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Clin Med 3 - Exam 3 (Women's Health) > Vulva, AGC, AIS, Uterine Corpus, & Ovarian Malignancies > Flashcards

Vulva, AGC, AIS, Uterine Corpus, & Ovarian Malignancies Flashcards

1
Q

what is vulvar intraepithelial neoplasia (VIN)? what types of lesions?

A

VIN = premalignant condition of vulva (non-HPV)

Refers to squamous lesions

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2
Q

VIN LSIL is associated with what disease? VIN HSIL is associated with what disease? Differentiated VIN is associated with what disease?

A

VIN LSIL is associated with low oncogenic HPV types

VIN HSIL is associated with high oncogenic HPV types

Differentiated VIN is associated with lichen sclerosus

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3
Q

what are the risk factors of vulva HSIL (VIN HSIL)?

A

HPV infection, cig smoke, immunodeficiency or immunosuppression

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4
Q

what is the clinical presentation of VIN?

A

Vulvar pruritis, vulvar lesion

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5
Q

what tests do you do to evaluate VIN lesions?

A

Colposcopy and bx

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6
Q

what is the criteria to do Colposcopy when suspect VIN?

A

visible vulvar lesions, persistent symptoms, persistent abnormal cervical cytology

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7
Q

what is the GOLD STANDARD management for vulvar HSIL with a lesion?

A

Surgical excision (wide local excision or vulvectomy)

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8
Q

when would you do ablative therapy for pt with vulvar HSIL with a lesion?

A

done if pt doesn’t want surgery or isn’t candidate

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9
Q

what medication can you use in the treatment of vulvar HSIL with a lesion?

A

Topical tx with Imiquimod

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10
Q

management for vulvar HSIL without a lesion?

A

ablative therapy

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11
Q

what is the management for differentiated VIN?

A

surgical excision

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12
Q

risk factors for recurrence of VIN after tx?

A

immunosuppression, multifocal/multicentric disease, positive margins

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13
Q

risk factors for progression of VIN to malignancy?

A

histologic type (high-grade > low-grade)

co-existant VIN and carcinoma at dx

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14
Q

how can you prevent VIN?

A

HPV vaccine, smoking cessation

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15
Q

follow-up for pts with VIN?

A

follow-up every 6 months for 5 years, then annualy

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16
Q

vulvar cancer is most frequently in what women?

A

post-menopausal women

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17
Q

risk factors for vulvar cancer?

A

vulvar or cervical intraepithelial neoplasia, prior hx of cervical cancer (HPV), vulvar lichen sclerosus

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18
Q

what is the main factor to vulvar carcinogenesis occurring?

A

Mucosal HPV infection

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19
Q

clinical manifestations of vulvar cancer?

A

vulvar lesion (vulvar plaque, ulcer, or mass), pruritus

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20
Q

how do you evaluate pt for vulvar cancer?

A

colposcopy and bx

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21
Q

vulvar cancer dx, is what type of dx and made based upon what?

A

histologic dx made based upon a vulvar bx

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22
Q

75% of vulvar cancer are what type of cells?

A

squamous cell carcinomas

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23
Q

if pt with vulvar cancer has no mets, what is the standard tx?

A

surgery with adjuvant therapy

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24
Q

if pt with vulvar cancer has locally advanced disease/unresectable or has distant mets, what is the tx?

A

chemo or radiation if locally advanced disease/unresectable

chemo with combo of carboplatin and paclitaxel plus restaging exams with CT of chest, abdomen, and pelvic every 3 cycles for distant mets

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25
Q

atypical glandular cells are classified as?

A

AGC - endocervical, endometrial, NOS (not otherwise specified)

Atypical glandular cells, favor neoplastic (not normal cells)

Endocervical adenocarcinoma in situ (AIS)

Adenocarcinoma (full blown cancer)

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26
Q

endocervical and endometrial atypical cells are of what origin?

A

glandular cell origin

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27
Q

what is cervical adenocarcinoma in situ (AIS)?

A

a premalignant glandular condition

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28
Q

what is the only known precursor to cervical adenocarcinoma?

A

cervical adenocarcinoma in situ (AIS)

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29
Q

risk factors for cervicl adenocarcinoma in situ?

A

HPV infection (subtypes 16 and 18)

30
Q

is it easy to distinguish AIS from cervical invasive adenocarcinoma?

A

NO!!! cytologically, they look the same, but histologally there is no invasion for AIS -> NEED BX

31
Q

sx’s of AIS?

A

asymptomatic

32
Q

what is the preserved management for AIS? what if you want to preserve fertility?

A

preferred management = hysterectomy

to preserve fertility = endocervical curetage

33
Q

dx of AIS?

A

colposcopy-direct bx, endocervical curettage, conization

34
Q

what is the definition of endometrial hyperplasia?

A

proliferation of endometrial glands

35
Q

endometrial hyperplasia is a precursor to what?

A

to endometrial cancer

36
Q

endometrial hyperplasia always results from?

A

unopposed chronic estrogen stimulation

37
Q

what is the WHO CLASSIFICATION of endometrial hyperplasia?

A
  • hyperplasia without atypia
  • atypical hyperplasia (endometrial intraepithelial neoplasm: EIN)
38
Q

endometrial hyperplasia risk factors?

A

Lynch Syndrome, endometrial exposure to unopposed estrogen

39
Q

clinical presentation of endometrial hyperplasia and endometrial cancer?

