Gyn Oncology Flashcards
What is Lynch syndrome?
aka hereditary nonpolyposis colorectal cancer. Under recognized.
Genetic, autosomal dominant.
Family hx of colorectal cancers that also has connection to endometrial and ovarian cancers.
Amsterdam criteria – must have all of these:
* 3 or more relatives with lynch associated cancers (colorectal/bowel/ureter/ovarian/endometrial, anything below the waist) * At least 2 successive generations * 1 or more cancers diagnosed before the age of 50
Very important – essence of high-risk family. Genetic testing
Earlier colonoscopy (age 20-25 or 2-5 years before family member dx) , EMB in the absence of irregular bleeding (q 1-2 yrs starting age 30-35) or at the hint of irregular bleeding. Not very good at picking up ovarian ca. Prophylactic hysterectomy by age 40
Preventive measures
* CHC’s for prevention of colon, endo, and ovarian ca. * Don’t smoke * Have children earlier and breastfeed * Diet/alcohol * Mirena for endometrial and maybe a little ovarian.
Uterine cancer (double check your notes, this is incomplete)
mean age dx = 61
Risk factors: mostly unknown except chronic excess/unopposed estrogen exposure. Fewer than 5 periods/year. Tamoxifen. Obesity. Age >50, Early menarche, late menopause. Lynch
Often not diagnosed until after hysterectomy
Signs and symptoms: abnormal vag bleeding pelvic or and pain new onset bleeding with clots rapid uterine enlargement sudden prolapsed polyp profuse, foul smelling discharge
Endometrial sampling not specific
CT or MRI imaging to dx
Treatment: usually surgery is enough
Gyn oncologist will decide if
Ovarian Cancer
Median age of 63 at dx
Risks: nulliparous early menarche, late menopause Caucasian, North American/Northern European Increased age Family hx, BRCA1 and BRCA 2 Hx of breast cancer Post menopausal hormone therapy PID Endometriosis
Preventative: combined CHC, breastfeeding, tubal ligation, salpingectomy, hysterectomy
Signs and symptoms:
Abdominal distention/swelling, back pain
Nausea
Loss of appetite, feeling full quickly, difficulty eating
Changes in bowel habits
if they feel like there is a pelvic mass, usually accompanied by ascites
vaginal bleeding
Tx:
CHC
Surgery to remove ovaries (often with hysterectomy)
Chemo
Dx:
Hard to make
Only 50% of ovarian cancer cases detected by TVS
Mature cystic teratoma
Presents younger - teens/20’s
Most have a Stage 1 dx
Excellent prognosis
Signs and symptoms:
Subacute abdominal pain
Hormonal changes (HCG can be high)
More advanced: ascites and abd distention
Ones that start out asymptomatic can be mistaken for pregnancy
- High incidence of bilateral and also family hx
- Chronic worsening discomfort, often with vaginal sex
Dx: TVS or CT
Tx: surgery, sometimes chemo/radiation with malignancy.
If someone is pregnant with a dermoid cyst, must be removed immediately
Cervical Cancer
Risk factors: HPV 16/18 Smoking Increased parity Long term COC use Sexual activity Immunocompromised women
Squamous cell carcinoma of SCJ → migrates endocervical → cervical lymphatic drains → metastasis
Prevention: paps per ASCCP guidelines
Tx: depends on spread/severity. colpo with excision/LEEP/cold knife cone. if very bad hysterectomy with/without chemo/radiation
Breast Cancer
Risk factors: Early menarche, late menopause Nulliparous Smoking First pregnancy after age 30 Alcohol Postmenopausal obesity Increasing age Female, caucasian Tall Estrogen levels increased Hx of breast disease, or family hx Night shift work Exposure to radiation and chemicals
Prevention: breastfeeding, exercise, diet, environment
What does BIRADS stand for?
Breast Imaging Reporting And Data System
0 = incomplete, need to rescreen
1 = negative
2 = benign
3 = probably benign
4 = suspicious (split into 3 subcategories)
* a) low suspicion
* b) medium suspicion
* c) high suspicion
5 = highly suggestive of malignancy
6 = known biopsy-proven malignancy
Gayle Model
helps determine breast cancer risk
Based on 5 year risk
Intended for women who have never had breast cancer or ductal or lobular carcinoma in situ
Age Age of first period Age of first child birth vs nullip Family breast cancer hx Number of past biopsies Number of biopsies showing atypical hyperplasia Race/Ethnicity
Average lifetime risk is 12 - 13% (anything <15% is average)
Moderate lifetime risk = 15 - 20 %
High lifetime risk anything > 20%
Breast cancer screening (USPSTF recommendations)
Ages 50 - 74 biannual screening
Ages 40 - 49 on individual basis, harm vs benefit, shared decision making
Age > 75 insufficient evidence
High risk (>20% lifetime risk): starting at age 25 or 10 years before diagnosis of earliest breast cancer
Endometrial Cancer
Presents early 60’s
Risk factors: Age, obesity (increased adipose → increased estrogen), unopposed estrogen, early menarche/late menopause, PCOS, family history/BRCA genes/Lynch, tamoxifen, diabetes, HTN, gallbladder disease
Protective/Prevention: CHC use for at least 1 year, IUD use (even copper), smoking (lower circulating estrogen, earlier menopause), manage obesity and PCOS
Symptoms: post-menopausal bleeding/abnormal vaginal discharge or AUB in premenopausal. Later stages: pelvic pain/pressure
Diagnostics: TVS for all ages. In post-menopausal, endometrial stripe > 4mm warrants EMB. No clear stripe guidelines for premenopausal.
Treatment: depends on age/goals. usually surgery (hysterectomy + BSO) with possible chemo/radiation. hormone therapy also an option for young women desperate to maintain fertility (do f/u EMBs q 3 months)
