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WH 2 > gyn onco > Flashcards

gyn onco Flashcards

1
Q

which is more common vaginal or vulvar cancer?

A

vulvar cancer

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2
Q

sx of vulvar cancer

A

vulvar lesion
itching
pain
bleeding
ulceration

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3
Q

is vulvar cancer always symptomatic?

A

no half the time its not

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4
Q

average age of vulvar cancer

A

70 yo

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5
Q

diagnosis of vulvar cancer

A

biopsy
enlarged inguinal nodes
CXR and pelvic CT

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6
Q

why would you do CXR and pelvic CT when evaluating vulvar cancer?

A

r/o advanced dz or inguinal lymphadenopathy

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7
Q

histology of vulvar & vaginal cancer

A

squamous cell carcinoma

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8
Q

tx of vulvar cancer

A

surgical
radiation therapy

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9
Q

surgeries for vulvar cancer

A

wide local excision
radical vulvectomy
inguinal lymphadenectomy

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10
Q

DES exposure, preinvasive dz are RF for what kind of cancer

A

vaginal cancer

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11
Q

sx of vaginal cancer

A

early dz asymptomatic
adv has bleeding, mass, foul-smelling, discharge & pain

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12
Q

tx for vaginal cancer?

A

upper 1/3– partial or complete radical vaginectomy
whole pelvic radiation + brachytherapy
pelvic exenteration

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13
Q

what must you do if a patient has postmenopausal bleeding?

A

must get endometrial biopsy

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14
Q

most common cause of postmenopausal bleeding

A

exogenous estrogen & atrophic things

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15
Q

least common cause of postmenopausal bleeding

A

endometrial hyperplasia

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16
Q

what is the most common gyn malignancy in the US

A

endometrial cancer

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17
Q

endometrial CA is predominantly dz of…

A

obese
postmenopausal women of low parity

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18
Q

histology for endometrial CA

A

epithelial and smooth muscle tumors
epithelial more common

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19
Q

RF for endometrial CA

A

unopposed estrogen use is biggest one
nulliparity
wt >175
BMI over 29, early menarche, DM, tamoxifen

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20
Q

sx of endometrial CA

A

abnormal vaginal bleeding!!
bowel or bladder abnormalities
pelvic pain

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21
Q

screening for endometrial CA

A

US and endometrial biopsy
colon screening

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22
Q

what age do you start US and endometrial biopsy screening for endometrial CA

A

30-35

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23
Q

what age do you start colon screening for endometrial CA?

A

20-25 every 1-2 yrs or 5yrs before earliest cancer in family

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24
Q

what do you use to diagnose endometrial CA in symptomatic ppl w/ negative endometrial biopsies?

A

hysteroscopy D & C

25
Q

what imaging allows you examine endometrial stripe thickness?

A

transvaginal US

26
Q

what is the normal endometrial stripe thickness?

27
Q

what biopsy result has highest chance of developing endometrial carcinoma?

A

complex hyperplasia w/ atypia

28
Q

tx for endometrial CA if too sick for surgery

A

whole pelvic radiation or IUD

29
Q

tx for endometrial CA if you wanna have kids

A

progesterone IUD or PO
repeat biopsy to see if its working

30
Q

tx for endometrical CAs

A

remove anatomy
peritoneal washings
pelvic & periaortic lymphadenectomy
omental and peritoneal biopsy if aggressive
debulking

31
Q

stages of endometrial CA

A

stage 1– uterus
stage 2– cervix
stage 4– bladder, bowel, inguinal node, distant metastases

32
Q

most lethal gyn caner

A

ovarian cancer

33
Q

which cancer is the silent killer/dz that whispers

A

ovarian cancer

34
Q

why is ovarian CA whispering?

A

bc the sx are vague

35
Q

sx of ovarian CA

A

bloating
fatigue
GI issues
urinary sx
pelvic/tummy pain
menstrual irregularities

36
Q

3 things that increases risk of ovarian CA

A

age
fam
infertility & meds for it

37
Q

which BRCA gene has the higher lifetime risk for causing ovarian CA

38
Q

who can get ovarian CA risk reduction surgery?

A

35yo for BRCA1
40yo for BRCA2

39
Q

4 things that can decrease risk of ovarian CA

A

OCP
multiple pregnancies
tubal ligation
breast feeding

40
Q

most effective risk reduction procedure

A

prophylactic oophorectomy–95%
risk of primary peritoneal CA remain

41
Q

ovarian CA histologies

A

epithelial– majority
germ cell
sex cord stroma

42
Q

what do germ cell tumors secrete?

A

beta hCP
LDH
AFP

43
Q

where do germ cell tumors come from?

A

primordial ovarian cell

44
Q

what is the most common germ cell tumor

A

dysgerminoma

45
Q

two sex cord stromal cells

A

granulosa cell and leydig cell

46
Q

what is the majority of epithelial histology with ovarian CA

A

papillary serous

47
Q

3 ways to screen for ovarian CA

A

CA125 testing
US screening
annual rectovaginal pelvic exam

48
Q

when is CA125 testing elevated? what does this mean for how we use the test?

A

elevated in stage 1 cancers
not good for general population– poor specificity in premenopause

49
Q

ovarian CA screening recommendation if no fam hx or 1 fam hx

A

fam hx + annual rectovaginal pelvic exam

50
Q

ovarian CA screening recommendation if 2+ fam hx

A

genetic counseling/testing, annual exam, CA125, transvaginal US?

51
Q

5 diagnostic modalities for ovarian CA

A

rectovaginal pelvic exam
transvaginal US
CT scan
MRI
CA125

52
Q

ovarian CA staging

A

stage 2— pelvis
stage 3— abdomen
stage 4— distant metastasis

53
Q

at what stage is most ovarian CA diagnosed?

54
Q

tx for ovarian CA (not advanced)

A

surgical debulking and chemotherapy

55
Q

tx for advanced ovarian CA

A

TAH-BSO
omentectomy
lymph node dissection
bowel resection
debulking
splenectomy, appendectomy

56
Q

what three surgeries can you do in early stage if they dont desire kids

A

TAH-BSO
LND
remove ovary and lymph node

57
Q

triad of fallopian tube carcinoma

A

prominent watery vaginal discharge
pelvic pain
pelvic mass

58
Q

what is fallopian tube CA similar to?

A

epithelial ovarian CA

WH 2 (8 decks)

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