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Gyn Onc > Study guide > Flashcards

Study guide Flashcards

1
Q

optimal treatment of dermoid cyst

A

cystectomy with only inspection of contralateral ovary

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2
Q

Most important prognostic factor for endometrial, cervical, vulvar and breast cancer is:

A

node status

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3
Q

hydrops tubae profluens is a classic sign of :

A

fallopian tube carcinoma

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4
Q

bleomycin MOA

A

inhibits synthesis of DNA; binds to DNA leading to single and double strand breaks

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5
Q

topotecan

A

inhibits topoisomerase I - stabilizes the cleavable complex so that religation of cleaved DNA strand cannot occur - S phase of cell cycle

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6
Q

5 fluorouracil MOA

A

pyrimidine analog antimetabolite that interferes with DNA and RNA synthesis - inhibits thymidylate synthetase

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7
Q

5 fluorouracil adverse reaction

A

Neutropenia, mucositis, diarrhea, dermatitis

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8
Q

carboplatinum adverse reaction

A

thrombocytopenia

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9
Q

What is Meig’s syndrome

A

triad of ovarian fibroma, hydrothorax, ascites

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10
Q

most common sites of ureteral injury

A

at cardinal ligaments and infundibulopelvic ligaments

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11
Q

Vulvar stage IVb

A

pelvic nodes, distant mets

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12
Q

Vulvar stage IIIc

A

with positive nodes with extracapsular spread

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13
Q

most important predictor of local recurrence of vulvar cancer after resection

A

tissue margin (>8mm on fixed tissue)

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14
Q

doxorubicin adverse effect

A

cardiotoxicity

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15
Q

vicristine adverse effect

A

neurotoxicity

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16
Q

How many stages in vulvar cancer?

A 
Ia
Ib
II
IIIa
IIIb
IIIc
IVa
IVb
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17
Q

2 plant alkaloids

A

vincristine

vinblastine

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18
Q

attributes of plain and chromic catgut

A

intense inflammation, absorbed quickly by phagocytosis

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19
Q

methotrexate MOA

A

folate antimetabolite that inhibits DNA synthesis, repair, and cellular replication - inhibits dihydrofolate reductase - cell cycle specific for S phase

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20
Q

dermoid with mostly thyroid tissue, benign

A

struma ovarii

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21
Q

treatment for vulvar cancer if positive inguinal nodes

A

adjuvant pelvic radiation

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22
Q

Lugol’s iodine MOA

A

glycogen stain; negative stain

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23
Q

most superior and medial inguinal node, considered sentinel node for spread to pelvic nodes

A

Cloquet’s node

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24
Q

BRCA2 on chromosome __

A

13

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25
Q

cisplatinum (cisplatin) MOA

A

inhibits DNA synthesis by formation of DNA cross-links, denatures double helix, covalently binds DNA

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26
Q

antidose to ifosfamide

A

mesna

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27
Q

treatment for vulvar cancer for well-lateralized lesions <2 cm

A

radical local excision of vulva with unilateral inguinal-femoral lymphadenectomy

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28
Q

chemo drug from the pacific Yew tree

A

Taxol

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29
Q

after transection the broad ligament, the ureter is where?

A

on medial leaf

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30
Q

cause of dyspereunia after radiation is usually:

A

atrophic vaginitis

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31
Q

paclitaxel (Taxol) adverse reaction

A

Alopecia, immediate hypersensitivity, neutropenia, bradycardia

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32
Q

carboplatinum MOA

A

alkylating agent - covalently binds to DNA, interstrand DNA cross-links; not cell-cycle specific

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33
Q

acetic acid MOA

A

dehydrate cells

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34
Q

Vulvar stage Ia

A

≤ 2 cm, ≤1 mm invasion, no nodes

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35
Q

heritability of BRCA mutations

A

autosomal dominant

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36
Q

Taxol is __ phase speicific

A

M phase

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37
Q

lymphatic drainage of uterus

A

iliac and paraaortic

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38
Q

cells found in Krukenburg tumors

A

signet ring cells

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39
Q

lymphatic drainage of upper vagina

A

iliac (pelvic)

