Neoplasms - Ovarian CA and vulvar/vaginal CA

Question 1

what cancer has the highest mortality of all gynecological cancers

Answer 1

ovarian CA - presents at late stage

Question 2

RF ovarian CA

Answer 2

family history of ovarian cancer, BRCA1 or BRCA2, age greater than 50 years, infertility, early menarche, late menopause, or nulliparity

endometriosis

Question 3

sx ovarian CA

Answer 3

early - asx
later - abdominal bloating

Question 4

PE ovarian CA

Answer 4

ascites
noticeable abdominal distention
palpable pelvic mass

Question 5

types of ovarian CA

Answer 5

epithelial
germ cell
stromal cel

Question 6

MC form of ovarian CA and what are it’s associations

Answer 6

epithelial

associated with women over the age of 50 years old

Question 7

germ cell ovarian CA associations

Answer 7

far less common and is associated with women between the ages of 15 and 19 years old

Question 8

stromal cell ovarian CA and its associations

Answer 8

seen in women of any age group

Question 9

dx ovarian CA

Answer 9

pelvic ultrasound and is confirmed with a biopsy

labs –> elevated CA-125

Question 10

tx ovarian CA

Answer 10

surgical excision of the tumor, a hysterectomy, a bilateral salpingo-oophorectomy with selective lymphadenectomy, and postoperative chemotherapy for those with advanced-stage cancer

Question 11

is there screening for ovarian CA

Answer 11

no

Question 12

What tumor markers would you expect to be elevated in a patient with cervical cancer?

Answer 12

Beta-hCG, squamous cell carcinoma, and serum sialyl-Tn (STN)

Question 13

second most common gynecologic malignancy

Answer 13

ovarian CA

Question 14

US features for ovarian CA

Answer 14

solid component within the mass, increased Doppler flow to the solid component, and irregular septations within the mass

Question 15

What finding on thoracentesis of a patient with a pleural effusion suggests a diagnosis of epithelial ovarian cancer?

Answer 15

Malignant müllerian cells

Question 16

what CA125 level is considered elevated

Answer 16

> 35 U/mL is considered elevated

Question 17

fourth most common gynecologic malignancy

Answer 17

vulvar CA

Question 18

MC type of vulvar CA

Answer 18

squamous cell carcinoma

Question 19

average age of onset vulvar CA

Answer 19

68

Question 20

RF vulvar CA

Answer 20

human papillomavirus, prior vulvar or cervical intraepithelial neoplasia, prior history of cervical cancer, cigarette smoking, and immunodeficiency syndromes
lichen sclerosis

Question 21

MC sx vulvar CA

Answer 21

vulvar lesion

Question 22

squamous cell carcinoma lesions in vulvar CA

Answer 22

firm; white, red, or skin-colored; nodules, papules, or plaques; and have varying degrees of erosion or ulceration

Question 23

evaluation of vulvar CA

Answer 23

assessing for risk factors, characterizing the lesion on exam, performing a colposcopy to detect subclinical lesions, and performing a biopsy

Question 24

types of vulvar CA

Answer 24

squamous cell carcinoma (most common), melanoma, basal cell carcinoma, Bartholin cyst adenocarcinoma, and extramammary Paget disease of the vulva

Question 25

Paget disease of the vulva

Answer 25

a rare adenocarcinoma affecting the apocrine or eccrine glands

Question 26

sx of Paget disease of the vulva

Answer 26

pruritus, soreness, irritation, and burning. If the area can be visualized, patients may report redness or thickened skin. In some cases, they may report bleeding, although patients are often unable to accurately locate the course of the bleed (wether vulvar, vaginal, or urinary)

Question 27

PE Paget disease of vulva

Answer 27

vulvar or perineal erythema and scale (typically well demarcated). It can present as a macule, patch, plaque, or ulceration. It is often tender or pruritic and may be friable vulvar lesion with an eczematoid appearance

Question 28

dx Paget disease of vulva

Answer 28

colposcopic biopsy of the vulva Under colposcopy, acetowhite changes after the application of acetic acid may indicate the presence of dysplasia and assist in performing the most accurate vulvar biopsy

Question 29

tx Paget disease of the vulva

Answer 29

wide local excision. Margins of 2–3 cm are recommended to reduce the risk of recurrence

Question 30

once Paget disease of the vulva is identified, a complete workup to rule out other malignancies is recommended. what malignancies should be ruled out

Answer 30

endometrial, endocervical, vaginal, bladder, breast, and rectal cancers

Question 31

Paget disease of the vulva is also known as

Answer 31

extramammary Paget disease

Question 32

MC sx of Paget dz of the vulva

Answer 32

vulvar pruritus

Question 33

melanoma vulvar CA presents as

Answer 33

black nodules with irregular borders that evolve rapidly

Question 34

tx vulvar CA

Answer 34

surgical excision with or without radiation and chemotherapy