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OB/Gyn > GYN Oncology > Flashcards

GYN Oncology Flashcards

1
Q

What is the 3rd most common malignancy in women worldwide?

A

Cervical Cancer.

*2nd MC in developing countries.

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2
Q

What is the most common cause of cervical cancer?

A

HPV 16 accounts for 55-60% of all cases.

HPV 18 is also a cause.

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3
Q

Name the risk factors for Cervical Cancer?

A
  1. High-risk HPV infection and CIN.
  2. Smoking.
  3. Early age at first intercourse.
  4. Multiple sexual partners.
  5. Smoking!!
  6. Hx of STI.
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4
Q

What are the most common signs of cervical cancer?

A
  1. Metrorrhagia — abnormal bleeding.
  2. Post-coital spotting or bleeding (MC presentation).
  3. Vaginal discharge.
  4. Dysuria.
  5. Vaginal discomfort.
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5
Q

What age group and race are the most common among those with cervical cancer?

A
  1. Cervical CA has a bimodal distribution — highest among women 40-59 yrs and >70.
  2. Hispanic > AA > American Indian > White > Asian.
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6
Q

What is the most common type of cervical cancer?

A

Squamous cell carcinoma (SCC) accounts for approx. 80% of cervical cancers.

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7
Q

How is cervical CA prevented and diagnoses?

A

Through PAP screening.

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8
Q

If your patient has a result of ASCUS on pap, what is required?

A

Reflex HPV testing for high-risk types.

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9
Q

What is the next step if you have ASCUS on PAP with a negative HPV? Positive HPV?

A
  1. Negative — repeat in 12 months.

2. Positive — refer pt for Colposcopy

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10
Q

Diagnostics of Cervical Cancer?

A
  1. FRIABLE, BLEEDING cervical lesion on exam.
  2. Biopsy of gross lesions and colposcopically directed biopsies are the definitive.
    —The majority of cases (80%) are invasive squamous cell types, usually arising from the ectocervix.
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11
Q

What are the treatment options for cervical cancer?

A

**Depends on the invasiveness.

  1. Surgical mgmt (Hysterectomy) is an option for pt’s in early-stage tumors.
  2. Chemo-radiation is the 1st line therapy for higher stage tumors (Stage III and IV).
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12
Q

How do we prevent cervical cancer?

A
  1. Regular screening and follow-up.
  2. HPV vaccination (Gardasil).
  3. Reduce risk factors — smoking, unprotected sex, etc.
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13
Q

What will be the most common presentation of a patient with cervical cancer?

A

A 45 y/o female with POST-COITAL BLEEDING and painful intercourse. On exam you notice a FRIABLE, BLEEDING CERVICAL LESION. Cytology shows a high-grade squamous intraepithelial lesion (HSIL/CIN2 or 3). She is referred for colposcopy and directed biopsies.

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14
Q

What will be the most common presentation for Ovarian Cancer?

A

A 66 y/o female who complains of ABDOMINAL FULLNESS, BLOATING, FATIGUE and WEIGHT LOSS. She underwent MENOPAUSE 17 YRS AGO and has NEVER HAD CHILDREN (Nulliparous). She had a PELVIC MASS but her pap is atrophic. A pelvic US is performed.

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15
Q

Which tumor marker is correct for ovarian cancer?

A

CA-125 — elevated in ovarian cancer and other benign ovarian lesions.

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16
Q

Why do we measure the tumor marker CA-125 in ovarian cancer besides diagnosis?

A

It is used to assess response to treatment and evaluation of recurrence.

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17
Q

What is the 2nd most common gynecological cancer? What is the first MC?

A

2nd most common is Ovarian Cancer. Endometrial is first.

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18
Q

What is the leading cause of gynecological cancer death in women?

A

Ovarian cancer.

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19
Q

75% of Ovarian Cancers are diagnosed at what?

A

Advanced stage.

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20
Q

What type of tumor is Ovarian Cancer most common?

A

90% epithelial tumors.

Germ cell tumors are MC in pt’s < 10 y/o.

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21
Q

What is the lifetime risk of getting Ovarian Cancer?

A

1 in 70.

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22
Q

What are the risk factors for getting Ovarian Cancer?

A
  1. FH.
  2. Multiple relatives with breast or ovarian CA increases risk.
  3. Nulligravidity or Infertility.
  4. Early menarche.
  5. Late menopause.
  6. Endometriosis.
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23
Q

What is the most significant risk factor for developing Ovarian Cancer?

A

FH, although, 90% of ovarian cancer is SPORADIC and NOT inherited.

24
Q

When do patients typically present with Ovarian Cancer?

A

Advanced Disease, possibly extensive METS. Early disease is often asymptomatic.

25
Q

What are the signs and symptoms of ovarian cancer?

A
  1. Ovarian or Pelvic mass (anexal mass).
  2. Ascites or abdominal fullness.
  3. Bloating.
  4. Pleural effusion — METS?
  5. Fatigue, weight loss.
26
Q

What therapy can be protective against ovarian cancer?

A

OCPs — 5 yrs decreases risk by 20%; 15 yrs by 50%.