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40
Q

p53 & Rb are examples of __ genes

A

tumor suppressor

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41
Q

cyclophosphamide MOA

A

alkylating agent – prevents cell division by cross-linking DNA strands and decreasing DNA synthesis

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42
Q

BRCA1: __% risk of breast cancer and __% risk of ovarian cancer

A

85% risk of breast cancer and 40% risk of ovarian cancer

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43
Q

treatment for endometrial hyperplasia

A

TAH vs progestin therapy (any progestin will do); premalignant potential directly related to degree of cellular atypia and to a far less extent the degree of architectural complexity; microscopically has crowded glands but no invasion

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44
Q

Vulvar stage IVa

A

mucosa of bladder or rectum, urethra, bone bilateral inguinal nodes

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45
Q

plant alkaloids are __ phase specific

A

M phase

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46
Q

Which HPV strains linked to VIN & invasive SCC?

A

HPV 16,18, 31, 33

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47
Q

Vulvar stage Ib

A

> 2 cm or >1 mm invasion, no nodes

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48
Q

cyclophosphamide adverse effect

A

hemorrhagic cystitis

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49
Q

topotecan adverse reaction

A

profound neutopenia

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50
Q

most common tumor to metastasize to fetus

A

melanoma

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51
Q

Sentinal lymph node mapping in vulvar cancer

A

False negative rate is acceptably low (3.7%) such that patients can have SLN dissected and sent for frozen. If positive, full LN dissection on that side. Midline lesions need BILATERAL sentinel nodes.

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52
Q

the action of lasers is based on __

A

Water (cells heat and explode)

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53
Q

What is luteoma of pregnancy

A

solid, benign tumor requiring no treatment; regresses after pregnancy

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54
Q

What is the most common tumor in the broad ligament?

A

leiomyoma

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55
Q

cycle nonspecific alkylating agents

A

cyclophosphamide
chlorambucil
platinum compounds

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56
Q

doxorubicin MOA

A

inhibits topoisomerase II – inhibition of DNA and RNA synthesis, inhibition of DNA repair

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57
Q

Lymph node spread of vulvar cancer

A
  • first to ipsilateral inguinal nodes, then pelvic (late)

- Well lateralized lesions ALWAYS spread to ipsilateral nodes before contralateral nodes

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58
Q

Main difference between tamoxifen and raloxifene is:

A

effect on endometrium (tamoxifen is proliferative)

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59
Q

bleomycin adverse effect

A

pulmonary fibrosis

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60
Q

methotrexate is __ phase specific

A

S phase

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61
Q

lymphatic drainage of cervix

A

iliac (pelvic)

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62
Q

paclitaxel (Taxol) MOA

A

inhibits microtubule disassembly, interfering with late G2 mitotic phase

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63
Q

metastatic tumore from stomach to ovary

A

Krukenburg tumors

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64
Q

ras, HER-2/neu are examples are __ genes

A

oncogenes

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65
Q

vincristine MOA

A

inhibits microtubule assembly - arrests cell at metaphase by disrupting formation of mitotic spindle (M & S phases)

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66
Q

BRCA1 on chromosome __

A

17

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67
Q

GROINS V Trial

A

False negative rate is acceptably low (3.7%) such that patients can have SLN dissected and sent for frozen. If positive, full LN dissection on that side. Midline lesions need BILATERAL sentinel nodes.

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68
Q

lymphatic drainage of vulva

A

inguinal

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69
Q

What are the steps of the cell cycle?

A

G1 - S (DNA replication) - G2 - M (mitosis)

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70
Q

lymphatic drainage of lower part of vagina

A

inguinal

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71
Q

Most likely histologies of vulvar cancer

A
  1. Squamous cell cancer most common (~85% of all vulvar cancers)
  2. melanoma (~9%)
  3. Basal Cell Carcinoma (2%)
  4. Paget’s disease, Bartholin’s adenocarcinoma, sarcomas, and neuroendocrine tumors all rare
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72
Q

cisplatin adverse reaction

A

nephrotoxicity, neurotoxicity, ototoxicity, emetogenic

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73
Q

Vulvar stage II

A

any size with adjacent spread (lower 1/3 vagina, lower 1/3 urethra, anus), no nodes

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74
Q

most important predictor of survival in vulvar cancer

A

+LN status (stage III disease)

