Gynecologic Oncology Flashcards
What are screenings for cervical cancer
Pap smear
HPV testing
how often should women 21-30 get PAP smears
every 3 years - if normal-risk
how often should women ages 30-65 get cervical cancer screenings
Cervical cytology alone every 3 years
OR
HPV testing alone every 5 years
OR
HPV and PAP every 5 years
what are the harms of screening
increase number of procedures - preterm labor, incompetent cervix
-many lesions would resolve on their own
when is no cytology screening recommended
under 21 or > 65 and previously screened
when is colposcopy + acetic acid stain used
ASCUS and + HPV
any CIN (-3)
when is cryosurgery used
small, non-invasive lesions
when is CO2 laser used
large visible lesions
when is the LEEP procedure used
excisional biopsy for lesions fully visible
in office, local anesthesia
what is Conization
surgical removal of entire transformation zone
CIN III or carcinoma in situ
when is cervical cancer most commonly diagnosed
between 35-44 years of age
What does CIN stand for
cervical intraepithelial neoplasia
what does ASCUS stand for
atypical squamous cells of undetermined significance
what are high risk factors for cervical cancers
HPV infection (types 16 and 18) - high number of sexual partners, early age at first intercourse, history of other STIs
HIV infection
Immunosuppression
Smoking
Exposure to DES in utero
previous tx for CIN 2 or CIN 3
What is CIN III
pre-cancerous stage
predominantly women ages 25-40
what are the different cervical carcinomas
Squamous cell carcinoma
adenocarcinomas
adenosquamous
arise primarily int he transitional zone
what are common symptoms of cervical cancers
metrorrhagia, postcoital spotting, cervical ulcerations
later stages: bladder and bowel dysfunction; fistulas
what is the definitive diagnosis for cervical cancer
biopsy
what imaging can be used for staging and treatment planning of cervical cancer
CT (primarily evaluates kidneys)
MRI (assesses uterine and paracervical extension)
US
what are the stages of cervical cancer
0-4
what is the treatment of choice for carcinoma in situ
total hysterectomy
what is the treatment for carcinoma in situ if the patient wishes to preserve childbearing abilities
removal of cervix and surrounding structures + lymph node dissection with retention of uterus
cervical conization, laser ablation, cryosurgery (all with close follow up)
What is the treatment of early, small cell stage 1 cervical cancer
total hysterectomy alone
what is the treatment for cervical cancer stages I-IV
radiation and chemo (primarily cisplatin)
+/- total hysterectomy
what are complications of cervical cancer stage II - IV
risk for vaginal hemorrhage
-cause of death in 10-20% of pts with invasive cervical CA
what is the treatment of vaginal hemorrhage
ligation of uterine or hypogastric arteries
hemostatic agents: acetone, monsel’s solution
vaginal packing
radiation
what are the types of uterine cancer
endometrial adenocarcinomas (endometrial lining)
Leiomyosarcomas (uterine smooth muscle)
what is the average age of diagnosis of leiomyosarcomas
50-52
what are risk factors of leiomyosarcomas
excess estrogen exposure
tamoxifen use
black patients
prior pelvic radiation
what can reduce your risk of leiomyosarcomas
OCPs and Smoking
what is different with leiomyosarcomas than other uterine tumors
grow more quickly
more aggressive
metastasize more quickly
poorer prognosis
what are the symptoms of leiomyosarcomas
abnormal vaginal bleeding (most common)
pelvic or abdominal pain
profuse foul smelling discharge
+/- GI or urinary complaints
what is the most common type of uterine cancer
endometrium cancer
how is Leiomyosarcomas worked up
may be detected on endometrial biopsy or D&C
MRI/CT
Many diagnosed incidentally on operative histology
what is the treatment for leiomyosarcomas
total abdominal hysterectomy
+/- radiation
how often should patients with leiomyosarcomas follow up
PE every 3 months for first 2 years
3rd year: every 6-12 months
CT chest/abd/pelvis every 6-12 months
what is the average age at diagnosis of endometrial cancer
50-70yo
What are the two types of endometrial cancer
type 1: endometrioid (estrogen dependent)
type 2: non-endometrioid
what is Lynch syndrome
hereditary non-polyposis colorectal cancer
autosomal dominant condition
what is the most common symptom of endometrial cancers
irregular vaginal bleeding
what are the symptoms of pre-menopausal women with endometrial cancers
prolonged, heavy menstruation
spotting between periods
what are the symptoms for post -menopausal women with endometrial cancers
any vaginal bleeding
may present as abnormal vaginal discharge
what are the later signs stages of endometrial cancer
related to uterine enlargement or extrauterine extension
pelvic pain or pressure
bloating
early satiety
increased abdominal girth
what can be seen on PAP smear with endometrial cancer
benign endometrial ells on PAP in post-menopausal women
atypical glandular cells on PAP
what is the mainstay of workup for endometrial cancers
endometrial biopsy
D&C if insufficient sample of AUB persists
what is the treatment of choice for endometrial cancer
hysterectomy with bilateral salpingo-oophorectomy (BOS)
+/- chemo/radiation
what is a tumor marker that can be related to endometrial cancer
CA-125
what is a precursor to vaginal cancer
vaginal intraepithelial neoplasia (VaIN)
what is the most common symptom of vaginal cancer
AUB
may see pelvic pain or vaginal discharge
urinary symptoms if involving anterior vaginal wall
what is the workup for vaginal cancer
often identified via pelvic exam
gross lesions on speculum exam should be biopsies
colposcopy if lesions suspected but not grossly identified
CT to assess for metastasis
what is the treatment of stage 1 or 2 vaginal cancer
surgery or radiation; vaginectomy, hysterectomy, +/- lymphadenecotmy
radiation: external beam +/- brachytherapy
what is the treatment of stage III vaginal cancer
typically radation + chemo (cisplatin)
what is the treatment of stage 4 vaginal cancer
systemic chemo +/- palliative care
what is a common association with vulvar cancer
HPV infection
what are risk factors for vulvar cancer
HPV infection
increasing age
HPV associated genital warts
HSV infection
smoking
chronic immunosuppression
Lichen Sclerosus
what is the most common vulvar cancer
squamous cell carcinoma
what are symptoms of vulvar cancer
primarily puritis and visible lesion
may have pain, bleeding, ulceration and inguinal mass
how is vulvar cancer worked up
vulvoscopy with acetic acid staining - biopsy
should preform colposcopy of vagina and cervix at same time
dont forget perineal exam
what is the treatment of SCC vulvar cancer
local excision
larger lesions: radical partial vulvectomy
total vulvectomy + flap reconstruction
chemo and or radiation
what are risk factors for ovarian cancer
nulliparity
use of HRT/fertility tx
obesity
diet
what are protective for ovarian cancer
Multiparity
use of OCPs
use of ASA
tubal ligation
breast feeding
what are the histological types of ovarian cancer
epithelial cell (90%)
germ cell
stromal cell
what are the symptoms of ovarian cancer
primarily asymptomatic
palpable mass identified on pelvic exam
vague pelvic pain/pressure
occasionally bloating, nausea, indigestions, early satiety (late stage)
bowl/bladder changes (later stage)
increasing abdominal girth (later stage)
what is the workup for ovarian cancer
tumor marker: CA-125
TVUS: to differentiate between benign and malignant masses
open biopsy - for definitive dx
what is the treatment of ovarian cancer
sx removal of mass
included total hysterectomy, BSO, removal of omentum and selective lymphadenectomy
