Neoplasms Flashcards
What is the most common malignancy in women?
breast cancer
What are the risk factors for breast cancer?
(increased exposure to estrogen)
- menarche before age 12
- old age of first-full term pregnancy, no pregnancies
- menopause after age 52
What are the characteristics of breast cancer?
- breast mass - immobile, irregular
- nipple retraction, bloody nipple discharge
What is the most common type of breast cancer?
Infiltrating intraductal carcinoma (IIC) 80%
What are the characteristics of infiltrating lobular?
10%
-frequently bilateral
What is Paget’s disease of the nipple?
1%
-chronic eczematous itchy, scaling rash on the nipples and areola
What is inflammatory breast cancer?
2%
-red swollen, warm and itchy breast often with nipple retraction and peau d’organs (NO LUMP)
What are the characteristics of breast cancer tumors?
may be estrogen receptor (ER) positive 75%, progesterone receptor (PR) positive 65% as well as HER2 positive 25%
What are the USPSTF guidelines for breast cancer screening?
- 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
What is the tx of breast cancer?
- 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)
What is the third most common type of cancer?
cervical cancer
What are the symptoms of cervical cancer?
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
What are most of the cervical cancers?
80% are squamous cells and arise from the squamocolumnar junction of the cervix (transformation zone)
What are the risk factors for carcinoma of the cervix?
multiple sexual partners, early age at first intercourse, early first pregnancy, and HPV positive
What is the reason for 99% of cervical cancer?
HPV
- types that cause cancer are 16, 18, 31, and 33
- especially types 16, 18
- associated with cigarette smoking
How is cervical cancer dx?
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
What is the tx for cervical cancer?
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%
What are the ACOG recommendations for Pap smear screening?
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
What are the recommendation for Pap smear screening for women aged 21 to 29?
all guidelines recommend only cytology screening every 3 years
What are the recommendation for Pap smear screening for women aged 30 years and older?
combination of cytology + HPV testing is recommended every 5 years
Who is annual screening recommended for?
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
What is the ACOG recommendations for discontinuation of Pap smear screening?
- 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
What are the PAP screening pathology report?
- 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
What are the risk factors for cervical dysplasia?
HPV types 16, 18 and 31 which lead to cervical cancer
What is the tx of cervical dysplasia?
- 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
What is the vaccination for cervical dysplasia?
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
When is the HPV vaccine recommended for females?
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
What is the HPV recommendation for males?
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)
What is the dosing of the HPV vaccine for <15 years old?
administer a two-rather than a three-dose vaccine series
-in such patients, the two doses are administered at least six months apart
What is the dosing of HPV vaccines for >15 years old?
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
What is the most common GYN malignancy?
endometrial cancer
-fourth most common malignancy in women in the US
What is the cardinal symptom of endometrial cancer?
postmenopausal vaginal bleeding = one third of women with postmenopausal bleeding have endometrial CA
-bleeding in postmenopausal women is CA until proven otherwise
What kind of caner is endometrial cancer most often?
adenocarcinoma
What are the risk factors for endometrial cancer?
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
How is endometrial cancer dx?
endometrial biopsy is the gold standard definitive diagnostic test
-endometrial biopsy is indicated in all postmenopausal women vaginal bleeding
What is the tx of 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?
ovarian cancer (first is endometrial cancer)
What is the average age to get ovarian cancer?
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
What are the protective factors for the risk of ovarian cancer?
multiparty, OCP use, and breast-feeding
-oral contraceptives: 5 years of use decrease risk by 20%; 15 years by 50%
What are the risk factors for ovarian cancer?
nulligravidity (or infertility), early menarche, late menopause, endometriosis
What is the most common type of ovarian cancer?
90% are epithelial tumors = germ cell tumors are most common in patients <10 years old
How is ovarian cancer dx?
diagnose with transvaginal ultrasound then biopsy
-serum tumor marker CA-125 = BRCA1 gene is associated with 5% of cases
What is the treatment of ovarian cancer?
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
What is vaginal cancer?
rare: 1% of gynecological malignancies and is usually secondary to other cancer
What is the peak incidence of vaginal cancer?
at 60-65 years of age
What is the most common cause of vaginal cancer?
- squamous cell represents 95% caused by HPV
- adenocarcinomia caused by DES exposure
What is the most common location of vaginal carcinoma?
upper one-third of the posterior vaginal wall
How does vaginal cancer present?
usually presents as changes in menstrual period and/or abnormal vaginal bleeding
What is the treatment of vaginal cancer?
with radiation therapy
What is the peak incidence of vulvar cancer?
at 50 years old
What is the presentation of vulvar cancer?
vaginal pruritus is the most common presentation (70% will present with this symptom)
What is the most common type of vulvar cancer?
90% are squamous cell cancers and melanoma
-risk factors include HPB subtypes 16, 18, and 31 - pruritic black lesions
How is vulvar cancer dx?
application of acetic acid or staining with toluidine blue may help direct optimal biopsy location
What is the tx of vulvar cancer?
- vulvectomy and lymph node dissection
- Paget’s - pruritic red lesions
- local resection
