Gyn oncology beyond the cervix Flashcards
MC Vulvar Cancer is
Squamous Cell;
arises from vestibule
Risk factors for vulvar cancer in women <55
HPV;
same risk profile as cervical cancer
Risk factors for vulvar cancer in women >55
nonsmoker w/o STD Hx HPV (only 15%) 35x greater risk if +smoker & + HPV genital warts HSV +/- chronic immunosuppression
Pt presents to clinic w/ pruritus / visual lesion on vulva w/ pain / bleeding / ulceration / inguinal mass that has persisted for wks - months. You suspect ?
Vulvar Cancer
Eval of Vulvar Cancer
Vulvoscopy w/ 3% acetic acid - acetowhite
endometrial hyperplasia is?
overgrowth of endometrial lining in the proliferative phase
endometrial hyperplasia occurs as a result of?
anovulation
MC presentation of endometrial hyperplasia
abnormal uterine bleeding
endometrial hyperplasia is most common in
postmenopausal women; typically between 50-54y/o; rare <30
greatest potential of malignancy w/ endometrial hyperplasia is with?
complex hyperplasia w/atypia
What may be used in 1st diagnostic step of postmenopausal women w?endometrial hyperplasia
TVUS
what indicates a low risk of cancer when using TVUS
=4mm thickness of stripe;
if thicker get biopsy
endometrial hyperplasia w/ atypia requires?
Hysterectomy (postmenopausal / post-child bearing)
Hormonal therapy in premenopausal Pts wanting to retain reproductive capabilities
Tx of a premenopausal women w/endometrial hyperplasia w/atypia
3-6 month vourse of progestin therapy or COC
MC GYN cancer in the US
Endometrial Cancer
risk factors for endometrial cancer
unopposed estrogen
obesity (MCC of unopposed estrogen)
advancing age
Tx of endometrial cancer
hysterectomy w/bilat salpingo-oophorectomy (BSO) & lymph node staging
advanced –> chemo, radiotherapy, or both
hormonal therapy (progestin)- Tamoxifen- upreg progesterone-receptor expression
40 y/o female cc of pelvicpressure / bloating / early satiety / increased ABD girth / IRREGULAR VAGINAL BLEEING (prolong menstrual / intermenstrual spotting) should consider?
Endometrial Cancer
TVUS on postmenopausal woman noted a stripe of 5mm (or greater)
must biopsy for hyperplasia and cancer
Risk factors of ovarian cancer
Fam Hx of breast / ovarian cancer (Most important)-BRCA1/2 Nulliparity Early menarche / late menopause white increasing age postmenopausal hormone therapy PID
protective factors of ovarian cancer
breast feeding
oral contraceptives
tubal ligation / hysterectomy
diet-high fiber/low fat rich in carotene other Vit.
this type of cancer accounts for more deaths than any other types of gynecologic cancer
ovarian (epithelial ovarian cancer 90-95%)
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
ovarian cancer
On physical exam you note a solid, nodular, fixed adnexal mass and ascites
highly suggestive of ovarian cancer
What lab findings maybe found in ovarian cancer
CBC- thrombocytosis (>400)
Hyponatremia - common
CA-125
Human epididymal protein 4 (HE4) tumor marker
TVUS is most useful intial test for ovarian cancer, malignant cancer will appear as?
multiloculated, solid, or echogenic
>5cm
Thick septa w/areas of nodularity
papillary projections or neovascularization
