Gynecologic Malignancies Flashcards
Majority of vulvar caners are _____ lesions and occur in women ___
squamous lesions; > 50 years
What are some risk factors for vulvar cancer?
HPV, smoking, vulva skin disorders, preinvasive disease
Vulvar cancer is the ___ most common gyn cancer
4th
What are the two pathways that can cause vulvar cancer?
HPV or chronic irritation
Immune disease of vulva that can lead to vulvar cancer
lichen schlerosis
Symptoms of vulvar cancer
itching, vulvar mass/ulcer, bleeding
How do you diagnose vulvar cancer?
biopsy of atypical vulvar lesion
colposcopy to identify areas for biopsy
If the vulvar cancer is small invasive basal cell carcinoma, what is treatment?
lesion excision
If vulvar cancer is unresectable, positive for nodal spread, or there is recurrence, how do you treat this patient?
radiation
In addition to surgery, if there is distant spread, recurrence or poor response to previous therapy, what would you give the patient?
chemotherapy
what is the most common cause of vaginal cancer?
metastases from adjacent gyn cancer → lymph, local, or hemtologic
where in the vagina is vaginal cancer MC?
posterior upper 1/3 wall
symptoms of vaginal cancer
bleeding, pain, postcoital bleeding, discharge, local mass
What are some methods to diagnose vaginal cancer?
cytology, colposcopy and biopsy
Treatments for vaginal cancer → depends on extent and severity/recurrence
surgery, radiation, chemotherapy
what is the primary risk factor for developing cervical neoplasia?
HPV
what is the screening recommendations for cervical dysplasia?
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
In the Bethesda System, what does ASC-US stand for?
atypical squamous cells of unknown signifiance
reflex to HPV
In the Bethesda System what does AGUS stand for?
most recently added → endocervical, endometrial, UK
IN the Bethesda System, what does LSIL and HSIL stand for?
low grade squamous intraepithelial lesion → CIN I
high grade squamous intraepithelial lesion → CIN II-III
In the Bethesda System, what does CIN stand for?
cervical intraepithelial neoplasia
According to Bethesda 2001 system how should you manage abnormal cervical cytology?
colposcopy with biopsy to assess → cryosurgery, CO2 laser, loop excision, conization of cervix
third most common gyn cancer
cervical cancer
symptoms of cervical cancer
abnormal vaginal bleeding (postcoital), vaginal discharge (bad smell due to necrotic tissue), pelvic pain
workup for patient suspected of having cervical cancer
pelvic/rectal exam, Pap smear (screen), HPV testing, biopsy, surgery (diagnostic!)
Most common type of cervical cancer
squamous cell → HPV 16 (16 > 18)
Stage I cervical cancer is located
junctional zone of cervix
Stage II cervical cancer has spread to
upper vagina/parametrium
Stage III cervical cancer has spread to and what may your patient present with
pelvic side wall → hydronephrosis (blocks kidney)
What is the treatment for early stage cervical cancer?
conization, cryotherapy
More advanced stages of cervical cancer may need?
hysterectomy (simple or radical), radiation, chemo
Treatment of choice for any cervical cancer if the woman does not want any more children
hysterectomy
most common cancer in female genital tract
endometrial cancer
Risk factors for endometrial hyperplasia and carcinoma
obesity, nulliparity, diabetes, polycystic ovaries with prolonged anovulation, unopposed estrogen therapy, extended use of tamoxifen, family history of colon cancer
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?
tamoxifen
If you have to give a post menopausal woman with a uterus estrogen, what should you also give her to decrease endometrial hyperplasia?
progesterone
This genetic condition that results in hereditary nonpolyposis colorectal cancer puts women at predisposition for endomentrial cancer
Lynch Syndrome
80% of endometrail cancers are due to excess ___ leading to hyperplasia. Due to ….
estrogen
obesity, nulliparity, estrogen excess, diabetes
Type II endometrial cancer are unrelated to ___ and are seen in what patient?
estrogen
skinny old patient
Symptoms of endometrial cancer
abnormal bleeding (90%), bleeding after menopause
what is the best method for diagnosing endometrial cancer?
endometrial biopsy or D&C/hysteroscopy
Two histological types of endometrial cancer
adenocarcinoma → endometroid is MC
sarcoma
treatment of endometrial cancer
total hysterectomy and bilateral salpingo-oophrectomy
may need chemo or radiation depending on stage
may get hormones
1 cause in gyn cancer death
ovarian cancer
why does ovarian cancer cause so many deaths?
vague symptoms and no way to screen
Risks for ovarian cancer
nulliparity, early, menarche, late menopause, caucasian, age, family history, history of breast cancer, BRCA1/BRCA2, Ashekenazi jews, HRT, talc powder
symptoms of ovarian cancer
mild nonspecific GI symptoms, pelvic pressure, early satiety, bloat, weight gain
what is a possible lab test that may indicate ovarian cancer?
CA 125
What also may cause elevated CA 125 levels?
benign disease in premenopausal women (endometriosis),
What may CA 125 be helpful in screening?
follow patient after surgical resection of tumor → look for recurrence or malignancy
what imaging test can you use to differentiate benign from malignant ovarian masses?
US with color doppler
Treatment for benign ovarian neoplasm
tumor removal or unilateral oophrectomy
Treatment for malignant ovarian cancer
abdominal hysterectomy and bilateral salpingo-oophrectomy with omentectomy and selective lymphadenectomy
most common variety of ovarian cancer
epithelial (85%)
why is it hard to treat ovarian cancer?
bad seeding
what do you do first when treating ovarian cancer?
surgical debulking → cryoreduction
why do you activate ovarian cancer cells prior to chemo with cryoreduction?
reactivate them so they are more responsive the chemo
what is the primary chemotherapy regimen for ovarian cancer?
carboplatin/Taxol
If ovarian cancer recurs, what do you want to see if it is sensitive to?
platinum
