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Gynecologic Oncology > Vulvar and vaginal disease > Flashcards

Vulvar and vaginal disease Flashcards

1
Q

Condyloma Acuminatum is associated with what virus?

A

HPV

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2
Q

What pathology is associated with Condyloma Acuminatum?

A

Stratified squamous epithelium, Koliocytosis, multinucleation, parabasal hyperplasia

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3
Q

What is the first line treatment for Condyloma Acuminatum?

A

Imiquimod

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4
Q

What is the second line treatment for Condyloma Acuminatum?

A

TCA, surgery

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5
Q

Common presentation of Lichen Sclerosus

A

itching, soreness, irritation

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6
Q

Physical exam findings consistent with lichen sclerosus

A

white, atrophic papules, depigmentation, agglutination obscuring clitoral hood, loss o architecture, fissues, erosions

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7
Q

Pathology of Lichen sclerosus

A

thin epithelium, blunt rete ridges, collagenization of dermis, chronic inflammation

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8
Q

Treatment for Lichen Sclerosus

A

Clobetasol 0.05% daily for 6 - 12 weeks then maintenance 1-3 times weekly

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9
Q

Physical exam findings for vulvar squamous cell hyperplasia

A

leather-like thickening of skin, red or pink with overlying gray-white keratin layer, thickened epithelium with acanthosis

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10
Q

Pathology of vulvar squamous cell hyperplasia

A

Hyperkaratosis without inflammatory infiltrate

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11
Q

Treatment of vulvar squamous cell hyperplasia

A

Triamcinolone 0.1%

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12
Q

What physical exam findings are associated with psoriasis?

A

erythematous papules and plaques with silvery scale

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13
Q

What are the treatment options for psoriasis?

A

Betamethasone 0.05% or Clobetasol 0.5%

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14
Q

What is the incidence of vulvar dysplasia?

A

3/100,000

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15
Q

What are main risk factors for vulvar dysplasia?

A

HPV, Smoking, immune supression

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16
Q

How does vulvar dysplasia typically present?

A

pruritis, pigmented papules in the labia, posterior fourchette and perineum

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17
Q

What characteristic pathology findings area associated with vulvar dysplasia?

A

high nuclear to cytoplasmic ratio, high mitotic rate, parakeratosis

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18
Q

What are the treatment options for vulvar dysplasia?

A

Imiquimod, wide local excision, laser topical therapy

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19
Q

What is the risk of cancer for untreated vulvar dysplasia?

A

4 - 8%

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20
Q

What is the recurrence rate for vulvar dysplasia

A

30%

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21
Q

What factors increase the risk of recurrence?

A

positive margins, immune supression, smoking

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22
Q

What is the general surveillance for vulvar dyspasia?

A

physical exam q 6 months for 5 years

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23
Q

Vulvar cancer is the ___ most common of all GYN cancer

A

4th

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24
Q

What is the average age of diagnosis of vulvar cancer?

A

65 - 70 yrs

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25
Q

HPV associated vulvar cancer is associated with:

A

Younger age, tobacco, h/o VIN, immune supression and condyloma

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26
Q

Non-HPV associated vulvar cancer is associated with:

A

older age, lichen sclerosis, hypertrophic lesions, HTN, DM, Obesity

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27
Q

What are the typical symptoms of vulvar cancer?

A

Vulvar mass, pruritis, bleeding

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28
Q

What physical exam findings are associated with vulvar cncer?

A

ulcerative lesion, friable or indurated mass

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29
Q

What lymphnode is associated with Vulvar cancer and where is it located?

A

Cloquest’s Node, deepest medial node to the femoral vein

30
Q

what is the next step in management when there is a suspicious vulvar lesion or mass?

A

Punch biopsy

31
Q

What is the most common pathology associated with vaginal cancer?

A

squamous cell carcinoma

32
Q

What is the next step in management of vulvar lesions > 2 cm

A

CT scan to rule out metastasis

33
Q

What is the definition of a radical vulvectomy?

A

Removal of tissue to the deep fascia of the thigh, periosteum of the pubis inferior fascia or urogenital diaphragm

34
Q

What is the definition of stage IA vulvar cancer?

