Gyn neoplasms

Question 1

What is the tx for uterine fibroids?

Answer 1

1. asymptomatic- follow with US to detect abnormal growth
2. GhRH agonists reduce uterine bleeding but should only be used temporarily (ie. to reduce size before surgery or as a temporizing measure before menopause)
3. Surgery- myomectomy or hysterectomy; could consider uterine artery embolization for small fibroids but there is a significant risk of reduced fertility

Question 2

What is the most common cause of bleeding in a post-menopausal woman?

Answer 2

-atrophic vaginitis (80%). However, endometrial cancer must be rueld out for any postmenopausal woman presenting with post-menopausal bleeds

Question 3

What radiaology should be done in a woman with endometrial CA?

Answer 3

CXR and CT for mets; consider transvaginal ultrasound to detect masses and measure the endometrial wall thickness

Question 4

Among women with endometrial cancer, who should get adjuvant radiation/chemo?

Answer 4

high grade malignancy or tumors with spread beyond the endometrial lining

Question 5

When is it ok to stop pap smears (age?)

Answer 5

65

Question 6

What is the tx for ASCUS?

Answer 6

HPV screening, repeat pap in 6 and 12 months, repeat HPV testing at 12 mo

Question 7

What is the tx for atypical squamous cells, cannot exclud HSIL?

Answer 7

HPV screening and endometrial biopsy, repeat pap in 6 and 12 mo, repeat HPV test in 12 mo

Question 8

What is the treatment for low grade squamous intraepithelial lesion?

Answer 8

repeat pap in 6 and 12 mo, repeat HPV test in 12 mo, consider LEEP or laser ablation

Question 9

What is the treatment for HSIL?

Answer 9

LEEP and repeat cervical cytology every 6 mo

Question 10

How is cervical cancer treated?

Answer 10

1. Microscopic invasion less than 5 mm: give TAH or conization if pt desires fertility
2. Small lesions with close margins: postop chemo
3. visibly invasive lesions or those that involve the uterus but not the pelvic wall or the lower 1/3 of the vagina: radical hysterectomy with lymphadenectomy or radiation plus cisplatin chemo
4. extension into parametrial tissue, pelvic wall, lower 1/3 of the vagina, adjacent organs, or distant mets: radiation and chemo

Question 11

What is the difference between a follicular cyst and a corpus luteal cyst?

Answer 11

follicular cyst in the first 2 wks of cycle and made of granulosa cells; corpus luteum cyst usually larger and firmer, may have blood, more common later in cylcle and made of thecal cells.
Both can cause torsion/rupture but risk is greater with corpus luteal cyst

Question 12

Which of the benign ovarian masses have malignant potential?

Answer 12

desmoid cyst (benign teratoma), stromal cell tumor (wich can also cause pecocious puberty or virulization)

Question 13

What is the treatment for epithelial ovarian cancer?

Answer 13

TAH/BSO, pelvic wall sampling, and appendectomy; adjuvant chemo often prescribed
tumor debulking with resection of involved bowel, liver, omentum, spleen, and lymph nodes done for mets