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Women's Health > Gyn Oncology > Flashcards

Gyn Oncology Flashcards

1
Q

age at which cervical cancer screenings should start

A

according to the USPSTF, age 21 regardless of the age of first sexual intercourse but in practice this is patient specific

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2
Q

Frequency of cervical cancer screenings

A

for ages 21-29 every 3 years. For 30+ can do cyto alone every 3 years or cyto + HPV every 5 years

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3
Q

age when you start doing HPV screenings

A

30

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4
Q

when can cervical cancer screenings be stopped in healthy women?

A

if negative consecutive screenings in the past 10 years, can stop at age 65

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5
Q

When can cervical cancer screenings be stopped in a woman with a total hysterectomy?

A

Should not have anymore from hysterectomy on IF they have no history of Cervical Intraepithelial neoplasia 2/3

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6
Q

When can cervical cancer screenings be stopped in women who have had abnormal results?

A

In women with CIN 2/3 they need routine screening for 20 years after the treatment, even if that extends past the age of 65

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7
Q

Frequency of cervical cancer screenings in HIV + pts

A

twice in the first year after diagnosis, and then annually

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8
Q

Frequency of cervical cancer screenings in immunosuppressed and DES+ pts

A

annually

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9
Q

Qualities a sample must have in order for it to be “Satisfactory for evaluation”

A

Patient name and birthdate, relevant clinical information (radiation history etc), adequate numbers of well preserved and visualized squamous epithelial cells, an adequate endocervical/transformation zone component

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10
Q

Qualities of a sample that will make it “unsatisfactory for evaluation”

A

broken slide, scant squamous epithelial cells, not enough transformation zone, and if there is significant blood, inflammation, etc that obscures interpretation of 75%+ of epithelial cells.

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11
Q

number of squamous cell epithelia that need to be present on conventional slides

A

8,000 +

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12
Q

number of squamous cell epithelia that need to be present on liquid preps

A

5,000 +

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13
Q

information gained from a wet prep slide

A

Trichomonas, yeast, WBC, Clue cells

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14
Q

ASC-US

A

atypical squamous cells of undetermined significance

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15
Q

ASC-H

A

Atypical squamous cells, cannot r/o high grade lesion

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16
Q

LSIL

A

low grade squamous intraepithelial lesion: most common type and often resolve spontaneously. There is a possibility for cervical dysplasia, but is usually mild, like CIN 1. Many of these are ok to just watch and wait, but is patient specific

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17
Q

HSIL

A

high-grade squamous intraepithelial lesion, indicative of CIN 2, 3 or CIS. These warrant an immediate colposcopy and biopsy.

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18
Q

CIN

A

Cervical intraepithelial Neoplasia

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19
Q

CIN 1

A

Mild dysplasia- there is disordered growth of the lower 1/3 of the epithelial lining

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20
Q

CIN-2

A

Moderate dysplasia- abnormal maturation of the lower 2/3 of the epithelial lining

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21
Q

CIN-3

A

Severe dysplasia- >2/3 involvement of the epithelial thickness

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22
Q

CIS

A

Carcinoma in situ- full thickness involvement.

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23
Q

factors that increase risk of vulvar neoplasms

A

obesity, HTN, T2DM, atherloscerosis, younger w/HPV, smoking, having cervical ca.

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24
Q

common manifestations of vulvar neoplasm

A

itchiness and pain. May have bleeding or a noticeable mass.

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25
Q

Diagnosis of Vulvar neoplasm

A

colposcopy and biopsy is gold standard for diagnosis. Can do an acetic acid stan or Toluidine blue stain to help locate

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26
Q

Treatment for vulvar neoplasm

A

Wide local incision with regional LAD is the treatment of choice for most neoplasms.