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75
Q

methotrexate adverse reaction

A

Neutropenia, mucositis, nephrotoxicity

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76
Q

When doing omentectomy must ligate the __ arteries

A

gastroepiploic arteries

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77
Q

Vulvar stage IIIb

A

with 2 or more lymph node metastases (≥5mm) OR 3 or more lymph node metastases (

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78
Q

attributes of PDS & Maxon

A

monofilament, highest tensile strength for absorbables

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79
Q

treatment for vulvar cancer for lesions >2cm or midline lesion

A

radical local excision of vulva with bilateral lymphadenectomy

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80
Q

predictors of lymph node spread in vulvar cancer

A

Tumor diameter, grade, depth of invasion into stroma (most important!) and LVSI

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81
Q

attributes of Nylon & Prolene

A

monofilament, highest tensile strength of all sutures, nonabsorbable

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82
Q

Vulvar stage IIIa

A

with 1 lymph node metastasis (≥5mm) OR 1–2 lymph node metastases (

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83
Q

attributes of Vicryl and Dexon

A

polyfilament, absorbed by hydrolysis

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84
Q

What is treatment for microinvasive squamous cell carcinoma of vulva?

A

wide local excision, NOT radical vulvectomy, NOT lymph node dissection

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85
Q

Define microinvasive squamous cell carcinoma of vulva

A

< 1 mm depth of invasion and <2 cm diameter - no risk of lymph node spread

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86
Q

In vulvar squamous cell carcinoma, if depth of invasion is 1.1 - 3 mm, likelihood of positive node is:

A

6 - 12% (need lymphadenectomy)

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87
Q

In vulvar squamous cell carcinoma, if depth of invasion is 3.1 - 5 mm, likelihood of positive node is:

A

15 - 20% (need lymphadenectomy)

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88
Q

second most common vulvar cancer

A

melanoma

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89
Q

survival with melanoma of vulva is related to:

A

Clark’s or Brewlow’s levels

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90
Q

treatment for melanoma of vulva with Clark level I or II (Breslow <1.5 mm)

A

wide local excision

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91
Q

treatment for melanoma of vulva with Breslow > 1.5mm

A

same as for squamous cell carcinoma, although nodes are only for prognosis

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92
Q

If nodes are positive in melanoma of vulva:

A

uniformly fatal

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93
Q

Paget’s disease of vulva may represent underlying __

A

adenocarcinoma (15%)

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94
Q

Cake icing effect of vulva

A

Paget’s disease

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95
Q

large clear cells at base of dermis

A

Paget cells

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96
Q

treatment of Paget’s disease of vulva

A

Wide local excision with clear margins of 2 cm

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97
Q

treatment of bartholin gland carcinoma

A

treat like squamous cell carcinoma

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98
Q

treatment of verrucous carcinoma

A

radical local excision without node dissection

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99
Q

verrucous carcinoma: __ rather than __ borders

A

pushing rather than infiltrative borders

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100
Q

Borders of femoral triangle

A

sartorius laterally
adductor longus medially
inguinal ligament superiorly

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101
Q

Where are the inguinal nodes?

A

In the femoral triangle, between superficial fascia (Camper’s) and deep fascia

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102
Q

Where are the femoral nodes?

A

In the femoral triage, deep to deep fascia

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103
Q

treatment for VIN I and II

A

observe

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104
Q

treatment for VIN III

A

wide local excision, CO2 laser ablation, Aldara (imiquimod)

105
Q

most common symptom of VIN

A

pruritis

106
Q

local recurrence __ after wide local excision of VIN III even with negative margins

A

20%

107
Q

most common tumor in vagina

A

metastases from cervix or vulva, not primary vaginal cancer

108
Q

most common histology of primary vaginal cancer

A

squamous cell carcinoma

109
Q

lymphatic drainage of vaginal

A

upper: same as cervix
lower: same as vulva

110
Q

vaginal cancer Stage I

A

mucosa

111
Q

vaginal cancer Stage II

A

subvaginal/paravaginal tissue but not to sidewall

112
Q

vaginal cancer Stage III

A

to pelvic sidewall

113
Q

vaginal cancer Stage IVa

A

mucosa of bladder or rectum

114
Q

vaginal cancer Stage IVb

A

distant mets

115
Q

pelvic or inguinal lymph nodes in vaginal cancer mean stage __

A

stage III

116
Q

treatment for vaginal cancer

A

Radiation for all stages: need external beam +/- brachy for lesions >2cm
Chemoradiation for locally advanced or metastatic