A

Lesions < 2 cm and < 1 mm stromal invasion

35
Q

What is the definition of Stage IB vulvar cancer?

A

Lesions > 2 cm and > 1 mm stromal invasion

36
Q

What is the definition of stage II vulvar cancer?

A

Any size extended to lower adjacent perineal structures

37
Q

What is the definition of stage IIIA vulvar caner?

A

1 or 2 node metastases

38
Q

What is the definition of IIIB vulvar cancer?

A

2 or more regional nodal metastasis

39
Q

What is the definition of IIIC vulvar cancer?

A

Node metastasis with extracapsular spread

40
Q

What is the definition of stage IVA Vulvar cancer?

A

Any size with extension to the upper adjacent perineal structures/pelvic bone

41
Q

What is the definition of Stage IV B Vulvar Cancer?

A

Distant metastasis to pelvic lymphnodes

42
Q

What is the treatment of IA vulvar cancer and 5 year survival percent?

A

Deep radical excision, 90&

43
Q

What is the treatment of IB - IIIC vulvar cancer?

A

Individualized radical vulvectomy and lymphnode dissection

44
Q

At what stage should you add chemo and radiation with in the treatment of vulvar cancer?

A

Stage IV

45
Q

What is the 5 year survival for stage II vulvar cancer with treatment?

A

75%

46
Q

What is the 5 year survival for stage III vulvar cancer with treatment?

A

50%

47
Q

What is the 5 year survival for stage IV vulvar cancer with treatment?

A

20%

48
Q

What margin should be obtained when performing a radical excision for vulvar cancer?

A

1 cm

49
Q

What are the indications for adjuvant RT in vulvar cancer?

A

Stage IV disease, positive nodes, < 8 mm margins, Large > 4 cm tumors, LVSI

50
Q

What factor affects prognosis the greatest in locally advanced vulvar cancer?

A

positive lymphnodes `

51
Q

Vaginal cancer is associated with what percent of gyn cancer?

A

3%

52
Q

True or false: the majority of vaginal cancers are metastatic?

A

True

53
Q

Where is the most common site of vaginal mass?

A

posterior wall and upper 1/3 vagina

54
Q

What nodes dose the upper 2/3 of the vagina drain to?

A

Pelvic nodes

55
Q

What nodes dose the lower 1/3 of the vagina drain to?

A

groin nodes

56
Q

What is the most common pathology associated with vaginal cancer?

A

Squamous

57
Q

What are the components of a full work up for vaginal cancer?

A

EUA, Cystoscopy, Proctoscopy, CXR, IVP

58
Q

What is the main treatment of vaginal cancer?

A

Radiation therapy

59
Q

When is surgery indicated for vaginal cancer?

A

Lesions< 2 cm located in the upper posterior vagina

60
Q

What type of surgery should be performed for vaginal cancers?

A

radial hysterectomy, upper vaginectomy, LND

61
Q

What is the definition of stage I vaginal cancer and survival rate?

A

Tumor confined to the vagina, 70- 90%

62
Q

What is the definition of stage II vaginal cancer and survival rate??

A

Tumor invades paravaginal tissues but not to pelvic side wall, 55%

63
Q

What is the definition of stage III vaginal cancer and survival rate??

A

Tumor invades pelvic side wall OR positive pelvic lymphnodes, 30 - 45%

64
Q

What is the definition of stage IV vaginal cancer and survival rate??

A

Tumor invades mucosa of the bladder, rectum or extends to distant metastasis. 20%

65
Q

At what stage are most vaginal cancers diagnosed?

A

Stage II

66
Q

What percent of DES daughters have vaginal adenosis?

A

45%

67
Q

What percent of DES daughters have cock’s comb cervix

A

25%

68
Q

What are characteristic GU abnormalities found with DES exposure?

A

T shaped uterus, hypoplastic uterus, vaginal adenosis, septum, cock’s comb cervix

69
Q

What is the increased risk of developing clear cell cancer if exposed to DES?

A

40X increase

70
Q

What is the screening regimen for DES exposure?

A

Yearly cervical cytology with pap smear of cervix and vagina

Gynecologic Oncology (11 decks)

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