Neoplasms Flashcards
6 women’s health neoplasms to know
breast cancer
cervical carcinoma
cervical dysplasia
endometrial cancer
ovarian neoplasms
vaginal/vulvar neoplasms
mc malignancy in women
breast ca
4 rf for breast ca
menarch before 12 yo
advanced maternal age w. first full term pregnancy
nulliparity
menopause after 52 yo
describe a malignant breast mass (2)
irregular
immobile
3 PE findings of breast ca
immobile irregular mass
nipple retraction
bloody nipple d.c
4 types of breast ca to know
infiltrating intraductal carcinoma (IIC)
infiltrating lobular
paget’s dz of the nipple
inflammatory breast ca
mc type of breast ca
infiltrating intraductal carcinoma (ICC)
which type of breast ca is frequently bilateral
infiltrating lobular
which breast ca is characterized by chronic, eczematous itchy, scaling rash on the nipples and areola
paget’s dz of the nipple
which breast ca is characterized by red, swollen, warm and itchy breast; nipple retraction, and peau d’orange
inflammatory breast ca
which type of breast ca is not associated w. a mass
inflammatory breast ca
3 types of breast ca tumors (hormones)
-estrogen receptor positive (ER)
-progesterone receptor positive (PR)
-human epidermal growth factor receptor positive (HER2)
breast ca tumors from most to least common
ER
PR
HER2
tx for breast ca
-segmental mastectomy (lumpectomy) followed by xrt in all pt’s +/- chemo
-anti-estrogen tamoxifen
-aromatoase inhibitors (estrogen inhibitors)
-monoclonal abs
indications for chemo w. breast ca
positive nodes stage I and II w. tumors < 4 cm in diameter
what pharm tx is most effective for ER positive breast ca tumors
tamoxifen
moa for tamoxifen
binds/blocks estrogen receptors in breast tissue
what pharm tx is most effective for postmenopausal ER positive breast tumors
aromatase inhibitors (anastrozole)
moa for aromatase inhibitors
reduces estrogen production
what pharm tx is most effective for HER2 positive breast tumors
monoclonal abs
triad associated w. cervical ca extension into the pelvic wall
unilateral leg edema
sciatic pain
ureteral obstruction
cervical ca is the _ mc type of ca
third
80% of pt’s w. cervical ca present w.
abnormal vaginal bleeding
mc age group for cervical ca
postmenopausal
besides abnormal vaginal bleeding, 3 less common sx of cervical ca
postcoital bleeding
vaginal d.c
pain
mc type of cervical ca _
mc arises from _
squamous cell
arise from squamocolumnar junction/ectocervix (transformational zone)
5 rf for cervical ca
multiple sex partners
early age of intercourse
early first pregnancy
HPV
smoking
99% of cervical ca is due to
HPV
which types of HPV are associated w. cervical ca
16
18
31
33
PE finding of cervical ca
friable, bleeding cervical lesion
gs dx for cervical ca (2)
bx of gross lesions
colposcopically directed bx
tx for cervical ca stages 1 and 2
stage 1: conservative, simple, or radical hysterectomy
stage 2: chemo +/- xrt
what age shold pt’s receive first pap regardles of sexual activity
21 yo
indications for pap earlier than 21 yo
at the time of intercourse for women who are:
-HIV (+)
-chronic immunosuppression (SLE, post organ transplant)
cervical ca screening guidelines for women 21-29
cytology only q 3 yaers
cervical ca screening guidelines for women 30 yo and older
q 5 years:
cytology
PLUS
HPV testing
4 indications for annual cervical ca screening
HIV (+)
immunosuppression
in utero DES exposure
past tx for cervical ca
guidelines for d.c of pap smears
