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Women's Health EOR > Neoplasms > Flashcards

Neoplasms Flashcards

1
Q

What is the most common malignancy in women?

A

breast cancer

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2
Q

What are the risk factors for breast cancer?

A

(increased exposure to estrogen)

  • menarche before age 12
  • old age of first-full term pregnancy, no pregnancies
  • menopause after age 52
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3
Q

What are the characteristics of breast cancer?

A
  • breast mass - immobile, irregular

- nipple retraction, bloody nipple discharge

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4
Q

What is the most common type of breast cancer?

A

Infiltrating intraductal carcinoma (IIC) 80%

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5
Q

What are the characteristics of infiltrating lobular?

A

10%

-frequently bilateral

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6
Q

What is Paget’s disease of the nipple?

A

1%

-chronic eczematous itchy, scaling rash on the nipples and areola

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7
Q

What is inflammatory breast cancer?

A

2%

-red swollen, warm and itchy breast often with nipple retraction and peau d’organs (NO LUMP)

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8
Q

What are the characteristics of breast cancer tumors?

A

may be estrogen receptor (ER) positive 75%, progesterone receptor (PR) positive 65% as well as HER2 positive 25%

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9
Q

What are the USPSTF guidelines for breast cancer screening?

A
  • baseline mammogram every 2 years from age 50-74
  • every 2 years beginning at age 40 if increased risk factors - 10 years prior to the age of the 1st degree relative was diagnosed
  • clinical breast exam every 3 years in women age 20-39 years then annually after age 40
  • breast self-exam monthly beginning at age 20 - immediately after menstruation on days 5-7 of the menstrual cycle
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10
Q

What is the tx of breast cancer?

A
  • segmental mastectomy (lumpectomy) followed by breast irradiation in all patients and adjunctive chemotherapy in women with positive nodes stage 1 and stage II with tumors less than 4 cm in diameter
  • anti-estrogen tamoxifen is useful in tumors that are ER-positive - binds and blocks the estrogen receptor in the breast tissue
  • aromatase inhibitors are useful in postmenopausal ER-positive patients with breast cancer - reduces the production of estrogen
  • monoclonal AB treatment is useful in patients with HER2 positive (Human Epidermal Growth Factor Receptor)
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11
Q

What is the third most common type of cancer?

A

cervical cancer

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12
Q

What are the symptoms of cervical cancer?

A

up to 80% of patients present with abnormal vaginal bleeding, most commonly postmenopausal

  • only 10% note postcoital bleeding
  • less frequent symptoms include vaginal discharge and pain
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13
Q

What are most of the cervical cancers?

A

80% are squamous cells and arise from the squamocolumnar junction of the cervix (transformation zone)

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14
Q

What are the risk factors for carcinoma of the cervix?

A

multiple sexual partners, early age at first intercourse, early first pregnancy, and HPV positive

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15
Q

What is the reason for 99% of cervical cancer?

A

HPV

  • types that cause cancer are 16, 18, 31, and 33
  • especially types 16, 18
  • associated with cigarette smoking
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16
Q

How is cervical cancer dx?

A

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
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17
Q

What is the tx for cervical cancer?

A

resect and/or chemotherapy and radiation

  • stage 1: conservative, simple, or radical hysterectomy
  • stage 2+: chemo +/- radiation
  • 5-y survival - Stage 1: 85-90% Stage 2: 65% Stage 3: 29% Stage 4: 21%
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18
Q

What are the ACOG recommendations for Pap smear screening?

A

pap smear screening should be 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 erythematous or post organ transplant

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19
Q

What are the recommendation for Pap smear screening for women aged 21 to 29?

A

all guidelines recommend only cytology screening every 3 years

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20
Q

What are the recommendation for Pap smear screening for women aged 30 years and older?

A

combination of cytology + HPV testing is recommended every 5 years

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21
Q

Who is annual screening recommended for?

A

any high-risk groups (HIV infection, immunosuppression, or in utero DES exposure) or women who have treated in the past for CIN 2, CIN 3, or cervical cancer

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22
Q

What is the ACOG recommendations for discontinuation of Pap smear screening?

A
  • no cytology screening after total hysterectomy if surgery for benign condition
  • if surgery for CIN I, II, or III then annually three times before discontinuing
  • discontinue screening at age 65 for women who have had adequate recent screening
  • adequate screening is defined as three consecutive negative cytology tests or two consecutive negative HPV/Pap co-tests in 10 years before stopping, with the most recent test within 5 years
23
Q

What are the PAP screening pathology report?

A
  • ASC-US: atypical squamous cells of undetermined significance
  • LSIL: low-grade squamous intraepithelial lesion, that is, mild dysplasia, CIN I
  • HSIL: high-grade squamous intraepithelial lesion, that is, moderate to severe dysplasia CIN II-III, carcinoma in situ
24
Q

What are the risk factors for cervical dysplasia?

A

HPV types 16, 18 and 31 which lead to cervical cancer

25
Q

What is the tx of cervical dysplasia?