117
Q

clear cell carcinoma of vagina is a subtype of __

A

adenocarcinoma

118
Q

DES exposure in utero is associated with __

A

clear cell carcinoma of vagina

119
Q

__% of patients with VaIN had or currently have either intraepithelial neoplasia or carcinoma of the cervix or vulva

A

50 - 90%

120
Q

VaIN stage I

A

lower one third of epithelium

121
Q

VaIN stage II

A

lower two thirds of epithelium

122
Q

VaIN stage III

A

involves more than two thirds of epithelium

123
Q

treatment of VaIN stage I

A

estrogen, follow; rare malignant potential

124
Q

treatment of VaIN II/III

A

topical 5-FU, imiquomod, CO2 laser vaporization, partial vaginectomy, brachytherapy(Rare)

125
Q

3 major risk factors for cervical cancer

A

1) age at first coitus
2) number of partners
3) Smoking

126
Q

cervical cancer stage Ia1

A

cervix, diagnosed only by microscopy with invasion of <3 mm in depth and lateral spread <7 mm

127
Q

cervical cancer stage Ia2

A

cervix, diagnosed with microscopy with invasion of >3 mm and <5 mm with lateral spread <7 mm

128
Q

cervical cancer stage Ib1

A

clinically visible lesion or greater than Ia2, <4 cm in greatest dimension

129
Q

How many cervical cancer stages are there?

A 
Ia1
Ia2
Ib1
Ib2
IIa1
IIa2
IIb
IIIa
IIIb
IVa
IVb
130
Q

cervical cancer stage Ib2

A

clinically visible lesion, >4 cm in greatest dimension

131
Q

cervical cancer stage IIa1

A

vaginal but no parametrial involvement

involvement of the upper two-thirds of the vagina, <4 cm in greatest dimension

132
Q

cervical cancer stage IIa2

A

vaginal but no parametrial involvement

involvement of upper 2/3 vagina, >4 cm in greatest dimension

133
Q

cervical cancer stage IIb

A

with parametrial involvement

134
Q

cervical cancer stage IIIa

A

lower 1/3 vagina

135
Q

cervical cancer stage IIIb

A

parametria to sidewall or hydronephrosis

136
Q

cervical cancer stage IVa

A

mucosa of bladder or rectum

137
Q

cervical cancer stage IVb

A

distant

138
Q

cervical cancer staging and 5 year survival

A

I 90%
II 70%
III 30%
IV 10%

139
Q

most common histology in cervical cancer

A

80% squamous cell carcinoma

20% adenocarcinoma – also HPV-related, tend to be endophytic and larger

140
Q

cervical cancer treatment for stage Ia1

A

simple hysterectomy

141
Q

cervical cancer treatment for stage Ia2 - IIa

A

radical hysterectomy and bilateral pelvic lymphadenectomy OR chemoradiation
-Surgery has higher immediate complication rate BUT better preservation of sexual fnx and ovarian fxn
-Radiation has fewer contraindications BUT long term complications
-They are equally effective
Worst is surgery then radiation

142
Q

cervical cancer treatment for stage IIb and beyond

A

chemoradiation

143
Q

most common complication after radical hyst and b/l pelvic lymphadenectomy

A

bladder atony

144
Q

In radical hyster and b/l pelvic LA, uterine artery is taken at its origin from the __

A

hypogastric

145
Q

Name 3 scenarios requiring chemoradiation in cervical cancer

A
  1. Stage IIb and beyond
  2. Bulky Ib (>3-4cm)
  3. Adjuvant treatment following radical surgery (positive nodes, positive margins, parametrial involvement)
146
Q

treatment for cervical cancer in first trimester of pregnancy

A

treat as usual; e.g. gravid radical hysterectomy and pelvic lymphadenectomy or radiation (fetus will die)

