Gyn Onc Flashcards
GTN stage I or low risk (score <7) stage II and III treatment
Single agent chemo with either methotrexate or actinomycin D
GTN high risk stage II/III (score 7 or more) or stage IV treatment
Multiagent chemo +/- surgery/radiotherapy
Etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine
Scores 4 points on GTN staging (WHO)
13 or more months from antecedent pregnancy
Pretreatment serum hCG 1,000,000 or more
Liver, brain mets
>8 metastases
Previously failed two or more chemo drugs
Recommended criteria for decision-making capacity
- Communicates choice between treatment options
- Understands treatment options
- Understands the information leading to the decision
- Understands consequences of treatment
Should a patient with PMB on tamoxifen get a biopsy?
Yes, regardless of endometrial thickness
Palliative option for treatment of large bowel obstruction in cancer patients
Colonic stent
Breast cancer screening in BRCA1 and BRCA2
Annual MRI alternating with semiannual digital mammography starting at 25-30 years
What do you do with a perimenopausal woman with low positive hCG?
1 week of OCPs and recheck hCG
If OCPs aren’t successful, do a CT chest/abd/pelvis
Ovarian cancer debulking should…
remove all visible disease, including bowel resection, as safely as possible.
Standard evaluation of all categories of AGC/AIS
ECC
If AGC and +HPV, likely…
cervical disease
AGC/AIS in women >35 (or younger with AUB or e/o chronic anovulation)
colposcopy + ECC + EMB
Table for statistics
DISEASE + DISEASE - T + a b E S - c d T
Next step after surgery of stage IIIC1 uterine carcinosarcoma
Adjuvant chemotherapy
Neutropenia < 1,500/mm3 on day of therapy
Delay until recovered
(if delay >7 days, reduce doses by 1 or add GCSF)
(if delay >14 days, reduce doses by 1 AND add GCSF)
Platelets 75,000-150,000 on day of chemotherapy
Delay until recovered
Platelets <75,000 on day of chemotherapy
Delay until recovered
If delay is >7 days, reduce doses by 1 level
Immature teratoma, surgically resected, stage IA, grade 1 management
Surveillance
Immature teratoma, surgically resected, stage IA, grade 2 or 3 management
Chemotherapy - bleomycin, etoposide, cisplatin
First line treatment of hyperkalemia to stabilize myocardium
IV calcium
can also use insulin with glucose
Greatest risk with oral conjugated equine estrogen use
Stroke
then DVT
Ovarian luteoma
Causes gestational hyperandrogenism
Benign
Usually regress and disappear 2-3 weeks after delivery
Risk of Ovarian Malignancy Algorithm
CA125
Human epididymis secretory protein 4
(In a woman with a pelvic mass)
International Ovarian Tumor Analysis
Classification of adnexal masses
Risk of Malignancy Index
CA125
Menopausal status
Ultrasound findings
(factors are multiplied together)
Risk of Ovarian Cancer Algorithm
Uses longitudinal increase in CA125 to determine risk
Ultrasound findings of pelvic mass consistent with malignancy
Irregular solid tumor
Ascites
At least four papillary structures
Irregular multilocular tumor with largest diameter 100mm
Very high color content on Doppler ultrasonography
After surgery for endometrial or colorectal cancer, first step to test for Lynch
Immunohistochemical TUMOR testing for MLH1, MSH2, MSH6, and PMS2 proteins
Ovarian cancer screening in BRCA1 or BRCA2
Periodic CA125 and transvaginal ultrasound starting at 30-35 or 5-10 years prior to earliest ovarian cancer diagnosis in the family
Prophylactic BSO in BRCA1 and BRCA2
Immediately after childbearing is complete or by 40
Managemnet of smooth muscle tumor of uncertain malignant potential
Surveillance for women desiring fertility
Hysterectomy for women not desiring fertility
Common prognostic prediction models use
Age
Comorbidities
Nodal status
Tumor size
Factors associated with abnormal anal cytology in HIV individuals
CD4 count of less than 200cell/mm3
History of STD other than HPV
Cervical cytology abnormality
Risk with St. John’s wort
Induces cytochrome P450 activity (doubles its metabolic activity)
(stop at least 5 days before surgery)
High risk patients with neutropenic fever
Neutropenia <100 cells/mm3
Anticipated duration of neutropenia >7 days
Significant comorbid conditions (hypotension, pneumonia, new abd pain, neuro changes)
Broad spectrum antibiotics for neutropenic fever
Cipro and augmentin
Mutation associated with uterine papillary serous carcinoma
TP53 mutations
Side effect associated with switching from tamoxifen to aromatase inhibitor
Joint aches
Recommended treatment for advanced ovarian cancer that has been suboptimally cytoreduced
IV carboplatin and paclitaxel
RIsk factors for ovarian cancer
Increasing age Endometriosis Family history of breast or ovarian cancer Nulligravidity Infertility Early menarche Late menopause