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27
Q

Frequently associated with a more severe degree of dysplasia or CIS

A

abnormal vascular patterns

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28
Q

peak age of premalignant lesions of the vulva

A

40

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29
Q

most common symptom of vulvar neoplasm

A

itching

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30
Q

appearance of early stage vulvar lesions

A

resemble chronic vulvar dermatitis

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31
Q

appearance of late stage vulvar lesions

A

resemble large cauliflower or hard ulcerations

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32
Q

typical age for vulvar cancer

A

post-menopausal, peak age 60-70

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33
Q

most common type of vulvar cancer

A

90% are squamous cell carcinoma

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34
Q

follow up after post-op for vulvar cancer

A

every 3 months for 2 years, then every 6 months thereafter. 80% of all recurrences happen in the first 2 years

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35
Q

VAIN

A

Vaginal Intraepithelial Neoplasia- multifocal disease is more common than isolated lesions

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36
Q

location where most vaginal lesions are diagnosed

A

upper 1/3 of the vagina

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37
Q

signs and symptoms of VAIN

A

almost all are asymptomatic- abnormal pap is usually the first sign. Many are in combination with an HPV infection- may complain of vulvar warts.

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38
Q

evaluation of VAIN

A

diagnosis is made by coposcopic exam with directed biopsy. Can be difficult, especially in hysterectomy patients because lesions can hide in the vaginal cuff.

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39
Q

follow up after lesion removal for VAIN

A

lesions are often difficult to eradicate with only 1 tx. F/u every 4-6 months with cyto and HPV- closely examine entire lower genital tract because tend to be mutifocal

40
Q

Tx for VAIN

A

surgical excision or CO2 ablation

41
Q

most common type of vaginal cancer

A

squamous cell carcinoma, but primary cancers of the vagina are rare

42
Q

Areas where metastatic vaginal cancers arise from

A

urethra, bartholin gland, rectum, bladder, endometrium, endocervix, kidney.

43
Q

signs and symptoms of vaginal cancer

A

most are asymptomatic. early lesions may just have painless bleeding. Late lesions will have painful bleeding, weight loss and swelling

44
Q

vaginal cancer and DES exposure

A

clear cell variant is associated with DES exposure in utero, with mean age of diagnosis 19

45
Q

benign tumors of the vagina

A

are uncommon

46
Q

Staging for vaginal cancer

A

is clinical, not surgical.

47
Q

Diagnosis of vaginal cancer

A

often made by abnormal pap, followed by colposcopy and biopsy.

48
Q

treatment of vaginal cancer

A

radiation is the primary treatment and is sometimes accompanied by surgical excision.

49
Q

treatment of clear cell vaginal cancer

A

radical hysterectomy and vaginectomy, or radiation

50
Q

peak age of incidence for vaginal cancer

A

50’s

51
Q

Serotypes of HPV associated with cervical cancer

A

16, 18, 31

52
Q

Serotypes of HPV assonated with condyloma acuminata

A

6, 11

53
Q

HPV is the primary causative agent

A

for 80% of CIN and 90% of invasive cervical cancer

54
Q

factors that increase risk for cervical cancer

A

HPV, early age at first intercourse, early childbearing, multiple sex partners/high risk sex partners, Hx of STD, Low socioeconomic status, AA heritage, Smoking

55
Q

most common type of cervical cancer

A

SCC, followed by adenocarcinoma

56
Q

Age associated with CIN

A

women in their 20’s

57
Q

age associated with CIS

A

25-35

58
Q

age associated with frank cervical cancer

A

after 40

59
Q

mean age of diagnosis of cervical cancer

A

47

60
Q

signs and symptoms of cervical cancer

A

most are asymptomatic and found from abnormal pap. classic sis are post-coital bleeding or abnormal bleeding and d.c

61
Q

annual pap smear reductio of invasive cervical carcinoma

A

reduces risk by 95%

62
Q

abnormal pap but no suspicious lesions

A

repeat the pap if ASC-US or post-menopausal LSIL.

63
Q

abnormal pap + lesions

A

mandatory biopsy of lesions

64
Q

prevention of cervical cancer

A

HPV vac.

65
Q

indications for colposcopy

A

abnormal cervical pap or HPV, clinically abnormal looking cervix, unexplained bleeding, vulvar or vaginal neoplasia, hx of DES exposure.

