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Women's Health EOR > Neoplasms > Flashcards

Neoplasms Flashcards

1
Q

What is the MC malignancy in women and 2nd leading cause of death

A

MC malignancy in women and 2nd leading cause of death = BCA

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2
Q

What type of BCA is MC

A

MC type of BCA = Invasive ductal carcinoma

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3
Q

2 types of non-invasive BCA

A

Non-invasive BCA (in situ)

  1. DCIS - ductal
  2. LCIS - lobular
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4
Q

What is the biggest RF for BCA

A

biggest RF for BCA = incr age

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5
Q

What 2 mutations a/w incr risk of developing BCA

A

BRCA1/2 mutations = incr risk of BCA

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6
Q

BRCA mutations/genetic testing

  1. how many 1st degree rel needed for testing to be indicated
  2. pts w/ what ancestry = incr risk
  3. BRCA mutations = what type of inheritance pattern
A

BRCA mutation genetic testing

  1. need 2 1st deg rel for testing to be indicated
  2. incr risk mutations w/ Ashkenazi Jewish pts
  3. Autosomal dominant
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7
Q

Pt presents w/ single, NT, firm, fixed, immobile mass w/bloody d/c that is poorly circumscribed and located in the upper outer quadrant of the breast. Mammogram reveals microcalcifications and a spiculated mass

What are you concerned about based on this presentation?

A

Concerned about BCA

  • NT, firm, fixed, immobile mass w/bloody d/c that is poorly circumscribed
  • upper outer quadrant
  • Mammo –> microcalcifications and a spiculated mass
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8
Q

Types of BCA

  1. what type a/w tumor cells that cause lymphatic obstruction, redness,
  2. what type a/w chronic ezcematous rash (nipple + areola)
  3. what type a/w peau de orange appearance of the breast
A

Types of BCA

  1. A/w tumor cells that cause lymphatic obstruction = Inflam BCA
  2. A/w chronic ezcematous rash (nipple + areola) = Paget’s Dz
  3. A/w peau de orange appearance of breast = Inflam
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9
Q

Why is radiation and adjuvant chemo done after breast CA surg?

A

Radiation and adjuvant chemo done after breast CA surg to prevent recurrence

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10
Q

What types of BCA respond to hormonal Tx

A

ER+/PR+ (estrogen/progesterone receptor +) BCA responds to hormonal Tx

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11
Q 
ER/PR+ BCA 
- what class of drugs can treat these types of BCA
A

ER/PR+ BCA

  • SERMs (Selective Estrogen Rec Modulators) Tx it
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12
Q

Pt is found have ER+ BCA. What 2 drugs in the SERM class could you give her that would be effective against it

A

ER + (or PR+) BCA drugs

  1. Tamoxifen
  2. AIs (Aromatase Inhibitors) -ozoles
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13
Q

If a pt has HER2+ BCA what is the only type of hormonal therapy that will work against it

A

HER2+ BCA –> monoclonal Ab (Trastuzumab/Herceptin)

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14
Q

1st LNs impacted by BCA called

A

1st LNs impacted by BCA = sentinel LNs

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15
Q

Pt determined to have BCA –> you perform a sentinel lymph node Bx that is (+). What is the next appropriate step?

A

SLN Bx (+) –> ALND (full axillary LN Dissection)

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16
Q

What is the most important/favorable prognostic factor for BCA

A

most important/favorable prognostic factor for BCA = (-) LN status

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17
Q

What is the minimum BIRADS score that indicates the mass is suspicious for malignancy therefore CNBx must be obtained

A

BIRADS score 4 –> suspicious for malignancy, CNBx must be obtained

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18
Q

Workup/Methods of Sampling for solid mass

  1. < 30 y/o –>
  2. > 30 y/o –>
  3. FNA non-Dx –>
A

Workup/Methods of Sampling for solid mass

  1. < 30 y/o –> FNA
  2. > 30 y/o –> CNBx
  3. FNA non-Dx –> excisional Bx
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19
Q

What other breast d/o can mimic BCA on mammogram

A

Fat necrosis can mimic BCA on mammogram

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20
Q

What is the typical cause of fat necrosis

A

Cause of fat necrosis –> trauma to breast

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21
Q

40 y/o women presents for BCA screening, mammogram reveals ill-defined mass w/ cluster of calcifications in L breast. About 1 yr pt states she was in an MVA, and seatbelt bruised her L breast

Dx?