147
Q

treatment for cervical cancer in second trimester of pregnancy

A

can wait for maturity or treat, depending on how early, patient preference

148
Q

treatment for cervical cancer in third trimester of pregnancy

A

wait for maturity and treat (Cesarean delivery and then radiation, or Cesarean radical hysterectomy with pelvic lymphadenectomy)

149
Q

Significance of microinvasion in cervical cancer:

A

is that there is no risk of lymph node metastasis

150
Q

Cervical cancer microinvasion requires __ to diagnose

A

LEEP or cone bx

151
Q

Definition of microinvasion in cervical cancer

A

less than 3 mm invasion with no lymphovascular space invasion (LVSI)

152
Q

treatment for microinvasion in cervical cancer

A

TAH OR LEEP/cone bx

153
Q

spread of cervical cancer

A

Locally
Pelvic lymph nodes - most common is obturator
Paraaortic lymph nodes

154
Q

most common cause of death in cervical cancer

A

bilateral ureteral obstruction

155
Q

treatment for cervical stump cancer

A

radiation or radical trachelectomy with nodes

156
Q

Can stop cervical cancer screening at 65 if:

A

3 consecutive negative cytology tests or 2 consecutive negative co-tests within the previous 10 years, with the most recent test within the previous five years

157
Q

bethesda system of glandular abnormalities of pap

A

AGUS (endometrioid v. endocervical)
adenocarcinoma in situ
adenocarcinoma

158
Q

What kind of virus is HPV

A

double stranded DNA

159
Q

E6 and E7 are HPV-encoded oncogenes whose protein products bind those of tumor suppressor genes __ and __, respectively

A

p53 and Rb

160
Q

most common gynecologic cancer

A

endometrial cancer

161
Q

risk factors for endometrial cancer

A

Estrogen excess - obesity, exogenous estrogen, chronic anovulation (type I)

162
Q

How many stages of endometrial cancer are there?

A 
Ia
Ib
II
IIIa
IIIb
IIIc1
IIIc2
IVa
IVb
163
Q

endometrial cancer stage Ia

A

corpus, <1/2 invasion

164
Q

endometrial cancer stage Ib

A

corpus, >1/2 invasion

165
Q

endometrial cancer stage II

A

cervix, stromal invasion

166
Q

endometrial cancer stage IIIa

A

adnexa or serosa

167
Q

endometrial cancer stage IIIb

A

vagina or parametrial

168
Q

endometrial cancer stage IIIc1

A

pelvic lymph nodes

169
Q

endometrial cancer stage IIIc2

A

paraaortic lymph nodes

170
Q

endometrial cancer IVa

A

bladder or bowel mucosa

171
Q

endometrial cancer IVb

A

distant mets

172
Q

3 scenarios in endometrial cancer requiring Adjuvant treatment with whole pelvic radiation OR vaginal brachytherapy

A 
Deep invasion (>50%)
High grade (3)
Stage II (cervical involvement)
173
Q

What studies showed that Radiation for endometrial cancer decreases local recurrences but does not improve survival?

A

PORTEC, GOG-99

174
Q

Most common types of histology in endometrial cancer

A

Type 1: Most common is endometrioid endometrial carcinoma
Type 2: Clear cell, papillary serous carcinoma have poorest prognosis
Papillary serous - looks like ovarian (papillary serous), acts like ovarian (spreads intraperitoneally), treated like ovarian (chemotherapy)

175
Q

normal endometrial stripe in postmenopausal women

A

<5mm

176
Q

tamoxifen increases the risk of endometrial carcinoma by

A

2-4 fold

177
Q

tumor marker for recurrence of endometrial cancer

A

CA125

178
Q

Cancer incidence for endometrial hyperplasia: simple without atypia

A

1%

179
Q

Cancer incidence for endometrial hyperplasia: complex without atypia

A

3%

180
Q

Cancer incidence for endometrial hyperplasia: simple with atypia

A

8-10%

181
Q

Cancer incidence for endometrial hyperplasia: complex with atypia

A

30-40%

182
Q

treatment for endometrial hyperplasia, simple without atypia

A

progestins

183
Q

treatment for endometrial hyperplasia, complex without atypia

A

progestins

184
Q

treatment for endometrial hyperplasia, simple with atypia

A

surgery or progestins

185
Q

treatment for endometrial hyperplasia, complex with atypia

A

surgery

186
Q

What does simple endometrial hyperplasia look like

A
  • glands are mildly crowded
  • cystically dilated with only occasional outpouching
  • Mitoses may or may not be present
187
Q

What does complex endometrial hyperasia look like

A
  • glands that are crowded (>50 percent gland to stromal ratio);
  • disorganized and have luminal outpouching.
  • Mitoses
  • Not Grade I endo CA because residual endometrial stroma that separates all glands
188
Q

What does atypia look like

A

nuclear enlargement, prominent chromatin

189
Q

How many stages of uterine sarcoma are there?

