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OB/GYN > Neoplasms > Flashcards

Neoplasms Flashcards

1
Q

What is definitive treatment for moderately differentiate vulvar squamous cell carcinoma?

A

Radical vulvectomy and groin node dissection

Squamous cell carcinoma is most common vulvar malignancy and may arise in setting of chronic irritation from lichen sclerosus.

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2
Q

DDx for vulvar squamous cell carcinoma:

  1. Shiny red/purple polygonal papules and plaques
  2. Thin, inelastic, white, “crinkled tissue paper” appearance
  3. White plaque-like lesions and poorly demarcated erythema
  4. Cauliflower-like lesions
A
  1. Lichen planus
  2. Lichen sclerosus
  3. Paget’s disease of the vulva (in situ carcinoma of vulva)
  4. Verrucous carcinoma
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3
Q

Bartholin gland mass - making the differential

A

Abrupt onset, post-menopausal: Primary vulvar adenocarcinoma is most likely
Slower onset: Fibroma, lipoma; younger age - benign Gartner’s duct cyst

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4
Q

Indications for trichloroacetic acid or imiquimod

A

Condyloma

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5
Q

Indication for cryotherapy

A

Cervical dysplasia

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6
Q

Flat, subtle, white vulvar lesions

A

Suggestive of vulvar dysplasia from HPV

DDx: Condyloma would be less flat

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7
Q

Indications for laser treatment

A

Vulvar HSIL with multifocal lesions

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8
Q

What are the guidelines regarding cervical screening? What are the special rules for ages 21-24?

A

If cytology shows ASCUS, either test for HPV now (+ —> colposcopy, — —> resume 3 years) or test with cytology in 1 year (+ —> colposcopy, — —> resume 3 years)

If 21-24 yo, if HPV+, repeat cytology at 12 months rather than colposcopy

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9
Q

What are signs of cervical cancer, and which are most concerning?

A

Atypical vessels (hairpin shapes or larger vessels branching from smaller ones)
Punctation = new blood vessels on end
Mosaicism = new blood vessels on their sides
Ectropion = columnar epithelium not yet undergone squamous metaplasia - reddish ring of tissue surrounding external os

Acetowhite epithelium can represent dysplasia but is less concerning

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10
Q

When should cervical screening be stopped?

A

Age 65 if negative 3x in a row or co-test negative 2x in a row in past 10 years

Continue if history of moderate-severe dysplasia or cancer

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11
Q

Risk factors for ovarian cancer; what is protective?

A

Low parity; delayed childbearing

Long-term suppression of ovulation appears to be protective against ovarian cancer - use OCPs

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12
Q

Different types of ovarian cysts

A

Functional ovarian cyst - 3-5 cm, form at time of ovulation; no blood, soft tissue elements or excrescences
Endometrioma - isolated collection of endometriosis involving ovary
Serous cystadenoma - larger than functional cysts; increased abdominal girth
Mucinous cystadenoma - multilocular and large
Dermoid tumor - solid components, echogenic; teeth, cartilage, bone, fat, hair

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13
Q

What is a routine part of ovarian cancer staging?

A

Omentectomy - does not spread hematogenously, but rather transcoelomic (across peritoneal surfaces)
Pelvic lymphadenectomy (but not inguinal)

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14
Q

What are the ovarian tumor subtypes? What are their risks?

A

Epithelial (90%) - malignant usually 6th decade of life
Germ cell (5%) - 10-30 yo
Sex-cord stromal (1-2%): granulosa cell tumors secrete high levels of estrogen —> endometrial hyperplasia or cancer

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15
Q

What typically causes ovarian torsion (lower quadrant pain, abdominal tenderness, on exam adnexal fullness and moderate tenderness and some voluntary guarding)

A

Dermoid cyst/mature cystic teratoma - enlarges ovary and are oily, which means less dense than surrounding tissue, rising to more anterior position and creating instability of infundibulopelvic ligament

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16
Q

What should someone with BRCA1?

