Repro wk 4 - neoplasia

Question 1

screening guidelines in BC for cervical cancer: when should they begin?

Answer 1

at age of 21 or 3 years after sexual debut ( where sexual means any skin to skin contact)

Question 2

you obtain a pap smear on your 17 yr old patient, and the smear is report as mile squamous dyskariosis/ LSIL. The patient asks you what chance there is that the pap smear is mistaken. you say, the false positive rate for pap is:

Answer 2

less than 1%.

generally, pap smears are considered an excellent screening tool.

Question 3

when you obtain a pap, it is important to sample all of the transformation zone. what is the transofrmation zone and why do we swab it?

Answer 3

TZ zone is the area extending between the original ( anatomical) squamocolumnar junctino and the new ( physiologic) squamocolumnar junction, where 80% of squamous cervical cancer originate.

Question 4

what transformation occurs in the TZ zone>

Answer 4

conversion from a columnar cell to a stratified squamous cell. when the columnar cells are exposed to the acidic/ bacterial vaginal environment, they metaplase and get cancerous sometimes

Question 5

your patient is a 43 yr old widowed woman who feels that is not at risk for cervical cancer, you recall what the risk factors for cervical cancer are:

Answer 5

multiple sex partners, history of STI, smoking, previous abnormal paps,
NOT low parity - the amount of kids youve had dont matta. a woman who has been sexually active in her lifetime is always at risk of cervical cancer, even i she is not currently sexually active or has not been for a long time.

Question 6

HPV 6 and 11 are associated with?

Answer 6

flat condyloma, condyloma acuminatus, mild cervical dysplasia, spontaneous regression of lesions in 30-50% of cases,
not associated with cervical carcinoma! we vaccinate people against 16 and 18.

Question 7

cervical intraepithelial neoplasia grade 2/ CIN 2 is defined by :

Answer 7

basaloid type dysplastic cells in the lower 2-3 of the epithelium

Question 8

a patient is referred to teh colposcopy clinic with a pap smear reporting severe squamous dyskarisis. a biopsy of a suspiscious area is reported as carcinoma in situ. On microscopy, carcinoma in situ of the cervix shows:

Answer 8

loss of cellular maturation on the surface

Question 9

a 32 year old woman presents to the colsposcopy clinic with a pap smear reporting moderate squamous dyskariosis/ HSIL. the exam was satisfactory and the cervical biopsy was reported as CIN 2. approrpriate treatments for this patient would include all the following except:

Answer 9

observation.

you cant just watch and wait a CIN2, you need to do LEEP, laser vaporiazation of the transformation zone or cryosurgery

Question 10

cone biopsy is indicted if:

Answer 10

1) the entire TZ zone cant be visualized,
2) the entire lesion cannot be visualized
3) the endocervical curetting procedure reports severe squamous dysplasia

Question 11

what does cone biopsy help you differentiate between?

Answer 11

1) preinvasive disease ( dysplasia, carcinoma), microinvasive disease, or frank invasion

Question 12

the most common symptom of certical cancer is:

Answer 12

POST COITAL BLEEDING

Question 13

a 50 yr old woman is diagnosed with cervical canecr. which lymph node group group be the first involved in metastatic spread of the disease beyond the cervix uterus?

Answer 13

paracervical or ureteral nodes

Question 14

what investigations are used to stage cervical cancer?

Answer 14

cytoscopy, sigmoidoscopy, chest x ray, liver functions test

—we DONT use CT though

Question 15

cervical caner staging: the patient has involvement of upper portion of the vagina, with node involvedment in the pelvis and periaortic area

Answer 15

apparently this is stage II

Question 16

what is a common presentation of molar pregnancy?

Answer 16

abnormal vaginal bleeding, and a uterus that is large for the dates. there may be a high BHCG, which will cause nausea, vomiting, and pregnancy-induced hypertention. however ausculation of the uterus will reveal absence of fetal heart sound

Question 17

how do you diagnose molar pregnancy?

Answer 17

pelvic ultrasound, reporting the classic snowstorm pattern

Question 18

a 35 yr old white female presents with positive pregnancy test. hre uterus is large for dates, and ultrasound shows snow storm pattern and no fetus. she has:

Answer 18

complete hydatidiform mole, molar pregnancy

Question 19

how do you know if youve found a partial mole/ partial molar pregnancy. what is the difference between complete and partial mole?

