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Cancer (OSI type) > Neoplastic Disease of the Lower Genital Tract > Flashcards

Neoplastic Disease of the Lower Genital Tract Flashcards

1
Q

HPV strains that have a low risk

A

HPV 6, 11, 49, 41, 42

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2
Q

HPV strains which are considered “high risk”

A

HPV 16, 18, 45, 58

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3
Q

HPV strains seen in HSIL (CIN II/III)

A

HPV 31, 33, 35, 51, 52

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4
Q

What are the risk factors for increased risk for HPV?

A
  1. Early coitarche
  2. Multiple sexual partners (>/6)
  3. History of STI
  4. OCP use
  5. History of vulvovaginal dysplasia
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5
Q

Smoking is a risk factor of what CA in the lower genital tract?

A

Squamous cell CA

NOT adenoCA

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6
Q

What are the contents of you bivalent HPV vaccine?

A

16,18

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7
Q

What are the components of your HPV quadrivalent

A

6,11,16,18

Gardasil 3 doses given at 0,1,6

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8
Q

[Secondary screening]

<21 years old, no vaginal intercourse

A

No screening

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9
Q

[Secondary screening]

<21 years old, sexually active at age 18

A

Screen

Screen 3 years after onset of intercourse but not earlier than 21 years old

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10
Q

[Secondary screening]

21-29 years old

A

Cytology alone

Local setting: annual screening by conventional cytology or biennial screening with liquid based cytology

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11
Q

[Secondary screening]

30-65 years old

A
  1. HPV and Cytology Co-testing every 5 years
  2. Cytology alone every 3 years

Local setting: annual screening by conventional cytology or biennial screening with liquid based cytology

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12
Q

[Secondary screening]

66 years old
3 negative PAP tests

A

No more screening

Not recommended for >65 years old with 3 consecutive negative Pap test or 2 consecutive negative HPV test

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13
Q

[Secondary screening]

66 years old
no history of pap smear

A

Screen!

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14
Q

[Secondary screening: pap smear]

21 years old
Pregnant

A

Screen!

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15
Q

What is the most common squamous abnormality?

A

ASCUS

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16
Q

[Cervical Cytologic Abnormality]

Atypical squamous cells, cannot exclude higher grade lesions

A

ASC-H

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17
Q

[Cervical Cytologic Abnormality]

Consistent with histology reports of low-grade dysplasia or cervical intraepithelial neoplasia (CIN1)

A

LSIL

May resolve or progress

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18
Q

[Cervical Cytologic Abnormality]

more severe dysplasia or CIN 2/3

A

HSIL

20% will progress to cervical CA

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19
Q

[Management of Cytologic Abnormalities]

ASC-US

21-24 years old

A

Repeat cytology yearly

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20
Q

[Management of Cytologic Abnormalities]

LSIL

21-24 years old

A

Repeat cytology yearly

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21
Q

[Management of Cytologic Abnormalities]

ASC-H

21-24 years old

A

Colposcopy + biopsy and ECC

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22
Q

[Management of Cytologic Abnormalities]

HSIL

21-24 years old

A

Colposcopy + biopsy and ECC

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23
Q

[Management of Cytologic Abnormalities]

ASC-US

25 to 65 years old

A

HPV testing preferred; repeat cytology is acceptable

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24
Q

[Management of Cytologic Abnormalities]

LSIL, HPV status unknown

25 to 65 years old

A

Colposcopy +/- biopsy and ECC

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25
Q

[Management of Cytologic Abnormalities]

LSIL, HPV negative

25 to 65 years old

A

Repeat cytology at 1 year; colposcopy acceptable

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26
Q

[Management of Cytologic Abnormalities]

LSIL, HPV positive

25 to 65 years old

A

Colposcopy + biopsy and ECC

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27
Q

[Management of Cytologic Abnormalities]

ASC-H

25 to 65 years old

A

Colposcopy + biopsy and ECC regardless of HPV status

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28
Q

[Management of Cytologic Abnormalities]

HSIL

25 to 65 years old

A

Immediate LEEP or colposcopy + biopsy and ECC

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29
Q

[Management of Cytologic Abnormalities]

AGC

25 to 65 years old

A

Colposcopy + biopsy + ECC

EM biopsy if >35y/o

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30
Q

[Management of biopsy proven lesions]