A

Dx = Fat necrosis

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22
Q

40 y/o women presents for BCA screening, mammogram reveals ill-defined mass w/ cluster of calcifications in L breast. About 1 yr pt states she was in an MVA, and seatbelt bruised her L breast

Dx?

A

Dx = Fat necrosis

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23
Q

What types of HPV cause Vulvar Cancer (3)

A

HPV types 16, 18, 31 cause vulvar cancer

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24
Q

What is MC histology for Vulvar and Vaginal CA

A

MC histology for Vulvar and Vaginal CA = SCC

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25
Q

MC Sx a/w vulvar CA

A

MC Sx a/w vulvar CA = vulvar pruritus/irritation

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26
Q

62 y/o pt postmenopausal pts w/ PMH of lichen sclerosus and HIV presents w/ vulvar pruritus, pain, and bleeding x 2 yrs that a/w lesion on labia majora. Also c/o of dysuria and perianal burning. 1 mo ago she was treated w/ for fungal infxn but Sxs persisted.

Most likely Dx?
What is next best step to confirm Dx

A

Dx = Vulvar CA

Next –> Bx

27
Q

Vulvar CA Dx + Tx

  1. What is commonly seen on Bx
  2. What type of surgical Tx is usually done
A

Vulvar CA Dx + Tx

  1. Bx –> red/acetowhite ulcerative lesions
  2. surgical Tx = wide local excision
28
Q

What is the MC site for Vaginal CA

A

MC site of Vaginal CA = upper 1/3 of vagina

29
Q

DES exposure in utero/ < age 20 increases the risk of what

A

DES exposure in utero/ < age 20 increases the risk of Clear Cell Adenocarcinoma

30
Q

DES exposure in utero/ < age 20 increases the risk of what

A

DES exposure in utero/ < age 20 increases the risk of Clear Cell Adenocarcinoma

31
Q

75 y/o pt w/ h/o cervical CA, HPV infxn, smoking, and DES exposure presents w/ painless vaginal bleeding/pruritus/ watery blood tinged d/c. Last pap was abnormal so colposcopy and Bx performed.

Dx?

A

Dx = Vaginal CA

32
Q

Tx of Vaginal CA

  1. Tx for Stage I/small lesions
  2. Tx for Stage III/IV/large lesions
A

Tx of Vaginal CA

  1. Stage I/small –> surgical excision
  2. Stage III/IV/larger –> radiation
33
Q

What is the biggest RF for HPV

A

biggest RF for HPV= # of lifetime partners

34
Q

About HPV

  1. What type of CA does high risk strains cause (gen + histological)
  2. Is it MC latent or expressed + transient or persistent
A

About HPV

  1. high risk strains cause cervical CA, SCC
  2. MC latent + transient (most ppl clear it)
35
Q

Pap Smear Recommendations

  1. what age must you begin testing
  2. HIV+ when do you begin testing, how often after
  3. After what age can you stop pap smears if no h/o high grade dysplasia in past 20 yrs
  4. If only Paps are done as screening how often must pts get it done (ages 21+)
  5. If Pap + HPV testing done together how often must pts get it done (ages 30+)
A

Pap Smear Recommendations

  1. Must you begin testing at age 21
  2. HIV+ –> begin testing when sexually active, then anually
  3. After age 65 can stop pap smears if no h/o high grade dysplasia in past 20 yrs
  4. Only Paps are done –> repeat Q3 yrs (ages 21+)
  5. Pap + HPV testing done together–> repeat Q5 yrs (ages 30+)
36
Q

Pap Results

  1. (+) ASCUS –> next step
  2. (+) ASC-H, LSIL, HSIL, or AGC –> next step
A

Pap Results

  1. (+) ASCUS –>HPV test
  2. (+) ASC-H, LSIL, HSIL, or AGC –> colposcopy
37
Q

Pap results: (+) ASCUS

  1. if HPV test (-) –>
  2. if HPV test (+) –>
A

Pap results: (+) ASCUS –> HPV test

  1. HPV test (-) –> repeat cotesting in 3 yrs
  2. HPV test (+) –> colposcopy
38
Q

Colposcopy

  1. what 2 things are applied to highlight changes in cervix
  2. what results are concerning (6, 3 main)
A