A 
Ia
Ib
IIa
IIb
IIIa
IIIb
IIIc
IVa
IVb
190
Q

uterine sarcoma stage Ia

A

Tumor limited to uterus < 5 cm

191
Q

uterine sarcoma stage Ib

A

Tumor limited to uterus > 5 cm

192
Q

uterine sarcoma stage IIa

A

Tumor extends to the pelvis, adnexal involvement

193
Q

uterine sarcoma stage IIb

A

Tumor extends to extra-uterine pelvic tissue

194
Q

uterine sarcoma stage IIIa

A

Tumor invades abdominal tissues, one site

195
Q

uterine sarcoma stage IIIb

A

Tumor invades abdominal tissues, more than one site

196
Q

uterine sarcoma stage IIIc

A

Metastasis to pelvic and/or para-aortic lymph nodes

197
Q

uterine sarcoma stage IVa

A

Tumor invades bladder and/or rectum

198
Q

uterine sarcoma stage IVb

A

distant mets

199
Q

risk factors for uterine sarcoma

A

prior radiation exposure, age, race, tamoxifen

200
Q

treatment for uterine sarcoma

A

TAH/BSO; all adjuvant therapies unproven

201
Q

ovarian stage Ia

A

tumor limited to one ovary or fallopian tube, surface not involved

202
Q

How many stages of ovarian cancer are there?

A 
Ia 
Ib 
Ic1 
Ic2 
Ic3 
IIa 
IIb 
IIIa - IIIa1i , IIIa1ii , IIIa2 
IIIb 
IIIc 
IVa
IVb
203
Q

ovarian stage Ib

A

tumor limited to both ovaries or fallopian tubes, surface not involved

204
Q

ovarian stage Ic1

A

tumor limited to one or both ovaries/fallopian tubes with intra-operative tumor rupture

205
Q

ovarian stage Ic2

A

tumor limited to one or both ovaries/fallopian tubes with pre-operative tumor rupture OR tumor on the surface/capsule

206
Q

ovarian stage Ic3

A

tumor appears limited to one or both ovaries/fallopian tubes with positive cytology from ascites or washings

207
Q

ovarian stage IIa

A

extension to gynecologic tissues beyond the primary organ (uterus, mets to fallopian tube, contralateral adnexa)

208
Q

ovarian stage IIb

A

extension to other pelvic intraperitoneal tissues (e.g. – bladder peritoneum, rectum, cul-de-sac)

209
Q

ovarian stage IIIa

A

positive LN or microscopic peritoneal metastases outside the pelvis

210
Q

ovarian stage IIIb

A

Macroscopic metastasis outside the pelvis within the peritoneal space ≤ 2 cm

211
Q

ovarian stage IIIc

A

Macroscopic peritoneal metastasis beyond pelvis > 2 cm in greatest dimension (includes extension of tumor to capsule of liver and spleen without parenchymal involvement of either organ), with or without positive retroperitoneal lymph nodes

212
Q

ovarian stage IVa

A

positive pleural cytology (effusion)

213
Q

ovarian stage IVb

A

parechymal metastasis to liver, spleen or extra-abdominal spread (thoracic or supraclavicular LN, pulmonary solid mets, etc.)