Answer 19

partial mole = 2 sperm and 1 egg, so there is fetal tissue. this is how you know you have found a partial mole, you will see molar tissue adjacent to a living to dead fetus.
complete mole = two sperm fertilized an empty or deactivated egg = no fetal tissue.

Question 20

the most common chromosomal pattern present in completel hydatidiform moles is:

Answer 20

46XX paternal homologous ( diantric diploidy) = two sperms fertilized an inactive/ empty egg

Question 21

how do you treat molar pregnancy?

Answer 21

evacuation of uterine contents, and then contraception because we watch for cancer with rising bHCG.

Question 22

the most common sympto of endometrial hyperplasia is:

Answer 22

vaginal bleeding. you usually get the endometrial hyperplasia due to unopposed estrogen, but there are also the type II non estrogen related endometroid cancers..

Question 23

endometrial adenocarcinoma is most often preceeded by which:

Answer 23

complex endometrial hyperplasia with cytologic atypia

Question 24

what endometrial cancer risk factor is not associated with estrogen?

Answer 24

hypertension.

Question 25

a 54 yr old patient had vaginal spotting for 5 days. her period was 2 years ago, physical is normal. what investigation does she require>

Answer 25

office endometrial biopsy - postmenopausal bleeding, or any vaginal bleeding needs to be treated as endometrial cancer until proven otherwise.

Question 26

endometrial cancer spreads by:

Answer 26

direct extension.

Question 27

treatment for stage 1 endometrial cancer is:

Answer 27

TAH-BSO : total abdominal hysterectomy and bilateral salpingoophorectomy

Question 28

Which of the following has NOT been associated with a risk of developing epithelial ovarian cancer?

Answer 28

a) use of birth control
- risks for ovarian cancer include anything that has been making you ovulate = low parity, delayed childbearing, familial predisposition

Question 29

in what group would the ovaries most likely be palpable?

Answer 29

reproductive age women. pre-menstrual and post menopausals should never have a palpable pelvic mass

Question 30

a 5cm mass is found in a 53 yr old woman. what is proper mgmt of this case?

Answer 30

investigate with exploratory laparotomy. the solid ovarian mass needs to be judged as benign or maligant.

Question 31

ovarian neoplasms most commonly arise from where?

Answer 31

the sloughed off fallopian tube cells, however 80% of ovarian cancers are “ epithelial” ovaries cancer so make sure you dont get confused

Question 32

an example of a germ cell tumor would be:

Answer 32

teratoma - the dermoid that has teeth and stuff

germ cell tumours include choriocarcinoma, gonadoblastoma, tertaoma, dysgerminoma

Question 33

the most predictive serum marker for epithelial adenocarcinom of the ovary is

Answer 33

Ca125

Question 34

what is CEA marker for>

Answer 34

this is elevated in metastatic bowel cancer, and other cancers. can also be elevated in mucinous ovarian cancers

Question 35

the most common route of ovarian cancer spread is:

Answer 35

exfoliation of the cells that are shed into the peritoneal cavity

Question 36

a 65 year old patient has an 8cm ovarian mass. the most likely diagnosis is:

Answer 36

serous cystadenocarcinoma.
this is because in the per-menarchal group the most common pelvic mass is a germ cell tumor. in the reproductive group, ovarian masses are benign are are probably just cysts, or benign teratomas. IN the postmenopausal age group, ovarian cancers should always be considered, the frist is cystadenocarcinoma, being the most common type of epithelial ovarian carcinoma.

Question 37

radiant energy produces biologic changes most commonly by:

Answer 37

damaging the DNA of target tissues, by creation of free radicals

Question 38

what is a complication noted after radiation therapy for cervical carcinoma?

Answer 38

radiation cystis, proctitis, dyspareunia,

Question 39

local irradiation of tumour cells is termed:

Answer 39

brachytherapy

Question 40

invasive squamous cell carcinoma of the cervix can be screened with?

Answer 40

it is virtually 100% preventable with regular pap smear screening

Question 41

a 65 yr old obese woman presents with post menopausal bleeindg. her last pap was normal 3 years ago and all previous smears have been normal. the most likely diagnosis is:

Answer 41

endometrial cancer

Question 42

the most common gynecological malignancy at age 35 wordwide is

Answer 42

cervical cancer