Colposcopy

  1. App acetic acid or lugol’s iodine to highlight changes in cervix
  2. Concerning results
    - acetowhite changes (brighter = bad)
    - lugol’s –> areas that dont take up the iodine
    - squamous changes at transformation zone
    - mosaicism, punctuations and atypical vessels
39
Q

Cervical Intraepithelial Neoplasia/Dysplasia (CIN 1-3)

  1. which type is considered low risk
  2. how much of the epithelium is involved w/ CIN-2
  3. Another name for CIN III that is full thickness
  4. What types is tx recommended for
  5. What are the 2 types of excisional methods for Txting CIN, which usu done
A

Cervical Intraepithelial Neoplasia/Dysplasia (CIN 1-3)

  1. CIN 1 = low risk
  2. CIN 2 –> 2/3 of epithelium involved
  3. CIN III that is full thickness = carcinoma in situ

4 tx recommended for CIN II/III (high risk)

  1. Excisional methods
    - LEEP (Loop Electrosurgical Excision Procedure) = electrocautery, usu done
    - Cold Knife Conization = scalpel

Note: CIN 1 = lower 1/3

40
Q

What is the MC GYN CA in women

A

MC GYN CA in women = cervical CA

41
Q

Cervical CA

  1. what 7 types of HPV is it a/w
  2. what type is a/w skip lesions/sprinkler effect
  3. MC presenting Sx
  4. What is usu seen on PE
  5. What location = MC
A

Cervical CA

  1. a/w HPV types 16, 18, 31, 33, 45, 52, 58
  2. skip lesions/sprinkler effect –> adenocarcinoma
  3. MC presenting Sx = post coital bleeding
  4. PE –> friable transformation zone
  5. MC location = transformation zone (sq. columnar junction)
42
Q

52 y/o women, G5P5 c/o of postcoital bleeding. She has had 15 sexual partners, began having sex at age 15, has a h/o of STIs and smokes. She also c/o watery vaginal d/c, vaginal bleeding, and pelvic pain/pressure. Speculum exam reveals friable transformation zone

Dx?
Best way to confirm Dx?

A

Dx = Cervical CA

Dx w/ colposcopy + Bx

43
Q

Tx of Cervical CA

  1. What is unique about how it is staged
  2. What stages can surgery be done to Tx it
  3. What is the tx for stages above #2
A

Tx of Cervical CA

  1. staged clincially!
  2. Stages I + IIA –> surgery
  3. Stages IIB+ –> chemoradiation
44
Q

What is prevention for Cervical CA

A

Prevention for Cervical CA = Gardasil Vaccine

45
Q

Gardasil Vaccine

  1. what age range can it be given, how many doses usu
  2. ideally given before _____
  3. how many types of HPV does it target
A

Gardasil Vaccine

  1. Given to BOYS + girls age 9-26, usu 2 doses
  2. ideally given before sexual activity
  3. Targets 9 types of HPV (all 7 high risk types + 6, 11)
46
Q

Pap Smears: additional info

  1. need to do routine cervical cytology for women w/ hysterectomy for benign reasons
  2. what type of Pap done for women w/ hysterectomy for CIN
A

Pap Smears: additional info

  1. DONT need routine cervical cytology for women w/ hysterectomy for benign reasons
  2. women w/ hysterectomy for CIN –> pap w/ vaginal cuff
47
Q

What GYN cancer is the MC cause of mortality + why (2)

A

GYN cancer MC cause of mortality = Ovarian Cancer

- b/c lack of good screening test and vague Sxs

48
Q

What is the likely cause of ovarian CA (Exs)

A

Likely cause of ovarian CA = chronic uninterrupted ovulation

Exs: early menarche, late menopause, nulliparity, infertile, late age of childbearing

49
Q

What factors are protective for ovarian CA (6)

A

Things that decr risk of ovarian CA: anything that interupts/suppresses ovulation

  1. breastfeeding
  2. multiparity
  3. late menarche
  4. early menopause
  5. OCPs
  6. BTL/hysterectomy
50
Q

What 2 genetic conditions incr risk of ovarian CA

A

Genetic conditions: incr risk ovarian CA

  1. Lynch Syndrome
  2. BRCA 1/2 mutations
51
Q

60 y/o obese pt has h/o of endometriosis, BCA and has be on estrogen replacement therapy for 7 yrs presents w/ Sxs of abd pain/fullness, bloating, early satiety, N/V, and fatigue. On PE you feel mass that is solid, fixed and irreg in abd.