214
Q

most common ovarian cancer histology

A

high grade serous - most common and most aggressive

215
Q

ovarian cancer with +AFP

A

Endodermal sinus tumor (aka Yolk Sac), +/- immature teratoma, +/- embryonal carcinoma

216
Q

ovarian cancer with +hcg

A

ovarian choriocarcinoma (rare); +/- dysgerminoma

217
Q

name 2 types of sex cord stromal tumors

A

granulosa cell tumors, sertoli-leydig cell tumors

218
Q

tumor markers for granulosa cell tumors

A

inhibins, estradiol

219
Q

tumor markers for sertoli-leydig cell tumors

A

androgens

220
Q

breast cancer stage 1

A

< 2 cm without nodes

221
Q

breast cancer stage 2

A

> 2cm but < 5 cm with or without 1-3 ipsilateral nodes OR > 5 cm without nodes

222
Q

breast cancer stage 3

A

Anything in between stage II and IV: direct extension to the chest wall and/or to the skin (ulceration or skin nodules), Inflammatory carcinoma

223
Q

breast cancer stage 4

A

distant mets

224
Q

underlying disease in Paget’s disease of breast

A

underlying carcinoma is ALWAYS present (unlike vulva)

225
Q

risk factors for endometrial cancer

A

obesity, nulliparity, tamoxifen, unopposed estrogen, Lynch, DM, gallbladder

226
Q

tamoxifen increases endometrial cancer risk by __

A

2-3 fold

227
Q

pharm category of tamoxifen:

A

SERM

228
Q

most COMMON pathology that results from tamoxifen

A

polyps

229
Q

What screening should you do in women taking tamoxifen?

A

None

230
Q

Are premenopausal women taking tamoxifen at increased risk of cancer?

A

No

231
Q

Call Exner bodies mean:

A

granulosa cell tumors

232
Q

Tumor markers for granulosa cell tumors

A

inhibin (A or B)

233
Q

Tumor marker for dysgerminoma

A

LDH

234
Q

3 types of ovarian cancer

A

epithelial (90%), germ cell, sex cord stromal

235
Q

risk factors for ovarian cancer

A

HNPPC, Peutz Jeughers, age, nulliparity, P1>35yo

236
Q

protective factors for ovarian cancer

A

OCPs, salpingectomy, breastfeeding

237
Q

Schillar Duval bodies mean:

A

endodermal sinus (yolk sac) germ cell cancer

238
Q

Oncogenes for cervical cancer in HPV

A

p53: E6
Rb: E7

239
Q

cutoff for elevated Ca125 in postmenopausal

A

> 35

240
Q

cutoff for elevated Ca125 in premenopausal

A

200

241
Q

causes of elevated ca125 other than cancer

A

endometriosis, pancreatitis, hepatitis, diverticulitis, cirrhosis, menses, PID, pregnancy, fibroids

242
Q

treatment for low risk GTN

A

methotrexate or dactinomycin (Act-D)

243
Q

treatment for high risk GTN

A

EMACO

244
Q

components of EMACO

A

etoposide, methotrexate, Act-D, cyclophosphamide, vincristine

245
Q

cure rate for GTN with treatment

A

> 80%

246
Q

How do you diagnose persistent GTN?

A

HCG plateaus for 4 measurements over 3w
HCG >10% over 3 measurements over 2w
HCG still persistent after 6 months

247
Q

If you are doing a hyst for hyperplasia with atypia, what is the likelihood of finding endometrial ca?

A

42%

248
Q

Risks for progression to endometrial ca from hyperplasia:

A

simple: 1
complex: 5
simple w atypia: 10
complex w atypia: 25

249
Q

risk factors for cervical cancer

A

smoking! HPV, immunocompromised, HIV, multiple partners, 3+ SVDs

250
Q

When do you start paps when +HIV

A

when she becomes sexually active

251
Q

When do you start paps for DES exposure hx

A

menarche

252
Q

next steps for 35yo negative pap, +HPV

A

16 or 18: colpo
low risk HPV: cotest 1 year
no HPV type: cotest 1 year

253
Q

oncogene in endometrial cancer

A

K-ras

254
Q

tumor suppressor gene in endometrial cancer

A

PTEN

255
Q

indications for risk reducing BSO

A

BRCA age >40, Lynch, strong family hx, hx breast cancer

256
Q

risk of primary peritoneal cancer after BSO in +BRCA

A

0.2%

257
Q

What HPV is associated with SCC

A

16

258
Q

What HPV is associated with adeno

A

18

259
Q

Stage: cervical cancer side wall w hydro

A

IIIB

Gyn Onc (2 decks)

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