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Gynecology > Gynecologic neoplasms > Flashcards

Gynecologic neoplasms Flashcards

1
Q

What are uterine leiomyomas (fibroids)

A

Most common BENIGN neoplasm with discrete, round, firm, multiple tumors made of smooth muscle and connective tissue

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2
Q

What are some characteristics of leiomyomas (fibroids)

A
  1. ) They are estrogen and progesterone sensitive, increasing in size during pregnancy
  2. ) 25% caucasians have it, 50% black women have it
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3
Q

The majority of leiomyomas are asymptomatic. What are the symptoms if they are present

A
  1. ) Bleeding - longer heavier periods
  2. ) Pressure
  3. ) Pain - dysmenorrhea
  4. ) Pelvic symptoms - irregularly enlarged uterus felt on physical examination
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4
Q

What labs are important to order for uterine leiomyoma

A

Ultrasound to look for uterine myomas or masses

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5
Q

Uterine leiomyoma has both a pharmacologic and surgical treatment. What are the pharmacologic treatments

A

NSAIDs + OCP’s + medroxyprogesterone acetate

GnRH analogs to reduce size and used prior to surgery

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6
Q

What are the complications of leiomyoma

A

Infertility due to myoma

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7
Q

There are two types of endometrial cancer. What are they, and their pearls

A

Type 1: Endometriod - derived from atypical endometrial hyperplasia, are 75% of cancers, caused by unopposed estrogen stimulation, and happens at younger age

Type 2: Serous - 25% of cancers, from serous cells and unrelated to estrogen but related to p53, more aggressive

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8
Q

What are the symptoms of endometrial cancer

A

Early finding: Bleeding

Late finding: Pain

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9
Q

How does one diagnose endometrial cancer

A

Endometrial/endocervical biopsy

Ultrasound shows thickened endometrium

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10
Q

Treatment of endometrial cancer dependds on whether woman is of childbearing age or postmenopausal. What are they

A
  1. ) Childbearing: High dose progestins

2. ) Postmenopausal: TAH/BSO with radiation, but if worse then give chemotherapy

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11
Q

Something can protect against endometrial cancer. What is it?

A

Hormonal contraceptives

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12
Q

How does cervical cancer happen

A

Upper third is made of columnar cells that is exposed to acidic vaginal pH resulting in metaplasia to squamous cells, eventually leading to cervical intraepithelial neoplasia (CIN)

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13
Q

What is both squamous cell and adenocarcinoma of CIN result in

A
  1. ) HPV 16 - squamous cell carcinoma
  2. ) HPV 18 - adenocarcinoma

Also associated are immunosuppression, HIV, STD,s tobacco, and OCPs (this protected against endometrial cancer)

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14
Q

What are some common symptoms of cervical cancer

A

Metrorhagia, postcoital spotting, cervical ulcerations

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15
Q

What is the screening recommendations for cervical cancer

A
  1. ) Pap smear every two years from age 21
  2. ) If woman > 30yo with 3 consecutive normal tests, can be tested every 3 years and screened with HPV DNA
  3. ) Screening d/c after 70yo if 3 or more normal smears

Pearls
4.) If immunosuppression or DES exposure, screen indefinitely

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16
Q

What is the algorithm for ASC-US for cervical cancer

A

If ASC-US, proceed to HPV DNA testing, if negative repeat pap smear at 12 months if less than age 24 and 3 years if greater than age 25, if positive then do colposcopy

Or you can skip to colposcopy

17
Q

What do you do if someone has ASC-H (atypical squamous cells - cannot exclude HSIL)

A

Colposcopy

18
Q

How do you manage LSIL (Low grade intraepithelial lesion)

A

If no visible lesion, do endocervical sampling

If CIN 2, 3 - ablation or excision

If no CIN 2,3 - repeat pap smear at 6 and 12 months

19
Q

How do you manage AGC (Atypical glandular cells of undetermined significance)

A

Colposcopy with endocervical sampling, but if bleeding ttoo then do endometrial sapling as well

20
Q

How do you manage HSIL (High grade squamous intraepithelial lesion

A

Same as LSIL

If CIN 2, 3 - ablation or excision

If no CIN 2,3 - repeat pap smear at 6 and 12 months or you can do excision in this case anyways (unlike LSIL)

21
Q

What is the treatment for CIN 1, and persistent CIN 1

A

Close observation by pap smear at 6 and 12 months or HPV DNA testing at 12 months, and after two negative pap smears or negative DNA test, then proceed to normal rates

However, iif persistent, do ablation or excision

22
Q

What is the treatment for CIN 2 and 3

A

Ablation, excision, or hysterectomy

23
Q

What is the treatment for invasive disease

A

Microinvasive carcinoma: Cone biopsy or simple hysterectomy

Stage 1A2, up to 2A - radical hysterectomy with radiation and chemotherapy

Stage 1B2 and above - radiation and chemotherapy only

Picture of stages on page 340

24
Q

What is the most common cause of death if cervical cancer goes untreated

A

Uremia when ureteral obstruction is bilateral

25
Q

What are the risk factors for vulvar cancer

A

HPV again, but this time lichen sclerosus, diabetes, HTN, CV disease, immunosuppression

26
Q

What is in the history of vulvar carcinoma

A

Lesions that eventually become like cauliflower and ulcerated

27
Q

How do you diagnose vulvar carcer

A

Vulvar punch biopsy with vulvar pruritis, especially if postmenopausal

28
Q

The treatment for vulvar cancer differs whether it is high grade VIN or totally invasive. What is the treatment

A

VIN: Topical chemotherapy, laser ablation

Invasive: Radical vulvectomy and lymphadenectomy

29
Q

Vaginal cancer has different subtyptes depending on age. What are they

A

Postmenopause: Squamous cell

Younger women: Adenocarcinoma, clear cell adenocarcinoma from DES

30
Q

What are the risk factors and symptoms for vaginal cancer

A

Risk factors: Immunosuppresion, low socioeconomic status, chronic irritation from pessary or prolapse, radiation for cervical cancer, smoking

Symptoms: Abnormal vaginal bleeding or postcoital bleeding, most likely found in upper vagina

31
Q

What are the risk factors for ovarian cancer

A
  • Age, low parity, decreased fertility, delayed childbearing
  • Positive family history

Risk decreased by OCP use, increased by BRCA mutation

32
Q

What is a good tumor marker for ovarian cancer and when is it most effective

A

CA-125: Marker for progression and recurrence

  1. ) Preenopause: Could be endometriosis
  2. ) Postmenopause: Raised Ca-125 more suspicious of a malignant ovarian tumor
33
Q

What is the first step in diagnosis if a symptomatic patient presents and you are concerned for ovarian cancer

A

Transvaginal ultrasound - if > 8cm, solid, multilocular, bilateral, and see ascites, think of cancer

34
Q

The treatment of ovarian masses depends on whether they are premenopausal or postmenopausal. What is it

A

Premenopausal: Close observation if all signs of benign tumor, but if malignant suspicion then surgically evaluate

Postmenopausal: Follow closely with ultrasound

35
Q

What is the treatment of ovarian cancer

A

Surgery - TAH and BSO
Postoperative chemotherapy

Only do radiation therapy if dysgerminomas

Remember that OCP use decreases the risk of this and endometrial cancer

Gynecology (6 decks)

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