Best way to Dx?
Most likely Dx?

A

Best way Dx = US

Dx = Ovarian Cancer

52
Q

What is the PE finding called that is a/w METs to the umbilical LNs in Ovarian CA

A

Sister Mary Joseph’s node = METs to the umbilical LNs in Ovarian CA

53
Q

What is the MC type of ovarian CA

A

MC type of ovarian CA = epithelial call

54
Q

1) Epithelial Cell Ovarian CA

  1. what type MC and usu bilat
  2. what type is usu very large
A

Epithelial Cell Ovarian CA

  1. MC and usu bilat = Serous
  2. Very large = Mucinous
55
Q

2) Stromal Cell Ovarian CA

  1. Are they cystic, complex or solid
  2. what are the two types
A

2) Stromal Cell Ovarian CA
1. Solid tumors

  1. Two types
    - Granulosa-Theca Cell
    - Sertoli-Leydig
56
Q

2) Stromal Cell Ovarian CA: Granulosa-Theca Cell
vs Sertoli-Leydig

  1. Which a/w estrogen production, precocious puberty and vaginal bleeding
  2. Which a/w androgen production, masculinization and hirsutism
A

2) Stromal Cell Ovarian CA: Granulosa-Theca Cell
vs Sertoli-Leydig

  1. Granulosa-Theca Cell a/w estrogen production, precocious puberty and vaginal bleeding
  2. Sertoli-Leydig a/w androgen production, masculinization and hirsutism
57
Q

3) Germ Cell Tumors

  1. What type is MC and usually benign/mature
  2. what age group are these MC in
  3. why are these usu Dx early (unique)
A

3) Germ Cell Tumors
1. MC type = dermoid cyst/teratoma (usually benign/mature)
2. MC in kids, young women (20-30s)
3. Usu Dx early b/c grow fast –> pain

58
Q

What type of Ovarian Tumor:

  • teratoma w/ thyroid tissue –> may cause Sxs of hyperthyroid
  • usu unilat
  • multilobulated mass w/thick septa on MRI
  • tx is cystectomy
A

What type of Ovarian Tumor:

  • teratoma w/ thyroid tissue –> may cause Sxs of hyperthyroid
  • usu unilat
  • multilobulated mass w/thick septa on MRI
  • tx is cystectomy

Stuma Ovarii

59
Q

What 4 labs are used to monitor ovarian CA

A

Labs for monitoring Ovarian CA

  1. CA 125
  2. AFP
  3. LDH
  4. hCG
60
Q

Ovarian CA staging/Tx

What is the type of surgery done for primary staging and Tx for early stage dz

A

Ovarian CA staging/Tx

TAH-BSO (w/LAD) done for primary staging and Tx for early stage dz

61
Q

54 y/o presents w/vaginal bleeding. Pt is obese, has a h/o PCOS and DM and currently is on tamoxifen to control postmenopausal Sxs. abn Pap smear results.

What is next best step?
likely Dx?

A

Next step –> EMB

Likely Dx –> Endometrial CA (AUB = hallmark)

62
Q

Name 2 types of Endometrial CA

- which type is estrogen dependent

A

Types of Endometrial CA

  1. Type 1 = Endometroid (estrogen dep)
  2. Type 2 = Serous/Clear Cell (estrogen indep)
63
Q

Types of Endometrial CA: Type I vs II

  1. which is well differentiated, good prognosis, ER+
  2. which is MC in thin, PMP pts and worse prognosis
A

Types of Endometrial CA: Type I vs II

  1. Type I = well differentiated, good prognosis, ER+
  2. Type II = MC in thin, PMP pts and worse prognosis
64
Q

Endometrial CA Tx

  1. What type of surg done (regardless of stage)
  2. What additional Txs used for higher stages
  3. What is 1st line Tx for adv + recurrent dz
A

Endometrial CA Tx

  1. TAH-BSO done (regardless of stage)
  2. Additional Txs used for higher stages = chemo + radiation
  3. 1st line Tx for adv + recurrent dz = high dose progestins

Women's Health EOR (7 decks)

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