Gynecological Cancers

Question 1

In early disease, does cervical cancer have symptoms?

Answer 1

cervical cancer usually does not cause signs or symptoms. Watery vaginal discharge, intermittent spotting, or postcoital bleeding may be signs of a lesion

Question 2

what is the most common pathology for cervical cancer?

Answer 2

squamous cell carcinoma is 85%

Question 3

Can cervical cancer be considered an STD?

Answer 3

according to current, it can. Both squamous cell and adenocarcinoma of the cervix are etiologically related to infection with HPV, primarily types 16 and 18

Question 4

in late disease, what are some signs of cervical cancer?

Answer 4

bladder or rectal dysfunction or fistulas, and pain

Question 5

What test should be performed for screening of cervical cancer? How about diagnosis of cervical cancer?

Answer 5

pap smear and biopsy respectively.

Question 6

If cervical cancer goes untreated, what do 2/3 of women die from?

Answer 6

If cervical cancer goes untreated, almost 2/3 die from uremia when ureteral obstruction is bilateral. Pain is in the back

Question 7

How can we prevent cervical cancer?

Answer 7

2 vaccines: Gardasil and Cervarix to prevent cervical cancers caused by 16 and 18

Question 8

How should we treat cervical cancer?

Answer 8

if women are past childbearing age, a pelvic surgery might be an option. If they are not, treatment can be managed by radiation with or without chemo depending on the stage of the disease. Surgery vs Radiation therapy for stage I and IIA disease is the same. However, some disadvantages of radiation are injury to surrounding organs, vaginal stenosis, sexual dysfunction, ovarian failure

Question 9

what is the number one presenting sign of endometrial cancer?

Answer 9

abnormal bleeding!!

Question 10

is a pap smear positive or negative for endometrial cancer?

Answer 10

negative, it is NOT RELIABLE.

Question 11

what is the usual age for endometrial cancer, and the risk factors?

Answer 11

It occurs most often in women 50-70 years of age. Obestity, nulliparity, diabetes, and polycystic ovaries with prolonged anovulation, unopposed estrogen therapy, and the extended use of tamoxifen for the treatment of breast cancer are also risk factors. Family history of colon cancer puts women at higher risk.

Question 12

what are the clinical signs of endometrial cancer?

Answer 12

• post menopausal bleeding
• peri menopausal bleeding
• irregular pre-menopausal bleeding

Question 13

what is the treatment for endometrial cancer?

Answer 13

Surgery is definitive treatment:

Total hysterectomy and bilateral salpingo-oophorectomy

Question 14

What are the risk factors of for vulvar cancer?

Answer 14

1. history of genital warts

2. history of prolonged vulvar irritation, with pruritus, local discomfort, or slight blood discharge.

Question 15

What is the histological majority of vulvar cancer?

Answer 15

• majority are squamous lesions, and usually occur in women over 50
• some may relate to HPV

Question 16

How do you DIAGNOSE vulvar cancer?

Answer 16

biopsy, multiple punches is best.

Question 17

How does vulvar cancer usually spread?

Answer 17

• vulvar cancer tends to spread by direct extension into the vagina, urethra, perineum, and anus, with discontinuous spread int the inguinal and femoral lymph nodes. CT or MRI of the pelvis or abdomen is generally not required except in advanced cases for planning therapeutic options.

Question 18

What is the treatment for vulvar cancer?

Answer 18

-wide variety of options: topical chemo, laser ablation, wide local excision, skinning vulvectomy, and simple vulvectomy

Question 19

What are the initial symptoms of ovarian cancer?

Answer 19

1. Vague GI discomfort, pelvic pressure or pain.

2. Many cases of early-stage cancer are asymptomatic

Question 20

What are the different types of ovarian cancer?

Answer 20

There are epithelial, germ cell, stromal carcinomas, and metastatic

Question 21

Women with what mutation have a much higher risk of ovarian cancer?

Answer 21

BRAC1 or BRAC2. screening starting at age 35 or 5-10 years earlier than the earliest age that ovarian cancer was first diagnosed in a family member. screening should be done every 6 months and do a CA-125 levels.

Question 22

what are some of the signs of ovarian germ cell tumors?

Answer 22

i. Most frequent in late teens or early twenties
ii. Fertility concerns
iii. Often present with acute pain, and can be confused with an appy or ectopic pregnancy (so you want to order appropriate tests to rule those out!)
iv. CHEMO SENSITIVE!!! (use chemo instead of comprising child bearing ability)
v. Almost always unilateral

Question 23

describe ovarian epithelial type:

Answer 23

MOST COMMON TYPE!!!

i. Leading cause of gynecological death
ii. Age: primary post-menopausal
iii. Race: Caucasian> black
iv. Geopgraphy: European
v. Reproduction: low parity, breast feeding, OCP (protective), ERT (no effect

Question 24

What labs may be indicated for ovarian cancer?

Answer 24

CA 125 is elevated in 80% of women with epithelial ovarian cancer but only in 50% of women with early disease. However, it can also be elevated in benign endometriosis so it is not clinically specific. Other markers such as hCG, LD, or alpha fetoprotein may be indicators of a tumor being present

Question 25

What imaging may be needed for ovarian cancer?

Answer 25

transvaginal sonography

Question 26

What is the definitive treatment for epithelial type ovarian cancer?

Answer 26

surgery. Advanced disease→ removal of all visible tumor is recommened. EXCEPT IN WOMEN WITH LOW GRADE CANCER, post operative chemo therapy is recommended
Mammogram is also recommended in those who are younger than 35 due to the increased co-risk of breast cancer

Question 27

What findings may suggest an oncology consult for an adnexal mass?

Answer 27

Oncology consult is suggested if:

1. elevated CA-125, LDH, AFP, or HCG
2. complex US findings
3. premenarchal
4. ascites
5. prior cancer diagnosis (especially breast cancer)