Gynecologic Malignancies

Question 1

Majority of vulvar caners are _____ lesions and occur in women ___

Answer 1

squamous lesions; > 50 years

Question 2

What are some risk factors for vulvar cancer?

Answer 2

HPV, smoking, vulva skin disorders, preinvasive disease

Question 3

Vulvar cancer is the ___ most common gyn cancer

Answer 3

4th

Question 4

What are the two pathways that can cause vulvar cancer?

Answer 4

HPV or chronic irritation

Question 5

Immune disease of vulva that can lead to vulvar cancer

Answer 5

lichen schlerosis

Question 6

Symptoms of vulvar cancer

Answer 6

itching, vulvar mass/ulcer, bleeding

Question 7

How do you diagnose vulvar cancer?

Answer 7

biopsy of atypical vulvar lesion

colposcopy to identify areas for biopsy

Question 8

If the vulvar cancer is small invasive basal cell carcinoma, what is treatment?

Answer 8

lesion excision

Question 9

If vulvar cancer is unresectable, positive for nodal spread, or there is recurrence, how do you treat this patient?

Answer 9

radiation

Question 10

In addition to surgery, if there is distant spread, recurrence or poor response to previous therapy, what would you give the patient?

Answer 10

chemotherapy

Question 11

what is the most common cause of vaginal cancer?

Answer 11

metastases from adjacent gyn cancer → lymph, local, or hemtologic

Question 12

where in the vagina is vaginal cancer MC?

Answer 12

posterior upper 1/3 wall

Question 13

symptoms of vaginal cancer

Answer 13

bleeding, pain, postcoital bleeding, discharge, local mass

Question 14

What are some methods to diagnose vaginal cancer?

Answer 14

cytology, colposcopy and biopsy

Question 15

Treatments for vaginal cancer → depends on extent and severity/recurrence

Answer 15

surgery, radiation, chemotherapy

Question 16

what is the primary risk factor for developing cervical neoplasia?

Answer 16

HPV

Question 17

what is the screening recommendations for cervical dysplasia?

Answer 17

start at age 21 with pap smear every 3 years → ages 30-65 either pap + HPV q5yr or just the pap q3yr → can stop at 65

Question 18

In the Bethesda System, what does ASC-US stand for?

Answer 18

atypical squamous cells of unknown signifiance

reflex to HPV

Question 19

In the Bethesda System what does AGUS stand for?

Answer 19

most recently added → endocervical, endometrial, UK

Question 20

IN the Bethesda System, what does LSIL and HSIL stand for?

Answer 20

low grade squamous intraepithelial lesion → CIN I

high grade squamous intraepithelial lesion → CIN II-III

Question 21

In the Bethesda System, what does CIN stand for?

Answer 21

cervical intraepithelial neoplasia

Question 22

According to Bethesda 2001 system how should you manage abnormal cervical cytology?

Answer 22

colposcopy with biopsy to assess → cryosurgery, CO2 laser, loop excision, conization of cervix

Question 23

third most common gyn cancer

Answer 23

cervical cancer

Question 24

symptoms of cervical cancer

Answer 24

abnormal vaginal bleeding (postcoital), vaginal discharge (bad smell due to necrotic tissue), pelvic pain

Question 25

workup for patient suspected of having cervical cancer

Answer 25

pelvic/rectal exam, Pap smear (screen), HPV testing, biopsy, surgery (diagnostic!)

Question 26

Most common type of cervical cancer

Answer 26

squamous cell → HPV 16 (16 > 18)

Question 27

Stage I cervical cancer is located

Answer 27

junctional zone of cervix

Question 28

Stage II cervical cancer has spread to

Answer 28

upper vagina/parametrium

Question 29

Stage III cervical cancer has spread to and what may your patient present with

Answer 29

pelvic side wall → hydronephrosis (blocks kidney)

Question 30

What is the treatment for early stage cervical cancer?

