Vulvar cancer Flashcards
Vulvar intraepithelial neoplasia is a ___ condition
premalignant
Three types of vulvar intraepithelial neoplasia
- low grade
- high grade
- differentiated type
Low grade VIN is associated with ___
low oncogenic HPV tyes
High grade VIN is associated with ___
high oncogenic HPV types
Differentiated VIN is associated with ___
lichen sclerosus
Risk factors for high grade VIN
- HPV
- smoking
- immunodeficiency
Clinical presentation of VIN
- pruritus and discomfort
- vulvar lesion
Treatment of high grade VIN with a lesion
- surgical excision
- ablative therapy
- topical imiquimod
Treatment of high grade VIN without a lesion
-ablative therapy
Treatment of differentiated VIN
surgical excision
What are the risk factors of recurrence of VIN after treatment
- immunosuppression
- multifocal/multicentric disease
- positive margins
When do you follow with with a patient that had VIN after treatment
every 6 months for 5 years then anually
What population is vulvar carcinoma most frequently seen in
postmenopausal women
What are the risk factors for vulvar cancer
- VIN/SIN
- prior hx of cervial cancer
- vulvar lichen sclerosus
- smoking
- immunodeficiency
- northern european ancestry
What complaint is associated with most vulvar disorders
pruritus
Histologically what are most vulvar cancers? What else can they be?
most are squamous cell carcinomas
can also be melanoma
Treatment of vulvar cancer with no evidence of distant disease
surgery with adjuvent therapy
Treatment for vulvar cancer with locally advanced disease
chemo or radiation alone
Treatmetn of vulvar cancer with distant mets
- chemo w/ carboplatin and paclitaxel
- restaging exams w/ CT of chest,abd, pelvis every 3 cycles
Origins of atypical glandular cells
- enodcervial
- endometrial
Are atypical glandular cells associated with premalignant/malignant lesions
YES
relationship between risk of malignancy and age in women with AGC
risk of malignancy increases with age
How are atypical enodmetrial cells worked up
endometrial and endocervical sampling–> colposcopy if no endometrial pathology
How are all subcategories of AGC (except endometrial) worked up
colposcopy with endocervial sampling and endometrial sampling
Adenocarcinoma in situ of the cervix is what
a premalignant condition
Adenocarcinoma in situ is the only precursor to what
adenocarcinoma
Cytology for adenocarcinoma in situ
atypical glandular cells resemble the same ones of cervical invasive adenocarcinoma
How does a patient with adenocarcinoma in situ present
- nearly always asymptomatic
- generally not visible on gross examination
How do you diagnose adenocarcinoma in situ
- colposcopy directed biopsy
- endovervical curettage
- conization
Preferred management for adenocarcinoma in situ
hysterectomy
Conservative management of adenocarcinoma in situ
if margins are negative after excision–> long term follow up
if margins are involved or ECC +—> re-excision is recommended or re-evaluate at 6 months
What is endometrial hyperplasia
proliferation of endometrial glands
Endometrial hyperplasia is typically a result from what
unopposed chronic estrogen stimulation
WHO classification of endometrial hyperplasia
- hyperplasia without atypia
- atypical hyperplasia (enodmetrial intraepithelial neoplasm)
Risk factors for endometrial hyperplasia
- HPV
- smoking
- exposure to estrogen
- Lych syndrome
Endometrial hyperplasia clinical presentation
- abnormal uterine bleeding
- same as endometrial carcimona
Diagnostic evaluation of endometrial hyperplasia
- pelvic sonography
- enodmetrial sampling
What are the two categories of endometrial carcinoma
- type I tumors
- type II tumors
Which endometrial carcinoma has the better prognosis
type I tumors
Which type of endometrial carcinoma is estrogen responsive
type I tumors
What may precede a type I endometrial carcinoma
intraepithelial neoplasm
Are type I or type II endometrial carcinoma tumors more common
type I
Cervical cytology findings with endometrial carcinoma
- adenocarcinoma
- aytpical glandular cells
- endometrial cells
Bleeding patterns in postmenopausal women that should make you think cancer. Age 45 to menopause. Younger the 45.
Postmenopausal: any bleeding
45 to menopause: any abnormal bleeding
Younger than 45: abnormal and persistent uterine bleeding
If suspected endometrial cancer, what should be done?
- physical exam (size, mobility and axis of uterus)
- urine HCG
- pelvic sonography
- endometrial sampling
Enodmetrial carcinoma is a ___ diagnosis based upon results of ____
histological diagnosis based on results of andometrial biopsy or hysterectomy
When is routine endometrial cancer screenings preformed
in women with lunch syndrome
Before treating someone for endometrial cancer what should be done
- evaluation for hereditary cancer syndromes
- serum tumor marker CA 125
- contrast MRI
Standard treatment for women with low risk endometrial cancer
Surgical staging
- total hysterectomy
- bilateral salpingo-oophroectomy
- lymph node evaluation
Standard treatment for women with recurrent of metastatic endometrial cancer
-if isolated to vaginal vault–>radiation
if limited to pelvis–> surgery and/or radiation
The majority of ovarian malignancies are derived from ___
epithelial cells
Risk factors for ovarian cancer
- lynch syndrome
- BRCA gene mutation
- increasing age
- hx of infertility
- endometriosis
- PCOS
- smoking
What factors can reduce a womens risk for ovarian cancer
- previous pregnancy
- use of OCP
- breastfeeding
Acute presentation of ovarian cancer. Subacute presentation.
acute- pleural effusion, bowl obstruction
subacute- adenxal mass, pelvic/abd pain, bloating, GI sx’s
How does a patient with advanced ovarian cancer present
- abd distension
- nausea
- anorexia
- early satiety d/t acites or bowel mets
When do you preform a surgical evaluation if ovarian cancer is suspected
if there is an adnexal mass is found
When to refer premenopausal women with a pelvic mass to gyn onc
- very elevated CA125 level
- ascites
- evidence of abdominal or distant mets
When to refer postmenopausal women with a pelvic mass to gyn onc
- elevated CA 125
- ascites
- nodular or fixed pelvic mass
- evidence of abdominal or fixed mets
