Gyn oncology beyond the cervix

Question 1

MC Vulvar Cancer is

Answer 1

Squamous Cell;

arises from vestibule

Question 2

Risk factors for vulvar cancer in women <55

Answer 2

HPV;

same risk profile as cervical cancer

Question 3

Risk factors for vulvar cancer in women >55

Answer 3

nonsmoker w/o STD Hx
HPV (only 15%)
35x greater risk if +smoker & + HPV genital warts
HSV +/-
chronic immunosuppression

Question 4

Pt presents to clinic w/ pruritus / visual lesion on vulva w/ pain / bleeding / ulceration / inguinal mass that has persisted for wks - months. You suspect ?

Answer 4

Vulvar Cancer

Question 5

Eval of Vulvar Cancer

Answer 5

Vulvoscopy w/ 3% acetic acid - acetowhite

Question 6

endometrial hyperplasia is?

Answer 6

overgrowth of endometrial lining in the proliferative phase

Question 7

endometrial hyperplasia occurs as a result of?

Answer 7

anovulation

Question 8

MC presentation of endometrial hyperplasia

Answer 8

abnormal uterine bleeding

Question 9

endometrial hyperplasia is most common in

Answer 9

postmenopausal women; typically between 50-54y/o; rare <30

Question 10

greatest potential of malignancy w/ endometrial hyperplasia is with?

Answer 10

complex hyperplasia w/atypia

Question 11

What may be used in 1st diagnostic step of postmenopausal women w?endometrial hyperplasia

Answer 11

TVUS

Question 12

what indicates a low risk of cancer when using TVUS

Answer 12

=4mm thickness of stripe;

if thicker get biopsy

Question 13

endometrial hyperplasia w/ atypia requires?

Answer 13

Hysterectomy (postmenopausal / post-child bearing)

Hormonal therapy in premenopausal Pts wanting to retain reproductive capabilities

Question 14

Tx of a premenopausal women w/endometrial hyperplasia w/atypia

Answer 14

3-6 month vourse of progestin therapy or COC

Question 15

MC GYN cancer in the US

Answer 15

Endometrial Cancer

Question 16

risk factors for endometrial cancer

Answer 16

unopposed estrogen
obesity (MCC of unopposed estrogen)
advancing age

Question 17

Tx of endometrial cancer

Answer 17

hysterectomy w/bilat salpingo-oophorectomy (BSO) & lymph node staging

advanced –> chemo, radiotherapy, or both

hormonal therapy (progestin)- 
Tamoxifen- upreg progesterone-receptor expression

Question 18

40 y/o female cc of pelvicpressure / bloating / early satiety / increased ABD girth / IRREGULAR VAGINAL BLEEING (prolong menstrual / intermenstrual spotting) should consider?

Answer 18

Endometrial Cancer

Question 19

TVUS on postmenopausal woman noted a stripe of 5mm (or greater)

Answer 19

must biopsy for hyperplasia and cancer

Question 20

Risk factors of ovarian cancer

Answer 20

Fam Hx of breast / ovarian cancer (Most important)-BRCA1/2
Nulliparity
Early menarche / late menopause
white
increasing age
postmenopausal hormone therapy
PID

Question 21

protective factors of ovarian cancer

Answer 21

breast feeding
oral contraceptives
tubal ligation / hysterectomy
diet-high fiber/low fat rich in carotene other Vit.

Question 22

this type of cancer accounts for more deaths than any other types of gynecologic cancer

Answer 22

ovarian (epithelial ovarian cancer 90-95%)

Question 23

Pt comes in w/ cc of bloating / increased ABD size / urinary urgency / Pelvic pain / Fatigue / indigestion / constipation / Abnormal vaginal bleeding for the past couple of months. should be thinking

Answer 23

ovarian cancer

Question 24

On physical exam you note a solid, nodular, fixed adnexal mass and ascites

Answer 24

highly suggestive of ovarian cancer

Question 25

What lab findings maybe found in ovarian cancer

Answer 25

CBC- thrombocytosis (>400)
Hyponatremia - common
CA-125
Human epididymal protein 4 (HE4) tumor marker

Question 26

TVUS is most useful intial test for ovarian cancer, malignant cancer will appear as?

Answer 26

multiloculated, solid, or echogenic
>5cm
Thick septa w/areas of nodularity
papillary projections or neovascularization