ovarian ca MC

A

40-60yo

53
Q

presentation of ovarian ca

A 
usu asx until late (extensive mets)
abd fullness, distension, back/abd pain
early satiety, constipation
urinary frequency
irreg menses, menorrhagia, postmeno bleeding
54
Q

how do you screen for ovarian ca

A

TVUS in all high risk pts

55
Q

what is the definitive dx of ovarian ca

A

biopsy
90% epithelia
germ cell MC in <30yo

56
Q

tx of ovarian ca

A

TAH-BSO + LN excision

chemo- paclitazel + cisplatin or carboplatin

57
Q

what marker can be used to monitor progress of tx of ovarian ca

A

CA-125

58
Q

what are the RFs for ovarian ca

A 
famhx
inc # of ovulatory cycles (infertile, nulliparous, 50yo+, late menopause)
BRCA
peutz-jehgers
turners syndrome
59
Q

protective factors for ovarian ca

A

OCPs
high parity
TAH

60
Q

what is the 3rd MC gyn ca

A

cervical

61
Q

what age is cervical ca MC

A

45yo

62
Q

which HPV viruses are high risk

A

16, 18, 31

63
Q

what is the MC sx of cervical ca

A

post-coital bleeding/spotting

64
Q

what type of discharge is present with cervical ca

A

watery

65
Q

if pt is >25yo and has normal pap cytology but HPV positive what are the future screening options

A

retest in 12mo

OR

genotype for HPV 16, 18, 31

66
Q

what % of ASCUS regresses at 24mo

A

70%

67
Q

if pt with ASCUS is 25yo+ what are the future screening options

A

HPV testing- if negative repeat pap in 3yrs, if positive –> colposcopy w bx

OR

repeat pap in 1yr

68
Q

if pt with ASCUS is 21-24yo what are the future screening options

A

repeat pap in 1yr

OR

HPV testing

69
Q

if pt with ASCUS is <21yo what are the future screening options

A

repeat pap in 1yr

70
Q

what is ASC-H

A

atypical squamous cells can’t exclude HSIL

higher chance of ca than ascus

71
Q

what future screening should be done if pt is ASC-H

A

colposcopy

72
Q

what is LSIL

A

MC transient HPV infection

includes CIN I

73
Q

what % of LSIL regresses in 24mo?

A

50%

74
Q

what future screening should be done if pt is 25-29yo and LSIL

A

colp w bx

75
Q

what future screening should be done if pt is 30+yo and LSIL

A

HPV negative- repeat pap in 1yr

HPV positive- colp w bx

76
Q

what is HSIL

A

includes CIN II, CIN III, Carcinoma in situ

77
Q

what future screening should be done if pt has HSIL

A

colp w bx in all ages

78
Q

what does CIN stand for

A

cervical intraepithelial neoplasm

79
Q

what is CIN I

A

mild dysplasia, contained to basal 1/3 of epithelium

80
Q

what is CIN II

A

moderate dysplasia, includes 2/3 thickness of basal epithelium

81
Q

what is CIN III

A

severe dysplasia- >2/3 or full thickness of basal epithelium

if full thickness = carcinoma in situ

82
Q

what is preinvasive cervical ca

A

severe dysplasia that is full thickness + has invaded the basement membrane

83
Q

what should be done for CIN I

A

observe- if <20yo

excise- LEEP or cold knife cervical connotation

+/-ablation

84
Q

what should be done for CIN II

A

excise (LEEP, cold knife cervical connotation)

or ablation (cryocautery, laser cautery, electrocautery)

85
Q

if pt has normal paps, how often should they be checked again

A

<25yo- q3yrs, no HPV testing
25-29yo- q3yrs w HPV testing
30yo+ - co-testing q5yrs, pap q3yrs

Women's health (7 decks)

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