Answer 30

conization, cryotherapy

Question 31

More advanced stages of cervical cancer may need?

Answer 31

hysterectomy (simple or radical), radiation, chemo

Question 32

Treatment of choice for any cervical cancer if the woman does not want any more children

Answer 32

hysterectomy

Question 33

most common cancer in female genital tract

Answer 33

endometrial cancer

Question 34

Risk factors for endometrial hyperplasia and carcinoma

Answer 34

obesity, nulliparity, diabetes, polycystic ovaries with prolonged anovulation, unopposed estrogen therapy, extended use of tamoxifen, family history of colon cancer

Question 35

what breast cancer treatment puts women at 2-3x increased risk of endometrial cancer → blocks estrogen receptors at breast cancer cells but upregulates at uterus?

Answer 35

tamoxifen

Question 36

If you have to give a post menopausal woman with a uterus estrogen, what should you also give her to decrease endometrial hyperplasia?

Answer 36

progesterone

Question 37

This genetic condition that results in hereditary nonpolyposis colorectal cancer puts women at predisposition for endomentrial cancer

Answer 37

Lynch Syndrome

Question 38

80% of endometrail cancers are due to excess ___ leading to hyperplasia. Due to ….

Answer 38

estrogen | obesity, nulliparity, estrogen excess, diabetes

Question 39

Type II endometrial cancer are unrelated to ___ and are seen in what patient?

Answer 39

estrogen | skinny old patient

Question 40

Symptoms of endometrial cancer

Answer 40

abnormal bleeding (90%), bleeding after menopause

Question 41

what is the best method for diagnosing endometrial cancer?

Answer 41

endometrial biopsy or D&C/hysteroscopy

Question 42

Two histological types of endometrial cancer

Answer 42

adenocarcinoma → endometroid is MC | sarcoma

Question 43

treatment of endometrial cancer

Answer 43

total hysterectomy and bilateral salpingo-oophrectomy may need chemo or radiation depending on stage may get hormones

Question 44

#1 cause in gyn cancer death

Answer 44

ovarian cancer

Question 45

why does ovarian cancer cause so many deaths?

Answer 45

vague symptoms and no way to screen

Question 46

Risks for ovarian cancer

Answer 46

nulliparity, early, menarche, late menopause, caucasian, age, family history, history of breast cancer, BRCA1/BRCA2, Ashekenazi jews, HRT, talc powder

Question 47

symptoms of ovarian cancer

Answer 47

mild nonspecific GI symptoms, pelvic pressure, early satiety, bloat, weight gain

Question 48

what is a possible lab test that may indicate ovarian cancer?

Answer 48

CA 125

Question 49

What also may cause elevated CA 125 levels?

Answer 49

benign disease in premenopausal women (endometriosis),

Question 50

What may CA 125 be helpful in screening?

Answer 50

follow patient after surgical resection of tumor → look for recurrence or malignancy

Question 51

what imaging test can you use to differentiate benign from malignant ovarian masses?

Answer 51

US with color doppler

Question 52

Treatment for benign ovarian neoplasm

Answer 52

tumor removal or unilateral oophrectomy

Question 53

Treatment for malignant ovarian cancer

Answer 53

abdominal hysterectomy and bilateral salpingo-oophrectomy with omentectomy and selective lymphadenectomy

Question 54

most common variety of ovarian cancer

Answer 54

epithelial (85%)

Question 55

why is it hard to treat ovarian cancer?

Answer 55

bad seeding

Question 56

what do you do first when treating ovarian cancer?

Answer 56

surgical debulking → cryoreduction

Question 57

why do you activate ovarian cancer cells prior to chemo with cryoreduction?

Answer 57

reactivate them so they are more responsive the chemo

Question 58

what is the primary chemotherapy regimen for ovarian cancer?

Answer 58

carboplatin/Taxol

Question 59

If ovarian cancer recurs, what do you want to see if it is sensitive to?

Answer 59

platinum