A

Bilateral salpingo-oophorectomy between 35-40 yo

BRCA2 can be postponed to after age 40

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17
Q

What are the germ cell tumor markers to order?

A

LDH: Dysgerminoma
hCG: Choriocarcinoma
AFP: Yolk sac or endodermal sinus tumors
Inhibin: granulosa cell tumor - would also have elevated estrogen

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18
Q

What are the risk factors for endometrial cancer?

A

Nulliparity; late menopause; unopposed estrogens; obesity; HTN; diabetes

Not typically genetically inherited except for Lynch II syndrome

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19
Q

Signs of endometrial cancer

A

Bleeding; vaginal discharge; abdominal pain

20
Q

What should be done for postmenopausal woman with light spotting?

A

Pelvic transvaginal ultrasound or endometrial biopsy - to rule out cancer

Causes: atrophy of endometrium; menopause hormone therapy; endometrial cancer; polyps; endometrial hyperplasia

21
Q

What should you do if a patient has a new palpable breast mass or lymph node?

A

Needle aspiration

22
Q

How do OCPs affect various cancer risks?

A

Decreased risk of ovarian and endometrial (ever used)
Increased risk of cervical (current or recent use)

23
Q

Call-Exner bodies

A

Granulosa cell tumor

24
Q

LDH and rapidly enlarging, painful pelvic mass

A

Dysgerminoma

25
Q

Elevated bhCG and AFP, and rapidly increasing pelvic pain

A

Embryonal carcinoma

26
Q

What is struma ovarii?

A

Mature teratoma that produces thyroxine

27
Q

How is choriocarcinoma staged?

A

Chest x-ray, not CT

28
Q

Cuboidal, non-ciliated epithelium in ovarian mass is?

A

Cystadenoma (benign)

29
Q

Dysgerminomas secrete…

A

LDH, bhCG

30
Q

what is imiquimod used for?

A

Warts, VIN

31
Q

Condyloma acuminata can be treated how?

A

Imiquimod (induces local cytokines)
Trichloroacetic acid

32
Q

BRCA1 and BRCA2 should undergo what ovarian cancer screening?

A

Pelvic US and CA-125 q6months starting at 30 yo

33
Q

How does atypical glandular cells on Pap test affect workup if <35 vs >=35?

A

> =35 or <35 with risk factors of endometrial cancer (abnormal uterine bleeding, anovulation, obesity) - add endometrial biopsy

All cases require colposcopy and endocervical curettage

34
Q

Endometrial cells on Pap test are worked up how, based on age?

A

<45: benign
>=45, especially postmenopausal: endometrial biopsy

35
Q

Does atypical squamous cells of undetermined significance suggest increased risk of cancer?

A

No, not without positive HPV status

36
Q

Hydatidiform mole vs fibroids

A

Mole is soft, cystic villi, not irregular uterine enlargement or firm mass

37
Q

What should be evaluated in new-onset constipation with early satiety and pain, unrelated to bowel movements in female >=50 yo?

A

Malignancy - ovarian cancer, colon cancer

38
Q

Risk factors for hydatudiform mole

A

Infertility
Extremes of age (<=15 and >35)

39
Q

Do women with postmenopausal bleeding require a Pap test?

A

Yes - cervical cancer peak is ~50 years old

40
Q

Complete vs partial mole

A

Complete is one sperm, empty ovum; 46,XX, no fetal tissue
Partial is two sperms, normal ovum; 69,XXY, fetal tissue

41
Q

Fat necrosis calcifications

A

Coarse (not micro)

42
Q

Postmenopausal vaginal cancer tends to be what?

A

Squamous (as opposed to adenocarcinoma in younger)

43
Q

Inhibin is marker for what ovarian cancer?

A

Granulosa

44
Q

LDH marker and sheets of uniform “fried egg” cells

A

Dysgerminoma

45
Q

Which ovarian cancer can secrete both AFP and bHCG?

A

Embryonal carcinoma

OB/GYN (29 decks)

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