66
Q

Conization

A

is diagnostic for cervical ca. Indicated if colposcopy was unsatisfactory, if lesion extends into cervical canal beyond colposcope view, if there is dysplasia on the endocervical sample

67
Q

3 options for ASC-US

A
  1. pap smear every 6 months x 1 year if normal. If abnormal get colposcopy.
  2. HPV test- if normal, repeat in 1 year. if abnormal get colposcopy.
  3. immediate colposcopy
68
Q

5 most common tx for cervical neoplasm

A

all equivalent efficacy. ablative techniques include cryotherapy and laser ablation. Excision techniques include cold knife conization, laser cone excision and LEEP. Cryotherapy and ablation are better if women desire pregnancy in the future

69
Q

treatment of early stage cervical cancer

A

radical hysterectomy and pelvic lymphadenectomy or with chemo and radiation.

70
Q

treatment of invasive cervical cancer

A

hysterectomy is a must, plus radiation and chemo- cisplatin based

71
Q

the most common gynecological cancer

A

endometrial

72
Q

endometrial cancer median age at diagnosis

A

58-60, 75% are post menopausal

73
Q

Most common type of endometrial cancer

A

adenocarcinoma

74
Q

Endometrial cancer prognostic factors

A

histologic grade and type, myometrial invasion and increased age

75
Q

Risk factors for endometrial cancer

A

Nulliparity, infertility, hypertension, GB disease, Late menopause, DM, Obesity, Unopposed EHT, Tamoxifen

76
Q

Signs and symptoms of endometrial cancer

A

irregular bleeding. Usually have a normal pelvic exam.

77
Q

Diagnosis of endometrial cancer

A

Endometrial biopsy is test of choice but D&C is the definitive diagnostic measure. Hysteroscopy can be considered but you risk spread of cancer if it is there.

78
Q

menopausal or post menopausal woman who has endometrial cells on routine pap smear

A

required evaluation for endometrial cancer- endometrial sampling

79
Q

gynecological cancer that has a significant mortality

A

Ovarian- 60% 5 year mortality rate

80
Q

Risk factors for ovarian cancer

A

not using OCP’s, family hx, BRCA 1/2, uninterrupted ovulation

81
Q

signs and symptoms of ovarian ca

A

often asymptomatic until disease is progressed. may have vague lower abdominal pain and enlargement, early satiety, change in bowel habits, fixed pelvic masss

82
Q

Diagnosis of ovarian cancer

A

pelvic US is the test of choice. Malignant masses tend to be > 8 cm, solid, multilocular and b/l

83
Q

labs for ovarian cancer

A

may have + Ca-125, alpha fetoprotein and hCG

84
Q

Epithelial tumors of ovarian cancer

A

most common type, occurs in 50’s. Will have elevated Ca-125.

85
Q

cell types of ovarian epithelial cancer

A

serous, mutinous endometrioid and clear cell

86
Q

Treatment and prognosis for epithelial ovarian ca

A

Tx is surgery with Cisplatin based chemotherapy. Prognosis is poor, 20% 5 year survival rate

87
Q

Germ cell tumors of ovarian cancer

A

up to 20% of all ovarian cancer, occurs in young women aged 1-25, will present as rapidly enlarging mass

88
Q

Germ cell ovarian cancer tx and prognosis

A

tx is surgery and multi-drug chemo. Prognosis is ok, 5 year surgical of 60-85%

89
Q

cell types of Germ cell ovarian cancer

A

teratoma, chroiocarcinoma, dysgermimoma

90
Q

Sex cord stroma ovarian cancer

A

can occur at all ages, accounts for 5-10% of ovarian cancers. This one has the best prognosis of 90% 5 year survival rate. Tx is surgery.

91
Q

radiation that is most common for gyn cancer

A

Cesium-137 and Iridium 192

92
Q

teletherapy

A

external radiation

93
Q

brachytherapy

A

internal radiation

94
Q

general cancer staging- stage 1

A

within the primary organ only

95
Q

general cancer staging- stage 2

A

outside but localized around the primary organ

96
Q

general cancer staging- stage 3

A

spread to regional LN

97
Q

general cancer staging- stage 4

A

mets to other organs

Women's Health (2 decks)

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