Gynecologic malignancies - aa

Question 1

Shockingly, the USPSTF and ACS/ASCCP/ACOG basically agree on cervical cancer screening. What are their recommendations?

Answer 1

~Under 21: don’t screen
~21-29: cytology every 3 years
~30-65: cytology every 3 years or cytology + HPV cotest every 5 years
~65+: if negative cytology for an adequate prior period, can stop screening. Do not restart, even if new sexual partners.
~hysterectomy with cervix removed: don’t screen
~HPV vaccinated: has no effect on screening recommendations

Question 2

What are the recommendations for endometrial cancer screening?

Answer 2

Don’t do it.

Question 3

What are the recommendations for ovarian cancer screening?

Answer 3

~USPSTF recommends against screening for ovarian cancer
~ACOG: For women at high risk of epithelial ovarian cancer, such as women with BRCA1/BRCA2, periodic tests to check for ovarian cancer may be recommended. These tests include transvaginal ultrasound and measurement of CA125 levels.

Question 4

What are the recommendations for vulvar cancer screening?

Answer 4

~ACS: There is no standard screening for this disease other than routine physical examinations.

Question 5

70% of vaginal cancers and 90% of vulvar cancers are of this type.

Answer 5

squamous cell carcinoma

Question 6

Vulvar cancer typically appears in what demographic?

Answer 6

postmenopausal women who have had infrequent medical exams

Question 7

Vulvar cancer just appears out of the blue, unfortunately.

T/F

Answer 7

False.

Long history of vulvar irritation with pruritus, local discomfort, and bloody discharge.

Question 8

HPV is strongly associated with vulvar cancer in ____ women, whereas in ____ women, vulvar dystrophy and chronic inflammation are the carcinogenic pathways.

Answer 8

younger, older

Question 9

What is the treatment for vulvar cancer?

Answer 9

excision or vulvectomy

Question 10

What are the symptoms of vaginal cancer?

Answer 10

~Often asymptomatic

~Postmenopausal vaginal and/or postcoital bleeding are the most common presenting symptoms

Question 11

If you see signs of vaginal cancer in the vagina, you can diagnose primary vaginal cancer.
T/F

Answer 11

False. Could be primary or metastasis.

~A diagnosis of primary cancer of the vagina cannot be established unless metastasis from another source is eliminated.

Question 12

What is the treatment for vaginal cancer?

Answer 12

~surgery

~radiotherapy with brachytherapy

Question 13

What are the most and least common gynecologic cancers?

Answer 13

most common: endometrial

least common: vaginal

Question 14

What are the presenting s/s of endometrial cancer?

Answer 14

~Abnormal uterine bleeding: menorrhagia, metrorrhagia, or postmenopausal bleeding

Question 15

What are the risk factors for endometrial cancer?

Answer 15

~Risk factors: hyperestrogenism—long-term exposure to unopposed estrogens (PCOS, chronic anovulation, late menopause, exogenous estrogens); metabolic syndrome including diabetes, hypertension, and obesity; nulliparity; increasing age; history of breast cancer; genetic predisposition

Question 16

How is endometrial cancer diagnosed?

Answer 16

endometrial sampling, ultrasonography

Question 17

How is endometrial cancer treated?

Answer 17

The mainstay of treatment is surgery, including a total hysterectomy with bilateral salpingo-oophorectomy and staging with pelvic and periaortic lymphadenectomy.

Question 18

Unlike cervical cancer, endometrial carcinoma is not related to sexual history.
T/F

Answer 18

True

Question 19

What is the most common gestational trophoblastic disease? Is it benign or malignant?

Answer 19

Hydatidiform mole is the most common form of gestational trophoblastic disease and is benign in nature.

Question 20

In what demographics is hydatidiform mole more common?

Answer 20

~under 20 and over 40
~nulliparous
~lower socioeconomic status
~diet deficient in protein, folic acid, and carotene

Question 21

What unique and characteristic tumor marker is associated with gestational trophoblastic tumors?

Answer 21

hCG

Question 22

From what is hydatidiform mole thought to arise?

Answer 22

extraembryonic trophoblasts

Question 23

Choriocarcinoma may accompany or follow any type of pregnancy.
T/F

Answer 23

True

Question 24

50% of choriocarcinomas are preceded by hydatidiform mole.

T/F

Answer 24

True

Question 25

What is the only way to prevent the occurrence of gestational trophoblastic diseases?

Answer 25

sexual abstinence

Question 26

What is the most common presenting symptom of molar pregnancy?

Answer 26

Abnormal uterine bleeding in the first trimester

Question 27

What sign has been said to be pathognomonic for a molar pregnancy?

Answer 27

Preeclampsia in the first trimester

Question 28

What is the treatment for molar pregnancy?

Answer 28

~suction curettage

~hysterectomy if not desirous of future pregnancy

Question 29

What should be closely monitored (weekly) following evacuation of molar pregnancy?

Answer 29

hCG levels