LGSIL (CIN 1)
preceded by ASC-US, LSIL, HPV 16+, HPV 18+, persistent HPV

A
  1. Co-testing at 12 months
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31
Q

[Management of biopsy proven lesions]

LGSIL (CIN 1)
Preceded by ASC-H, HSIL

A

If adequate colposcopy: Ablation or diagnostic excisional procedures

If inadequate colposcopy: diagnostic excisional
procedures

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32
Q

Risk factors for cervical CA

A
  1. HPv
  2. Parity >7
  3. OCP use >5 years with HPV
  4. Current smokers and younger age at smoking
  5. Co-infected with chlamydia or HSV
  6. HIV
  7. Early age at sex <14 y/o
  8. Sex partners >6
  9. Pregnancy <17
  10. No screening
  11. Low socio-economic status
  12. Poor access to healthcare services,
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33
Q

[Cervical CA]

arising from ectocervix, most common

A

squamous cell CA

85 to 95%

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34
Q

[Cervical CA]

arising from endocervical columnar epithelium (10-15%)

A

AdenoCA

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35
Q

What is the most common symptom of cervical CA

A

Vaginal bleeding

other ssx:
post-coital bleeding, intermenstrual bleeding, brownish, foul-smelling discharge

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36
Q

[Cervical CA staging]

Stage I

A

confined to the cervix

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37
Q

[Cervical CA staging]

Stage II

A

Cancer extends beyond cervix but not to pelvic wall or lower third of vagina

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38
Q

[Cervical CA staging]

Stage III

A

Cervix + pelvic wall + hydronephrosis/non-functioning kidney

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39
Q

[Cervical CA staging]

Stage IV

A

Cervix extending to true pelvis or biopsy proven bladder or rectum

40
Q

[Cervical CA treatment]

IA1 - Desirous of pregnancy

A

Negative Margins - BLND

Positive margins - repeat cone biopsy/trachelectomy + BLND +/- PALS

41
Q

[Cervical CA treatment]

IA1 - Not desirous of pregnancy

A

EH +/- BSO (+BLND if + LVSI)

42
Q

[Cervical CA treatment]

IA2 - if desirous of pregnancy

A

Radical vaginal or abdominal trachelectomy + pelvic lymphadenectomy

43
Q

[Cervical CA treatment]

IA2 - not desirous of pregnancy

A

RH, BLND, +/- BSO

44
Q

[Cervical CA treatment]

IB1, IIA1

A
  1. RH, BLND, +/- PALS +/- BSO

2. Chemotherapy and pelvic EBRT + brachytherapy

45
Q

[Cervical CA treatment]

IVB

A

Cisplatin based chemotherapy + individualized RT

46
Q

What is the current standard of care and mainstay treatment?

A

Concurrent chemoradiation

Surgery until IIA2

47
Q

[Vulval Intraepithelial Neoplasia]

Mild dysplasia

A

VIN I

48
Q

[Vulval Intraepithelial Neoplasia]

moderate dysplasia

A

VIN II

49
Q

[Vulval Intraepithelial Neoplasia]

severe dysplasia - Carcinoma in situ

A

VIN III

50
Q

[Diagnosis]

elongation and widening of rete ridges, white firm cartilaginous lesions with hyperkeratotic changes

A

squamous cell hyperplasia

51
Q

[Diagnosis]

Large pale cells, occurring in nests and infiltrate upward through the epithelium

A

paget disease

52
Q

Atypia is defined as

A
  1. Loss of polarity
  2. Increased N:C ratio
  3. Irregular size and shape
  4. Prominent nuclei
  5. Thick nuclear membrane
53
Q

[Management for premanopausal women: endometrium]

hyperplasia without atypia

A
  1. OCP x 6 cycles
  2. MPA 10-20mg OD x 14 days

Then do UTZ sample endometrium after 3 months.

Normal: MPA 5mg x 10days for 12 months

Persistent: increase dose 40-100mg daily for 3 months

54
Q

[Management for premanopausal women: endometrium]

hyperplasia with atypia, desirous of pregnancy

A
  1. Continuous MPA 10-20mg OD x 3 months
  2. Megestrol acetate 40-200mg OD
  3. DMPA 150mg q3months
  4. LNG-IUS for 1-5 years
55
Q

What factors diminishes the risk of endometrial cancer?

