Test 3 Deck 3 Flashcards
What are the first and second MC vulvar cancers?
Squamous cell MC (vestibule) then
Malignant melanoma (poor prognosis)
Vulvar cancer in a person less than <55 is MC linked to what?
HPV
Vulvar cancer in a woman 55+ is most like a NONSMOKER, and it linked to ___ ___.
Lichen sclerosis
What two things make you much more likely to develop vulvar cancer?
Smoker + genital warts
What is the presentation of early vulvar cancer?
Pruritis and visible lesion (pain bleeding, ulceration, inguinal mass)
What is the evuaaltion procedure for vulvar cancer?
Vulvoscopy (4mm punch, acetowhite)
Treatment for vulvar cancer?
Wide local excision (1A) good prognosis,
Radical vulvar resection (w/ inguinal lymphadenectomy + chemo)
What is the follow up for vulvar cancer?
Q3 months 2 years, q6 months 5 years, annually
What indicates very poor prognosis for vulvar cancer?
Recurrence
Vaginal cancer is most commonly from where?
Somewhere else
Very old 80+ year old woman presents w/ vaginal bleeding (MC), and dysuria, hematuria, urgency/ constipation. Dx__
Vaginal cancer, anterior wall for the urine stuff and posterior for the constipation
What is the treatment for vaginal cancer?
Surgery, radiation, chemo
Endometrial hyperplasia is a result of?
Anovulation
What is the gold standard diagnosis for a woman w/ suspected endometrial hyperplasia?
Endometrial biopsy, but can use TVUS in a post menopausal woman
POST menopausal woman w/ complaint of bleeding presents. You perform a transvaginal U/S and see thickened endometrium >4mm. What do you do?
Endometrial biopsy, looking for endometrial atypia
What is the treatment for atypical endometrial hyperplasia in a post-menopausal woman?
Hysterectomy and BSO
What is the treatment for atypical endometrial hyperplasia in a pre menopausal woman that wants to still give birth?
Progestins
What is the treatment for a pre menopausal woman w/ hyperplasia and no atypia?
Progestins, or COC. F/U bx after treatment, if resolves continue treatment until menopause. If fails to resolve then refer for minimally invasive surgery
What is the MC GYN in cancer in the US?
Endometrial cancer
What is the treatment for endometrial cancer if you are not concerned w/ fertility?
Hysterectomy w/ BSO and lymph node staging. If advanced then chemo
What are the two MC risk factors for endometrial cancer?
Obesity and unopposed estrogen
What is the MC presenting symptom for endometrial cancer?
Irregular vaginal bleeding. In premenopausal woman it heavy or intermenstrual, post menopausal (any bleeding)
Women w/ lynch syndrome are at an increase risk for ___. They receive an EMB every 1-2 years starting age __-__. MC endometrial cancer is the __ cancer. What do you offer to these patients in their mid 40’s?
Cancer (colon, endometrium, small bowel, renal pelvis, ovary), 30, 35, sentinel, prophylactic hysterectomy
What are additional labs/ studies to perform for endometrial cancer?
CXR/ CT for metastasis, CA125 (to response)
Treatment for endometrial cancer if you are attempting to retain fertility?
Evaluate to see if possible w/hysteroscopy and D&C. Then provide hormonal treatment w/ progestin and tamoxifen (unregulated progesterone)
Woman that gets cancer following/ with pregnancy?
Gestational trophoblastic neoplasia
Gestational trophoblastic neoplasia produces what?
B-hCG so follow the levels.
What is the treatment for gestational choriocarcinoma?
Very responsive to chemo/ invasive mole
What are some risk factors for ovarian cancer?
Fam hx breast/ovarian (BRCA),
Nulliparity (more periods cause of the Fallopian tubes)
Personal hx or breast cancer
Postmenopausal hormone therapy (estrogen)
What is the most deadly GYN cancer?
Ovarian cancer (epithelial MC)
What are some protective factors for ovarian cancer?
Breast feeding
Long term oral contraceptives
Tubal ligation/hysterectomy
Diet (high fiber)
Large masses on pelvic exam tend to be __
Benign
What are some common lab and exam findings in ovarian cancer?
Ascites, pleural effusion on pulm. Exam
Labs: CBC- thrombocytosis Hyponatremia CA-125 Human epididymal protein 4 tumor marker
What is the most useful initial test for ovarian cancer and what may you see?
TVUS Multiloculated, solid, echogenic Large->5cm Thick septa w/ nodules Papillar projections/neovasularization
Treatment for ovarian cancer?
Hysterectomy w/ BSO, lymph node Eval, very rarely would you consider performing fertility sparing because so deadly
Size and treatement for premenopausal simple ovarian cysts?
<=3 normal
<=5 nada
>5/ <=7 TVS repeat 6-12 wks the yearly TVS if persistent
> 7 MRI/ surgery
Pot menopausal treatment of simple cyst w/ benign qualities
<=1 normal
<=5 CA125, if normal TVS 6-12 weeks, then years TVS if persistent
>7 MRI surgery
Treatment for cysts we/ indeterminate, but probably benign qualities pre/post menopausal?
Premenopausal: TVS reprinted in 6-12 weeks, if persistent MRI/surgery
Post menopausal: surgery
Treatment for cysts w/ qualities suggesting malignancy?
Surgical (thick (>3mm) irregular septations)(nodule w/ blood flow)
Hemorrhagic ovarian cyst pre/post menopausal treatment?
Premenopausal
<=3 norm
<=5 nada
5-7 TVS repeated 6-12 weeks then MRI/surgery
Early post menopause: CA125 (if normal) then TVS 6-12 weeks, if persistent MRI/ surgery
Late menopause: surgery
