Module 7 genital tract cancers

Question 1

Endometrial cancer risk factors

Answer 1

estrogen exposure without progesterone 
family hx
- ovarian, endometrial, colon cancer
hypertension
diabetes

Question 2

Factors that influence risk of endometrial cancer

Answer 2

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

Question 3

oral contraceptives and endometrial cancer

Answer 3

medium to long term use of oral contraceptives results in substantially reduced risk

Question 4

increased risk of endometrial cancer

Answer 4

1st degree relative
personal hx of colon and breast cancers
Lynch II syndrome
hereditary nonpolyposis colorectal cancer

Question 5

endometrial cancer s/s

Answer 5

postmenopausal bleeding
painful urination 
dyspareunia
pelvic pain
cramping
pelvic discomfort
postcoital bleeding

Question 6

endometrial cancer physical exam

Answer 6

general physical exam
bimanual pelvic examination
transvaginal ultrasound

Question 7

endometrial cancer dx

Answer 7

endometrial biopsy
dilation and curettage
CT with contrast of abd/pelvis

Question 8

ovarian cancer risk factors

Answer 8

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

Question 9

ovarian cancer physical exam

Answer 9

pelvic exam including rectovaginal exam

Question 10

ovarian cancer s/s

Answer 10

persistant

• pelvic pain
• abd. pain
• urinary urgency/frequency
• inc. abdominal size
• abdominal bloating
• difficultly eating
• early satiety

Question 11

ovarian cancer dx

Answer 11

transvaginal pelvic ultrasound
tumor marker
- CA-125, OVA1, HE4
CT
- look for: lymphadenophathy, ascites, omental caking, diaphragmatic thickening, pleural effusion

Question 12

ovarian cancer tx

Answer 12

referral to gynecologic oncologist

• complete debulking surgery
• • hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and node sampling

Question 13

vulvar cancer risk factors

Answer 13

cigarette smoking
HIV
immunosuppression
low socioeconomic status
vulvar intraepithelial neoplasia
other genital cancers
lichen sclerosus 
HPV
chronic venereal granulomatous disorders

Question 14

vulvar cancer s/s

Answer 14

vulvar irritation
burning
pain
pruritis
local discomfort
excoriation
fissuring
painful irritation
bleeding
discharge
painful vulvar lesion

Question 15

vulvar cancer physical exam

Answer 15

initial lesion may appear as a small raised area or as an ulceration that will not heal

Question 16

vulvar cancer dx

Answer 16

biopsy

Question 17

vaginal cancer risk factors

Answer 17

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

Question 18

vaginal cancer s/s

Answer 18

most asymptomatic and present with vaginal bleeding w/out discomfort

symptomatic:
- vagina pain
- pelvic pain
- dysparenunia
- postcoital bleeding
- dysuria
- constipation
- vaginal discharge

Question 19

vaginal cancer physical exam

Answer 19

thorough pelvic exam

Question 20

vaginal cancer dx

Answer 20

colposcopic exam and biopsy

pap test of the cervix and vagina

Question 21

cervical cancer s/s

Answer 21

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

Question 22

cervical cancer physical exam

Answer 22

vaginal examination

• enlarged cervix
• friable tumor on the cervix
• ulcerative lesion that bleeds easily on contact

Question 23

cervical cancer dx

Answer 23

pap smear