Neoplasms - Ovarian CA and vulvar/vaginal CA Flashcards
what cancer has the highest mortality of all gynecological cancers
ovarian CA - presents at late stage
RF ovarian CA
family history of ovarian cancer, BRCA1 or BRCA2, age greater than 50 years, infertility, early menarche, late menopause, or nulliparity
endometriosis
sx ovarian CA
early - asx
later - abdominal bloating
PE ovarian CA
ascites
noticeable abdominal distention
palpable pelvic mass
types of ovarian CA
epithelial
germ cell
stromal cel
MC form of ovarian CA and what are it’s associations
epithelial
associated with women over the age of 50 years old
germ cell ovarian CA associations
far less common and is associated with women between the ages of 15 and 19 years old
stromal cell ovarian CA and its associations
seen in women of any age group
dx ovarian CA
pelvic ultrasound and is confirmed with a biopsy
labs –> elevated CA-125
tx ovarian CA
surgical excision of the tumor, a hysterectomy, a bilateral salpingo-oophorectomy with selective lymphadenectomy, and postoperative chemotherapy for those with advanced-stage cancer
is there screening for ovarian CA
no
What tumor markers would you expect to be elevated in a patient with cervical cancer?
Beta-hCG, squamous cell carcinoma, and serum sialyl-Tn (STN)
second most common gynecologic malignancy
ovarian CA
US features for ovarian CA
solid component within the mass, increased Doppler flow to the solid component, and irregular septations within the mass
What finding on thoracentesis of a patient with a pleural effusion suggests a diagnosis of epithelial ovarian cancer?
Malignant müllerian cells
what CA125 level is considered elevated
> 35 U/mL is considered elevated
fourth most common gynecologic malignancy
vulvar CA
MC type of vulvar CA
squamous cell carcinoma
average age of onset vulvar CA
68
RF vulvar CA
human papillomavirus, prior vulvar or cervical intraepithelial neoplasia, prior history of cervical cancer, cigarette smoking, and immunodeficiency syndromes
lichen sclerosis
MC sx vulvar CA
vulvar lesion
squamous cell carcinoma lesions in vulvar CA
firm; white, red, or skin-colored; nodules, papules, or plaques; and have varying degrees of erosion or ulceration
evaluation of vulvar CA
assessing for risk factors, characterizing the lesion on exam, performing a colposcopy to detect subclinical lesions, and performing a biopsy
types of vulvar CA
squamous cell carcinoma (most common), melanoma, basal cell carcinoma, Bartholin cyst adenocarcinoma, and extramammary Paget disease of the vulva
Paget disease of the vulva
a rare adenocarcinoma affecting the apocrine or eccrine glands
sx of Paget disease of the vulva
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)
PE Paget disease of vulva
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
dx Paget disease of vulva
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
tx Paget disease of the vulva
wide local excision. Margins of 2–3 cm are recommended to reduce the risk of recurrence
once Paget disease of the vulva is identified, a complete workup to rule out other malignancies is recommended. what malignancies should be ruled out
endometrial, endocervical, vaginal, bladder, breast, and rectal cancers
Paget disease of the vulva is also known as
extramammary Paget disease
MC sx of Paget dz of the vulva
vulvar pruritus
melanoma vulvar CA presents as
black nodules with irregular borders that evolve rapidly
tx vulvar CA
surgical excision with or without radiation and chemotherapy
