Neoplasms Flashcards
what is the most common malignancy in women?
Breast cancer
What are some risk factors for breast cancer?
- increased exposer to estrogen
a. Menarche before age 12
b. old age of first full term pregnancy, no pregnancies
c. menopause after 52 - Breast mass- immobile, irregular
- Nipple retraction, bloody nipple discharge
What is the most common type of breast cancer?
infiltrating intraductal carcinoma accounting for about 80%
A chronic eczematous itchy scaling rash on the nipples and areola is what?
Pagets disease of the nipple
is infiltrating lobular usually unilateral or bilateral?
Bilateral
describe some PE findings with inflammatory breast cancer?
red swollen, warm and itchy breast often with nipple retraction and peau d’orange (NO LUMP)
What are the three catagories for which breast tumors can be positive for?
Estrogen receptor positive 75%
Progesterone receptor positive 65%
HER2 positive 25%
How often should women get a mammogram if they are in the age range of 50-74?
every 2 years
If someone has risk factors for breast cancer when should they start to get screened and how often?
they should start at 40 and every 2 years
If they had a relative with breast cancer then when should they start mammograms.
10 years before the age of the first relative or 50 which ever comes first
When should clinical breast exams start and how often?
should start at 20-39 and every 3 years, until they reach 40 then its yearly for the exam not mammogram
What is the USPSTF recommendations for self breast exam screening?
monthly beginning at age 20- immediately after menstruation on days 5-7 of the menstrual cycle
What is the tx for breast cancers in all patients?
Segmental mastectomy (lumpectomy) followed by breast irradiation in all patients
When would you add on chemotherapy in a pt with breast cancer?
in women with positive nodes stage I and stage II with tumors less than 4 cm in diameter
If a tumor is ER positive what medication can be helpful in the treatment?
Anti-estrogen Tamoxifen- binds and blocks the estrogen receptor in the breast tissue
a woman who is postmenopausal with ER positive tumor would benefit from what type of medication?
Aromatase inhibitors- these reduce the production of estrogen
Patients with HER2 positive tumors benefit from what type of treatment other than chemo and shit?
Monoclonal AB treatment
What clinical triad is strongly indicative of cervical cancer extension to the pelvic wall?
unilateral leg edema, sciatic pain, ureteral obstruction
Cervical cancer is the _______ most common type of cancer
Third
What is the main presenting symptom for cervical cancer
Abnormal vaginal bleeding most commonly postmenopausal
What cell is most commonly involved in cervical cancer (i.e epithelial or squamous)
Squamous cells which arise from the squamocolumnar junction of the cervix aka the transformational zone
What are some risk factors for carcinoma of the cervix?
multiple sex partners
early age of first intercourse
early first pregnancy
HPV positive
What HPV types cause cervical cancer, which one are the most common?
16, 18, 31 and 33
True or false squamous cell cervical cancer is associated with smoking?
True
How do you Dx cervical cancer?
Friable, bleeding cervical lesion on exam
Biopsy of gross lesions and colposcopically directed biopsies are the definitive means of diagnosis
Majority of cases (80%) are invasive squamous cell types usually arising from the ectocervix
Tx for strage 1 cervical cancer?
conservative, simple or radical hysterectomy
Tx for stage 2 cervical cancer?
Chemo +/- radiation
What is the 5 year survival rate for stage 1, 2, 3 and 4
Stage 1: 85-90
stage 2: 65%
Stage 3: 29%
Stage 4: 21%
At what age should someone receive their first PAP regardless of sexual activity?
21
ACOG guidelines for pap smear initiation?
initiated at age 21. Plus at the time of initial intercourse for women under 21 who have HIV infection or who are on chronic immunosuppressive therapy for systemic lupus erythematosus or post organ transplantation
For woman 21-29 what type of PAP screening is recommended and how often?
cytology and every 3 years
For woman 30 years and older what are the PAP screening recommendations?
cytology and HPV testing every 5 years
What groups is annual pap smear screening recommended?
high risk: HIV, immunosupression or in utero DES
Do woman need cytology screening if they have had a hysterectomy?
nope
What age can you discontinue screening PAP sear screening?
at age 65 for woman who have had adequate recent screening
How is adequate screening defined?
Adequate screening is defined as three consecutive negative cytology tests or two consecutive negative HPV/Pap co-tests in the 10 years before stopping, with the most recent test within 5 years
What does ASC-US stand for?
Atypical squamous cells of undetermined significance
what does LSIL stand for?
Low-grade squamous intraepithelial lesion, that is, mild dysplasia, CIN I
what does HSIL stand for on pathology report?
High-grade squamous intraepithelial lesion, that is, moderate to severe dysplasia, CIN II-III, carcinoma in situ
if a womans pap smear is negative cytology but positive HPV when should their tests be repeated?
in one year
If a pathology report comes back with ASC-US and up what type of testing is required?
reflex HPV testing if negative can repeat in 12 months if + then send for colposcopy
If reflex HPV test is positive and they are at least 25 years old what do you do next?
Colposcopy
if reflex HPV test is negative or they are under 25 years old, what do you do next?
retest in 1 year
Dosing for HPV vaccine in those younger than 15 years old?
dminister a two- rather than a three-dose vaccine series. In such patients, the two doses are administered at least six months apart
Dosing of HPV vaccine in those greater than 15 years old?
the HPV vaccine is administered in three doses at 0, at 1 to 2 months, and at 6 months
should immunocompromised pt receive the 2 or 3 dose HPV vaccine series?
the three dose
What is the most GYN malignancy?
Endometrial cancer
what is the cardinal symptom for endometrial cancer?
postmenopausal vaginal bleeding- 1/3 of woman with postmenopausal bleed have endometrial cancer
What is the most common type of endometrial cancer?
adenocarcinoma
What are some risk factors for endometrial cancer?
- obesity
- nulliparty
- early menarche
- late menopause
How do you diagnose endometrial cancer?
endometrial biopsy
If a woman presents with postmenopausal bleeding what should you do?
an endometrial biopsy is indicated for all woman with postmenopaual bleeding
Tx for endometrial cancer
Usually total hysterectomy and bilateral salpingo-oophorectomy, pelvic radiation therapy with or without chemotherapy for stage II or III cancer
What is the second most common type of GYN cancer in women? what is the first?
second most common is ovarian, first is endometrial
If a women has ascites what type of cancer is most likely to be found?
ovarian tumor
what are some protective factors for ovarian cancer?
multiparty
OCP use
Breast-feeding
feel like smoking too
What are risk factors for ovarian cancer?
nulligravidity (or infertility), early menarche, late menopause, endometriosis
What type of cell makes up most of the ovarian cancers?
90% are epithelial tumors
How do you diagnose ovarian cancer?
transvaginal ultrasound then biopsy
What serum tumor marker can you test for ovarian cancer?
Marker CA-125,
BRCA1 gene is also associated with 5% of ovarian cancer
For stage 1A or 1B what is the Tx?
Surgical excision alone
what should be monitored after tx of ovarian cancer?
serum CA-125
What age is the peak incidence of vulvar cancer?
50 years old
What is the most common presentation of vulvar cancer?
Vaginal pruritus (70%) will have this symptom
What kind of cell is vulvar cancer?
90% are squamous cell and also melanoma
What is the Dx for vulvar cancer?
Application of acetic acid or staining with toluidine blue may help direct optimal biopsy location
What is the tx for valvular cancer?
Vulvectomy and lymph node dissection