A

abnormal uterine bleeding

40
Q

diagnostic evaluation for endometrial hyperplasia?

A

endometrial sampling

41
Q

what is the management for endometrial hyperplasia but NEGATIVE endometrial sampling?

A

if negative endometrial sampling, but still have persistent or recurrent bleeding, then repeat endometrial sampling

42
Q

what is the management for endometrial hyperplasia, POSITIVE endometrial sampling?

A

follow-up of bx or curettage results

43
Q

what is the most common Gyn malignancy in developed countries?

A

Endometrial Carcinoma

44
Q

what is Type I tumors of endometrial carcinoma (comprise how much of endometrial carcinoma? prognosis? responsive to estrogen?)?

A

make up 80% of endometrial carcinomas, favorable prognosis, estrogen-responsive

45
Q

what is Type II tumors of endometrial carcinoma?

A

only comprises 10-20% of endometrial carcinomas, high-grade tumors, poor prognosis, not associated with estrogen stimulation

46
Q

what is the main risk factor for endometrial cancer?

A

Lynch syndrome

47
Q

Lynch syndrome is a risk factor for what cancers?

A

Ovarian, Uterine, and Colon cancers

48
Q

what are the cervical cytology findings for endocervical cancer?

A

adenorcarcinoma, atypical glandular cells, endometrial cells

49
Q

endometrial cancer may be what type of finding?

A

an incidental finding

50
Q

what bleeding patterns should you watch for in endometrial cancer?

A

Postmenopausal women -> any bleeding b/c should not have any bleeding if post-menopausal

Age 45-menopause -> any abnormal uterine bleeding

Younger than 45 years -> abnormal and persistent uterine bleeding

51
Q

how do you evaluate a women with SUSPECTED endometrial cancer?

A

Pelvic US and endometrial sampling

52
Q

what kind of dx is endometrial cancer?

A

a histologic dx

53
Q

in what cases do you screen women for endometrial cancer?

A

women with lynch syndrome get screened for endometrial cancer

54
Q

pre-treatment evaluation for endometrial cancer

A

look for Lynch syndrome (high risk factor), tumor markers (CA-125), contrast MRI

55
Q

what is the standard initial tx to women with newly dx low risk endometrial cancer? what about women who want to preserve fertility?

A

surgical staging with total hysterectomy = GOLD STANDARD

women who desire fertility preservation should have MEDICAL THERAPY

56
Q

what is the standard tx approach to women with recurrent or metastatic endometrial cancer?

A

radiation therapy if only in vaginal vault

surgery and/or radiation if only in pelvis

57
Q

what cells is ovarian cancer derived from?

A

epithelial cells

58
Q

what cancers are considered a single entity?

A

high-grade epithelial ovarian carcinoma, fallopian tubal, and peritoneal carcinomas

59
Q

what are the risk factors for ovarian cancer?

A

Lynch syndrome, BRCA gene mutation, older age

60
Q

the risk of ovarian cancer decreases in women with a history of what?

A

previous pregnancy, use of OCPs, breastfeeding

61
Q

the risk of ovarian cancer is increased in women with a history of what?

A

infertility, endometriosis, polycystic ovarian syndrome, cig smoking

62
Q

what are the acute presentations of ovarian cancer? what are they associated with?

A

pleural effusion and bowel obstruction

associated with advanced stages of ovarian cancer and need immediate tx

63
Q

what are the subacute presentations of ovarian cancer?

A

adenexal mass, pelvic or abd pain, urinrary symptoms (urgency or frequency), bloating, GI sx’s

64
Q

advanced epithelial ovarian cancer presents with what sx’s?

A

abd distention, nausea, anorexia, early satiety d/t to ascites and bowel mets

65
Q

most women with epithelial ovarian cancer have what sx’s prior to dx?

A

pelvic or abd sx’s -> subacute sx’s

66
Q

physical exam results of pt with epithelial ovarian cancer that leads you to their dx?

A

abd ascites, mass in mid-left upper abdomen, pleural effusion, groin or supraclavicular lymphadenopathy

67
Q

lab and imaging studies for ovarian cancer?

A

transvaginal and transabdominal US exam and measuring the serum CA-125 (high CA-125 = ovarian cancer)

68
Q

expert panels endorse theuse of ___ as a prompt for evaluation for ovarian cancer

A

use of symptoms

69
Q

is routine screening recommended for ovarian cancer? who do you screen for ovarian cancer?

A

screening is NOT recommended for ovarian cancer unless the pt has LYNCH SYNDROME d/t it’s high association with ovarian cancer

70
Q

what is the 2 phase process of evaluation for ovarian cancer?

A
  1. initial evaluation - if no indication for sugery (no adnexal mass, no sx’s, no elevated CA-125, or peritoneal carcinomatosis) -> evaluate for other etiologies
    - if there is adexal mass and sx’s -> surgical evaluation
  2. surgical evaluation
71
Q

when do you refer premenopausal women with a pelvic mass to gynecologic oncologist?

A

if have very elevated CA-125 level, ascites, or evidence of abdominal or distant mets

72
Q

when do you refer postmenopausal women with a pelvic mass to gynecologic oncologist?

A

if have elevated CA-125 level, ascites, nodular or fixed pelvic mass, evidence of abdominal or distant mets

Clin Med 3 - Exam 3 (Women's Health) (9 decks)

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