-total hysterectomy if for benign condition
-65 yo if 3 negative cytology tests OR 2 consecutive negative HPV/pap co-tests 10 years before stopping w most recent test w.in 5 years
pap pathology:
asc-us:
lsil:
hsil:
asc-us: atypical squamous cells of undetermined significance
lsil: low grade squamous intraepithelial lesion -> mild dysplasia (CIN I)
hsil: high grade squamous intraepithelial lesion -> mod-sev dysplasia (CIN II-III, carcinoma in situ)
management of pt w. negative pap cytology but hpv positive
repeat both tests in 12 mo
management of ASC-US, LSIL, and CIN-1
reflex HPV testing:
if negative or < 25 yo -> retest in 12 mo
if positive and >/= 25 yo -> colposcopy
management of HSIL, CIN-2, CIS
colposcopy::
outside cervix -> LEEP vs cryotherapy
inside cervix: cone bx
gardasil 9 guidelines
-females and males 11-12 yo (as early as 9 yo)
-catch up: females 13-26 yo, msm 22-26 yo, immunocompromised
-27-45 yo: shared decision making
dosing of gardasil 9
<15 yo: 2 doses 6 months apart
>15 yo and immunocompromised: three doses at 0, 1-2mo, and 6 mo
mc gyn malignancy
endometrial ca
cardinal sx of endometrial ca
postmenopausal vaginal bleeding
bleeding in postmenopausal women is _ until proven otherwise
endometrial ca
mc type of endometrial ca
adenocarcinoma
9 rf for endometrial ca
obesity
nulliparity
early menarche
late menopause
unopposed estrogen therapy
HTN
gallbladder dz
DM
prior ovarian/endometrial/breast ca
50% of women w. endometrial ca will have an
abnormal pap
dx for endometrial ca
endometrial bx
all women w. postmenopausal vaginal bleeding should get a
endometrial bx
tx for endometrial ca
1.total hysterectomy w. bilateral salpingoophorectomy
2. pelvic xrt +/- chemo
2nd mc type of gyn ca
ovarian
age range for ovarian ca
40-60
if a woman has _ ovarian ca is the most likely tumor to be found
ascites
2 sx associated w. ovarian ca at advanced age
ascites
abd pain
3 protective factors against ovarian ca
multiparity
OCP
breast feeding
5 rf for ovarian ca
nulligravidity
infertility
early menarche
late menopause
endometriosis
mc type of ovarian ca
epithelial
dx for ovarian ca
- transvaginal US
- bx
serum tumor marker for ovarian ca
ca-125
what gene is associated w. ovarian ca
BRCA1
tx for ovarian ca stages 1-2
hysterectomy w. bilateral salpingoophorectomy
tx for ovarian ca stages III-IV
- hysterectomy w. bilateral salpingoophorectomy
- chemo + xrt
what is used to monitor tx of ovarian ca
ca-125
4 rf for vulvar/vaginal carcinoma
hpv
smoking
cervical carcinoma
in utero des exposure
vaginal ca is rare and is usually caused by
other gyn cancer
peak age of vaginal ca
60-65 yo
mc type of vaginal ca
squamous cell
squamous cell vaginal ca is associated w. what rf:
adenocarcinoma vaginal ca is associated w. what rf:
sqamous cell: hpv
adenocarcinoma: in utero DES exposure
mc location of vaginal carcinoma
upper one-third of posterior vaginal wall
2 mc presenting sx of vaginal carcinoma
abnormal vaginal bleeding
changes in menstruation
tx for vaginal carcionma
xrt
peak incidince of vulvar ca
50 yo
mc presenting sx of vulvar ca
vaginal pruritis
what 2 types of vulvar ca represent 90% of cases
squamous cell
melanoma
rf for vulvar ca
hpv 16, 18, 31
PE finding of vulvar ca
pruritic black lesions -> hpv
dx for vulvar ca
bx
what guides bx location for vulvar ca
toludine blue
OR
acetic acid staining
tx for vulvar ca
vulvectomy
PLUS
lymph node dissection
what do pruritic red lesions on the vulva make you think
paget’s dz