A
  • women with negative cytology and HPV positive = both tests should be repeated in 12 months
  • ASC-US and up require reflex HPV testing if negative can repeat in 12 months if + then send for colposcopy
  • ASC-US or LSIL, CIN-1
  • reflex HPV
  • if positive and at least 25 years old - colposcopy
  • if negative or under 25 years old - retest in 1 year
  • HSIL, CIN-2, CIN-3, CIS
  • colposcopy
  • outside cervix - LEEP or cryotherapy
  • inside cervix - cone biopsy
  • squamous cell carcinoma = resect and/or chemotherapy and radiation
26
Q

What is the vaccination for cervical dysplasia?

A

in the United States, only the 9-valent vaccine is available = targets the same HPV types as the quadrivalent vaccine (6, 11, 16, and 18) as well as types 31, 33, 45, 52, and 58
-protects against 90% of warts, 73% of cervical cances

27
Q

When is the HPV vaccine recommended for females?

A

at 11 to 12 years
-can be administered starting at 9 years of age, and catch-up vaccination is recommended for females aged 13 to 26 years who have not previously vaccinated or who have not completed the vaccine series

28
Q

What is the HPV recommendation for males?

A

at 11 to 12 years
-can be administered as starting at 9 years of age, and catch-up vaccination is recommended for males aged 13 to 21 years who have not previously vaccinated or who have not completed the vaccine series

males 22 to 26 years old, catch-up HPV vaccination is recommended if they are men who have sex with men or immunocompromised (including HIV-infected men)

29
Q

What is the dosing of the HPV vaccine for <15 years old?

A

administer a two-rather than a three-dose vaccine series

-in such patients, the two doses are administered at least six months apart

30
Q

What is the dosing of HPV vaccines for >15 years old?

A

the HPV vaccine is administered in three doses at 0, at 1 to 2 months, and at 6 months
-immunocompromised patients should also receive a three-dose series

31
Q

What is the most common GYN malignancy?

A

endometrial cancer

-fourth most common malignancy in women in the US

32
Q

What is the cardinal symptom of endometrial cancer?

A

postmenopausal vaginal bleeding = one third of women with postmenopausal bleeding have endometrial CA
-bleeding in postmenopausal women is CA until proven otherwise

33
Q

What kind of caner is endometrial cancer most often?

A

adenocarcinoma

34
Q

What are the risk factors for endometrial cancer?

A

obesity, nulliparity, early menarche, late menopause, unopposed estrogen stimulation, hypertension, gallbladder disease, DM, prior ovarian, endometrial, or breast cancer
-50% of women with endometrial cancer will have an abnormal PAP smear

35
Q

How is endometrial cancer dx?

A

endometrial biopsy is the gold standard definitive diagnostic test
-endometrial biopsy is indicated in all postmenopausal women vaginal bleeding

36
Q

What is the tx of endometrial cancer?

A

usually total hysterectomy and bilateral salpingo-oophorectomy, pelvic radiation therapy with or without chemotherapy for stage II or III cancer

37
Q

What is the second most common type of GYN cancer?

A

ovarian cancer (first is endometrial cancer)

38
Q

What is the average age to get ovarian cancer?

A

40-60 years of age, ascites, abdominal pain = 75% diagnosed at an advanced stage
-if a women has ascites ovarian cancer is the most likely tumor to be found

39
Q

What are the protective factors for the risk of ovarian cancer?

A

multiparty, OCP use, and breast-feeding

-oral contraceptives: 5 years of use decrease risk by 20%; 15 years by 50%

40
Q

What are the risk factors for ovarian cancer?

A

nulligravidity (or infertility), early menarche, late menopause, endometriosis

41
Q

What is the most common type of ovarian cancer?

A

90% are epithelial tumors = germ cell tumors are most common in patients <10 years old

42
Q

How is ovarian cancer dx?

A

diagnose with transvaginal ultrasound then biopsy

-serum tumor marker CA-125 = BRCA1 gene is associated with 5% of cases

43
Q

What is the treatment of ovarian cancer?

A

Stage 1A or 1B - surgical excision also (abdominal hysterectomy and bilateral salpingo-oophorectomy

  • other stages - surgical resection followed by adjuvant chemotherapy or radiation
  • monitor CA-125 afterward to assess disease progress
44
Q

What is vaginal cancer?

A

rare: 1% of gynecological malignancies and is usually secondary to other cancer

45
Q

What is the peak incidence of vaginal cancer?

A

at 60-65 years of age

46
Q

What is the most common cause of vaginal cancer?

A
  • squamous cell represents 95% caused by HPV

- adenocarcinomia caused by DES exposure

47
Q

What is the most common location of vaginal carcinoma?

A

upper one-third of the posterior vaginal wall

48
Q

How does vaginal cancer present?

A

usually presents as changes in menstrual period and/or abnormal vaginal bleeding

49
Q

What is the treatment of vaginal cancer?

A

with radiation therapy

50
Q

What is the peak incidence of vulvar cancer?

A

at 50 years old

51
Q

What is the presentation of vulvar cancer?

A

vaginal pruritus is the most common presentation (70% will present with this symptom)

52
Q

What is the most common type of vulvar cancer?

A

90% are squamous cell cancers and melanoma

-risk factors include HPB subtypes 16, 18, and 31 - pruritic black lesions

53
Q

How is vulvar cancer dx?

A

application of acetic acid or staining with toluidine blue may help direct optimal biopsy location

54
Q

What is the tx of vulvar cancer?

A
  • vulvectomy and lymph node dissection
  • Paget’s - pruritic red lesions
  • local resection

Women's Health EOR (10 decks)

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