27
Q

How are OCPs protective against Ovarian cancer?

A

The progestin component of OCPs may protect against ovarian cancer by regulating apoptosis of the ovarian epithelium.

28
Q

Diagnostics for Ovarian Cancer?

A
  1. Physical exam.
  2. Pelvic U/S.
  3. Blood test: CA-125.
  4. Transvaginal U/S.
29
Q

What are commonly encountered in women?

A

Adnexal masses.

30
Q

What is the treatment of Asymptomatic premenopausal patients with simple ovarian cysts < 10 cm in diameter?

A

Observation or placed on suppressive therapy with OCPs.

31
Q

What warrants further evaluation in a woman who presents with an adnexal mass?

A

A cyst >3 cm or the CA-125 is elevated.

32
Q

What is the evaluation for a postmenopausal woman with simple cysts < 3 cm in diameter?

A

Observation, provided the serum CA-125 level is not elevated and the pt has no S/Sx, suggestive of malignancy.

33
Q

What is the treatment for a patient diagnosed with Ovarian Cancer?

A
  1. Early Stage: TAH-BSA plus selective lymphadenectomy.
  2. Surgery: tumor debulking, serum CA-125 levels to monitor treatment progress.
  3. Chemotherapy : Taxol + Cisplatin or Carboplatin.
34
Q

What is the most common type of malignant ovarian tumor?

A

Cystadenocarcinoma.

35
Q

What is the most common presentation of a pt with Endometrial Cancer?

A

A 53 y/o female with NO PERIOD FOR FOUR YEARS, but now is having ABNORMAL BLEEDING and BLEEDING AFTER INTERCOURSE. She has lower abdominal pain, feels as though she may have her menses, pelvic heaviness, girth and bloating.

36
Q

What is endometrial cancer till proven otherwise?

A

Any type of dysfunctional uterine bleeding in a post-menopausal female.

37
Q

What are the risk factors for endometrial cancer?

A
  1. Older age.
  2. Postmenopausal bleeding.
  3. DM.
  4. Early menarche.
  5. Late menopause.
  6. Nulliparity.
  7. Smoking is assoc. with the reduced risk.
38
Q

What is the epidemiology of endometrial cancer?

A
  1. 75% of cases are in postmenopausal women.
  2. Ages 50-59.
  3. 1/3 of women with postmenopausal bleeding have ovarian cancer.
39
Q

What should be less than 4 mm in a postmenopausal woman?

A

The endometrium.

40
Q

What is the most common GYN malignancy? MC type?

A

Endometrial Cancer; most often adenocarcinoma.

41
Q

Diagnostics for Endometrial Cancer?

A
  1. Endometrial Biopsy — vaginal bleeding in postmenopausal women is endometrial CA till proven otherwise.
  2. PAP smear while performing the biopsy.
  3. US to look at the lining of the endometrium, which may be THICKENED in a postmenopausal woman.
42
Q

What is the treatment of Endometrial Cancer?

A
  1. Usually TOTAL Hysterectomy and bilateral Salpino-oophorectomy.
  2. Pelvic radiation w/ or w/o chemotherapy for stage II and III.
  3. Multimodal, individualized therapy for stage IV.
    —Medical: Progestins, Tamoxifen or both.
    —GnRH agents.
43
Q

What is the common presentation of Vaginal Cancer?

A

A 62 y/o woman, G4P4, who complains of ABNORMAL VAGINAL BLEEDING that occurs intermittently between her predictable menstrual cycle.

44
Q

What is the most common presentation of vulvar cancer?

A

A 50 y/o w/VAGINAL ITCHING and irritation, red/white ULCERATIVE CRUSTED LESIONS ON VULVA.

45
Q

Where is the most common site for invasive vaginal cancer, upper or lower vagina?

A

Upper.

46
Q

Epidemiology of vaginal cancer?

A
  1. Rare; 1% of GYN malignancies.
  2. Usually secondary to other cancer.
  3. MC age at incidence is 60-65 yrs.
47
Q

What is the most common type of vaginal cancer?

A

Squamous cell type represents 95%.

48
Q

What is the most common cause of vulvar cancer?

A

Infection with HPV 16, 18, and 31.

49
Q

What is the peak incidence age of vulvar cancer?

A

50 yrs old.

50
Q

What is the most common presentation symptom of vulvar cancer?

A

Vaginal pruritus; 70%.

51
Q

What is the most common symptom of vaginal cancer?

A

Vaginal bleeding.

52
Q

What does stage 3 vaginal cancer involve?

A

Extension of lesion to the pelvic wall.

53
Q

What is stage 0 of vaginal cancer?

A

Intraepithelial neoplasia.

54
Q

What is stage IV for vaginal cancer?

A

Lesion involving the mucosa of bladder and rectum.

55
Q

What is stage 2 of vaginal cancer?

A

Invasive carcinoma confined to vaginal mucosa.

56
Q

Treatment for vaginal cancer?

A

Radiation therapy.

57
Q

Treatment for vulvar cancer?

A

Surgical excision, chemotherapy and laser treatment.

OB/Gyn (14 decks)

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