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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
Diagnosis of Vulvar neoplasm
colposcopy and biopsy is gold standard for diagnosis. Can do an acetic acid stan or Toluidine blue stain to help locate
26
Treatment for vulvar neoplasm
Wide local incision with regional LAD is the treatment of choice for most neoplasms.
27
Frequently associated with a more severe degree of dysplasia or CIS
abnormal vascular patterns
28
peak age of premalignant lesions of the vulva
40
29
most common symptom of vulvar neoplasm
itching
30
appearance of early stage vulvar lesions
resemble chronic vulvar dermatitis
31
appearance of late stage vulvar lesions
resemble large cauliflower or hard ulcerations
32
typical age for vulvar cancer
post-menopausal, peak age 60-70
33
most common type of vulvar cancer
90% are squamous cell carcinoma
34
follow up after post-op for vulvar cancer
every 3 months for 2 years, then every 6 months thereafter. 80% of all recurrences happen in the first 2 years
35
VAIN
Vaginal Intraepithelial Neoplasia- multifocal disease is more common than isolated lesions
36
location where most vaginal lesions are diagnosed
upper 1/3 of the vagina
37
signs and symptoms of VAIN
almost all are asymptomatic- abnormal pap is usually the first sign. Many are in combination with an HPV infection- may complain of vulvar warts.
38
evaluation of VAIN
diagnosis is made by coposcopic exam with directed biopsy. Can be difficult, especially in hysterectomy patients because lesions can hide in the vaginal cuff.
39
follow up after lesion removal for VAIN
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
Tx for VAIN
surgical excision or CO2 ablation
41
most common type of vaginal cancer
squamous cell carcinoma, but primary cancers of the vagina are rare
42
Areas where metastatic vaginal cancers arise from
urethra, bartholin gland, rectum, bladder, endometrium, endocervix, kidney.
43
signs and symptoms of vaginal cancer
most are asymptomatic. early lesions may just have painless bleeding. Late lesions will have painful bleeding, weight loss and swelling
44
vaginal cancer and DES exposure
clear cell variant is associated with DES exposure in utero, with mean age of diagnosis 19
45
benign tumors of the vagina
are uncommon
46
Staging for vaginal cancer
is clinical, not surgical.
47
Diagnosis of vaginal cancer
often made by abnormal pap, followed by colposcopy and biopsy.
48
treatment of vaginal cancer
radiation is the primary treatment and is sometimes accompanied by surgical excision.
49
treatment of clear cell vaginal cancer
radical hysterectomy and vaginectomy, or radiation
50
peak age of incidence for vaginal cancer
50's
51
Serotypes of HPV associated with cervical cancer
16, 18, 31
52
Serotypes of HPV assonated with condyloma acuminata
6, 11
53
HPV is the primary causative agent
for 80% of CIN and 90% of invasive cervical cancer
54
factors that increase risk for cervical cancer
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
most common type of cervical cancer
SCC, followed by adenocarcinoma
56
Age associated with CIN
women in their 20's
57
age associated with CIS
25-35
58
age associated with frank cervical cancer
after 40
59
mean age of diagnosis of cervical cancer
47
60
signs and symptoms of cervical cancer
most are asymptomatic and found from abnormal pap. classic sis are post-coital bleeding or abnormal bleeding and d.c
61
annual pap smear reductio of invasive cervical carcinoma
reduces risk by 95%
62
abnormal pap but no suspicious lesions
repeat the pap if ASC-US or post-menopausal LSIL.
63
abnormal pap + lesions
mandatory biopsy of lesions
64
prevention of cervical cancer
HPV vac.
65
indications for colposcopy
abnormal cervical pap or HPV, clinically abnormal looking cervix, unexplained bleeding, vulvar or vaginal neoplasia, hx of DES exposure.
66
Conization
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
3 options for ASC-US
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
5 most common tx for cervical neoplasm
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
treatment of early stage cervical cancer
radical hysterectomy and pelvic lymphadenectomy or with chemo and radiation.
70
treatment of invasive cervical cancer
hysterectomy is a must, plus radiation and chemo- cisplatin based
71
the most common gynecological cancer
endometrial
72
endometrial cancer median age at diagnosis
58-60, 75% are post menopausal
73
Most common type of endometrial cancer
adenocarcinoma
74
Endometrial cancer prognostic factors
histologic grade and type, myometrial invasion and increased age
75
Risk factors for endometrial cancer
Nulliparity, infertility, hypertension, GB disease, Late menopause, DM, Obesity, Unopposed EHT, Tamoxifen
76
Signs and symptoms of endometrial cancer
irregular bleeding. Usually have a normal pelvic exam.
77
Diagnosis of endometrial cancer
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
menopausal or post menopausal woman who has endometrial cells on routine pap smear
required evaluation for endometrial cancer- endometrial sampling
79
gynecological cancer that has a significant mortality
Ovarian- 60% 5 year mortality rate
80
Risk factors for ovarian cancer
not using OCP's, family hx, BRCA 1/2, uninterrupted ovulation
81
signs and symptoms of ovarian ca
often asymptomatic until disease is progressed. may have vague lower abdominal pain and enlargement, early satiety, change in bowel habits, fixed pelvic masss
82
Diagnosis of ovarian cancer
pelvic US is the test of choice. Malignant masses tend to be > 8 cm, solid, multilocular and b/l
83
labs for ovarian cancer
may have + Ca-125, alpha fetoprotein and hCG
84
Epithelial tumors of ovarian cancer
most common type, occurs in 50's. Will have elevated Ca-125.
85
cell types of ovarian epithelial cancer
serous, mutinous endometrioid and clear cell
86
Treatment and prognosis for epithelial ovarian ca
Tx is surgery with Cisplatin based chemotherapy. Prognosis is poor, 20% 5 year survival rate
87
Germ cell tumors of ovarian cancer
up to 20% of all ovarian cancer, occurs in young women aged 1-25, will present as rapidly enlarging mass
88
Germ cell ovarian cancer tx and prognosis
tx is surgery and multi-drug chemo. Prognosis is ok, 5 year surgical of 60-85%
89
cell types of Germ cell ovarian cancer
teratoma, chroiocarcinoma, dysgermimoma
90
Sex cord stroma ovarian cancer
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
radiation that is most common for gyn cancer
Cesium-137 and Iridium 192
92
teletherapy
external radiation
93
brachytherapy
internal radiation
94
general cancer staging- stage 1
within the primary organ only
95
general cancer staging- stage 2
outside but localized around the primary organ
96
general cancer staging- stage 3
spread to regional LN
97
general cancer staging- stage 4
mets to other organs

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