GYN ONCOLOGY Flashcards
What is the MC GYN cancer?
Endometrial cancer (in postmenopausal women)
Endometrial cancer is what type of cancer?
Adenocarcinoma
What is the cardinal symptom of endometrial cancer?
Inappropriate uterine bleeding
How do we diagnose endometrial cancer?
In post menopausal bleeding do a Pap Smear, endocervical curettage, and endometrial biopsy.
- Endometrial biopsy has an accuracy of 90-95% - Can also do D&C and transvaginal U/S
How do we treat endometrial cancer?
Total hysterectomy (bilateral salpingo-oophorectomy)
What type of GYN cancer is the second MC but the highest mortality rate?
Ovarian cancer
What are the risk factors for ovarian cancer?
Older women, nulliparous, white, and family Hx
What is thought to be protective against ovarian cancer?
Long-term OCP’s
What are the sxs of ovarian cancer?
Usually none :(
- Palpable ovary in a postmenopausal woman is a PROBLEM
- Otherwise ascites, abdominal distention, early satiety, changes in bowel habits, or a fixed mass
How do you diagnose ovarian CA?
Transvaginal U/S
- Genetics: BRCA1, CA-125, and mutations in P53
How do you treat ovarian cancer?
surgery + chemo and radiation
What is the MC cancer in women?
Breast Cancer
What genes are associated with breast cancer?
BRCA 1 and BRCA 2
What are some associated risk factors for breast cancer?
nulliparity, early menarche, late menopause, long-term estrogen use, radiation exposure, and delayed childbearing, and first degree relatives
How does breast cancer present?
lumps, bumps, skin changes, dimpling, red/hot, pain/no pain, regional node enlargement
When do we start mammograms?
Age 40 annually or every 2 years
Age 50 annually or every 2 years
if you have a post-menopausal woman with a new mass, discharge, or asymmetry what should you always think about?
Presumed cancerous until proven otherwise
What is the GOLD STANDARD of breast mass diagnosis?
Aspiration/biopsy = superior to imaging
What’s the most common type of breast cancer?
Infiltrating ductal carcinoma = spreads
What sxs make you think of infiltrating ductal carcinoma?
redness, scaling, dimpling, thickening of the nipple
How do you treat infiltrating ductal carcinoma?
Lumpectomy (if <2cm) or mastectomy
Sentinel node biopsy
What type of breast cancer does not metastasis but has a high incidence of recurrence?
Ductal carcinoma insitu
What are the systemic treatment options for breast CA?
Chemo, hormonal therapy, estrogen receptor downregulators (Tamoxifen) for pre-menopausal
If breast CA were to metastasize, where does it most likely go?
obvi lymph nodes/muscle/fat/skin around the breast
But vertebral pedicles & ribs
What does the F/U involve after breast CA?
every 3-6 months x 3 years
Every 6-12 months years 4 & 5
Every year after year 5
*Yearly mammogram + pelvic exams (some drugs can increase uterine cancer)
If a pt has itching, burning, pain, scales/thickening of the nipple – what should you think?
Not just eczema but possible breast CA!
Paget’s
What is cervical cancer associated with 99.7% of the time?
HPV
What are the risk factors for cervical cancer?
early onset sexual activity, multiple partners, high-risk, hx of STIs, smoking
What are the sxs associated with cervical cancer?
Early on = asymptomatic
Irregular or heavy vaginal bleeding
Postcoital bleeding
What would the cervix look like that would make you think cervical cancer? Dx?
lesions that are raised, red, and friable
Dx – based on histologic evaluation
Where does cervical cancer typically originate on the cervix?
transformational zone (SJC)
How do we manage cervical cancer?
early detection
- Radical hysterectomy, fertility sparing surgery, and radiation
When do we start paps?
Age 21
A 23y/o female has a pap result that shows ASCUS, how do you move forward?
repeat pap in 1 year
- If repeat pap is NORMAL, or ASCUS or LSIL again – screen in 1 year
- If repeat pap is ABNORMAL – colposcopy
A 26y/o female has a pap result that shows ASCUS, how do you move forward?
Reflex HPV testing
- HPV Positive = colposcopy
- HPV negative = repeat co-testing in 3 years
A 23y/o (21-24y/o) female has a pap result that shows LSIL, how do you move forward?
repeat pap in 1 year
- If repeat pap is NORMAL, or ASCUS again – screen in 1 year
- If repeat pap is ABNORMAL – colposcopy
A 28y/o female has a pap result that shows LSIL, how do you move forward?
HPV positive = colposcopy
HPV negative = repeat co-testing in ONE YEAR (not 3 like ASCUS)
A 22y/o female has a pap result of HSIL, how do you move forward?
Colposcopy FOR ALL, no matter the HPV status
*high risk of carcinoma, correlates with CIN II or III
A 27y/o has a pap result of ASC-H, how do you move forward?
colposcopy
What if you 35y/o has a pap result of ASC-H, what do you do?
Colposcopy PLUS endometrial sampling if 35 or older
What are the grades of CIN?
CIN I = mild dysplasia
CIN II = moderate dysplasia
CIN III = severe dysplasia to carcinoma in situ
How does a colposcopy work?
Magnify the cervix
- Staining to identify areas to be biopsied (acetic acid and iodine)
How do we treat the abnormal areas after biopsy via colposcopy?
LEEP
Ablation of T-zone with cryotherapy or laser
Tell me about vaginal cancer?
Rare, mostly SCC
Diagnose via pap and biopsy
Treat with chemo or radiation
If on the vulva you note red/white lesion that are itchy for the patient, dx? Tx?
Think Vulvar cancer
- Biopsy
- Surgery/chemo/radiation
