Module 7 genital tract cancers Flashcards
Endometrial cancer risk factors
estrogen exposure without progesterone family hx - ovarian, endometrial, colon cancer hypertension diabetes
Factors that influence risk of endometrial cancer
hormone levels - estrogen after menopause, birth control pills, tamoxifen number of menstrual cycles pregnancy obesity ovarian tumors PCOS intrauterine device age diet and exercise DM breast or ovarian cancer endometrial hyperplasia hx radiation therapy to pelvis
oral contraceptives and endometrial cancer
medium to long term use of oral contraceptives results in substantially reduced risk
increased risk of endometrial cancer
1st degree relative
personal hx of colon and breast cancers
Lynch II syndrome
hereditary nonpolyposis colorectal cancer
endometrial cancer s/s
postmenopausal bleeding painful urination dyspareunia pelvic pain cramping pelvic discomfort postcoital bleeding
endometrial cancer physical exam
general physical exam
bimanual pelvic examination
transvaginal ultrasound
endometrial cancer dx
endometrial biopsy
dilation and curettage
CT with contrast of abd/pelvis
ovarian cancer risk factors
genetic - BRCA1/2 - hereditary nonpolyposis colon cancer (lynch syndrome) - Peutz-Jeghers syndrome - PTEN tumor hamartoma syndrome - MUTYH-associated polyposis hormonal environmental obesity late menopause nulliparity early menarche
ovarian cancer physical exam
pelvic exam including rectovaginal exam
ovarian cancer s/s
persistant
- pelvic pain
- abd. pain
- urinary urgency/frequency
- inc. abdominal size
- abdominal bloating
- difficultly eating
- early satiety
ovarian cancer dx
transvaginal pelvic ultrasound tumor marker - CA-125, OVA1, HE4 CT - look for: lymphadenophathy, ascites, omental caking, diaphragmatic thickening, pleural effusion
ovarian cancer tx
referral to gynecologic oncologist
- complete debulking surgery
- hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and node sampling
vulvar cancer risk factors
cigarette smoking HIV immunosuppression low socioeconomic status vulvar intraepithelial neoplasia other genital cancers lichen sclerosus HPV chronic venereal granulomatous disorders
vulvar cancer s/s
vulvar irritation burning pain pruritis local discomfort excoriation fissuring painful irritation bleeding discharge painful vulvar lesion
vulvar cancer physical exam
initial lesion may appear as a small raised area or as an ulceration that will not heal
vulvar cancer dx
biopsy
vaginal cancer risk factors
HPV
diethylstilbestrol (DES) exposure
hx of cervical, vaginal, or uterine cancer
young age at coitarche (first sexual intercourse)
greater number of sexual partners
smoking
hx of pelvic irradiation
vaginal cancer s/s
most asymptomatic and present with vaginal bleeding w/out discomfort
symptomatic:
- vagina pain
- pelvic pain
- dysparenunia
- postcoital bleeding
- dysuria
- constipation
- vaginal discharge
vaginal cancer physical exam
thorough pelvic exam
vaginal cancer dx
colposcopic exam and biopsy
pap test of the cervix and vagina
cervical cancer s/s
early symptoms: - abnormal uterine bleeding: begins light and serosanguineous and becomes heavier and more persistent - foul vaginal discharge: thin, watery Late symptoms - pain - leg edema - urinary and rectal symptoms
cervical cancer physical exam
vaginal examination
- enlarged cervix
- friable tumor on the cervix
- ulcerative lesion that bleeds easily on contact
cervical cancer dx
pap smear