A
  1. Ovulation
  2. Progestin therapy
  3. Combination oral contraceptives
  4. Menopause before 49 years old
  5. multiparity
56
Q

[Endometrial CA type]

early postmenopause
hyperplastic background epithelium
Low grade
Estrogen dependent
ER positive
A

Type 1

Endometrioid CA

57
Q

[Endometrial CA type]

Late menopause
atrophic
high grade
non-dependeng
ER negative
A

Type 2

Serous papillary

58
Q

[FIGO Grade: Endometrial CA]

Stage I

A

confined to the corpus

59
Q

[FIGO Grade: Endometrial CA]

Stage II

A

invades the cervical stroma but does not extend beyond the uterus

60
Q

[FIGO Grade: Endometrial CA]

Stage III

A

local and/or regional spread of the tumor

61
Q

[FIGO Grade: Endometrial CA]

Stage IV

A

tumor invades the bladder and or bowel mucosa and or distant metastasis

62
Q

What is the mainstay treatment for endometrial CA (if cervix is not involved)

A

Extrafascial hysterectomy

63
Q

What is the most frequent ovarian epithelial tumor?

A

Serous Cystadenoma

64
Q

Ovarian tumor that can reach enormous size

A

Mucinous cystadenoma

65
Q

Ovarian tumor that appears to have “coffee bean” appearing nucleus

A

Brenner TUmor

66
Q

Most common neoplasm in prepubertal female

A

Benign cystic teratoma

67
Q

What is the tumor marker of Epithelial tumors

A

CA-125

CEA

68
Q

What is the tumor marker of Germ Cell Tumor

A

LDH
hCG
AFP

69
Q

What is the tumor marker of Granulosa-Theca Cell or Sertoli-Leydig cell

A

Estrogen, Testosterone

70
Q

[Ovarian CA Staging]

Confined to ovaries of FT, with surgical spill

A

IC1

71
Q

[Ovarian CA Staging]

Confined to ovaries or FT, ruptured before surgery

A

IC2

72
Q

[Ovarian CA Staging]

confined to ovaries or FT, positive malignant cells in the peritoneal fluid

A

IC3

73
Q

[Ovarian CA Staging]

pelvic extension or primary peritoneal cancer

A

Stage II

74
Q

[Ovarian CA Staging]

spread to peritoneum outside the pelvis and metastasis to retroperitoneal LN

A

Stage III

75
Q

Most frequent ovarian epithelial tumor

A

Serous tumor

76
Q

___ CA that contains hobnail cells

A

clear cell

77
Q

What is the most common malignancy in women <30 years old

A

Germ Cell Tumor

78
Q

Most common malignant germ cell tumor

A

dysgerminoma

79
Q

What is the tumor marker of dysgerminoma?

A

LDH

80
Q

What is the tumor marker of Yolk Sac tumor or Endodermal sinus tumor?

A

AFP

81
Q

What is the tumor marker of choriocarcinoma?

A

hCG

82
Q

What is the tumor marker of Immature Teratoma?

A

AFP

83
Q

[Ovarian Tumor]

functionally estrogenic

A

Granulosa Theca Cell Tumor

84
Q

[Ovarian Tumor]

functionally testosterogenic

A

Sertoli Leydig Cell Tumor

85
Q

Most common benign tumor for <30 years old

A

dermoid

86
Q

Schiller-duvall bodies

A

Endodermal sinus/yolk sac tumor

87
Q

Call exner bodies

A

Granulosa-theca tumor

88
Q

Precocious puberty in children

A

granulosa-theca cell

89
Q

Nipple projections in dermoids

A

Tubercle of rokitansky

90
Q

Numerous hyaline droplets

A

Endodermal sinus/yolk sac tumor

91
Q

Tumor marker of Choriocarcinoma

A

HCG

92
Q

Tumor marker of dysgerminoma

A

LDH

93
Q

Analogous to seminoma in males

A

Sertoli-Leydig Tumor

94
Q

Composed of malignant syncitiotrophoblast and cytotrophoblast

A

Choriocarcinoma

95
Q

most common malignant tumor <30 years old

A

dysgerminoma

Cancer (OSI type) (2 decks)

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