Week 4 pt 1 Flashcards
Define the following:
1) Cone Biopsy
2) Cryotherapy
3) Dilation and curettage (D&C)
1) Removal of cone-shaped portion of the cervix for biopsy with cold knife or laser
2) Application of liquid nitrogen, used for condylomas of cervix, vagina, and vulva (high failure rate for large lesions)
3) Opening the cervix and using a curette to scrape out the uterus for diagnostic or therapeutic reasons
What are the 3 contraindications to colposcopy?
Active cervicitis, pregnancy, severe immunosuppression
Cone Biopsy of Cervix (cold knife conization):
1) What is it?
2) What is cervical dysplasia?
3) How is it usually performed?
1) Surgery to remove a sample of abnormal tissue from the cervix.
2) Abnormal changes in the cells on the surface of the cervix
3) Under general or regional anesthesia.
Cone Biopsy of Cervix:
1) Why is it done?
2) When is it done?
1) To detect cervical cancer or early changes that lead to cancer.
2) If a colposcopy cannot find the cause of an abnormal Pap smear.
D&C (Dilation and Curettage): How is it done?
To perform the test, your provider collects a tissue sample from the lining of your uterus (endometrium) and sends the sample to a lab for testing.
Hysterectomy: What is it?
Surgical removal of uterus through the abdomen, vagina, or laparoscopically
List & describe the 3 types of hysterectomy
1) Total (removes uterus and cervix, leaves ovaries): most common
2) Hysterectomy with oophorectomy (removes uterus, cervix, the top portion of your vagina, most of the tissue that surrounds the cervix, and sometimes the pelvic lymph nodes)
3) Radical hysterectomy (excision of the uterus en bloc with the parametrium and upper 1/3-1/2 of the vagina w likely bilateral pelvic lymph node dissection)
Hysterosalpingography (HSG): What is it/ what does it do?
Radiographically (xray procedure) evaluates the patency/shape of the uterus and fallopian tubes.
Hysteroscopy:
1) What is it?
2) What 3 things is it most commonly used for?
1) A very thin telescope (camera) which is inserted into the uterus to allow visualization of the interior of the uterus
2) Infertility, AUB, endometrial ablation
Endometrial Biopsy: What are the 3 ways to do it?
1) Can be done via D&C
or
2) With a special disposable suction apparatus which aspirates some of the endometrial lining for evaluation/biopsy
or
3) Can be done in office with hysteroscope
Define:
1) Laparoscopy
2) Laser Vaporization
3) Mammography
4) Needle aspiration of breast mass
1) Insertion of the laparoscope to less-invasively perform surgery within the abdomen to examine pelvic and upper abdominal structures
2) A tiny beam of light is used to vaporize abnormal cells. (Very expensive)
3) Special low-dose X-ray of the breasts to detect cancer
4) Done usually under ultrasound guidance to obtain a specimen for cytology
What are the different methods of pregnancy termination?
Oral meds, suction curettage, D&C, vaginal prostaglandins with or without Pitocin.
Vulvar or Vaginal Biopsy:
1) What is it?
2) What different methods are there to obtain a specimen?
1) Obtaining a tissue sample to send for cytology from suspicious areas of the vulva or vagina.
2) A Keyes punch, shaving of the lesion, and removal with scalpel or scissors
Define trophoblasts
Cells forming in the outer layer of a blastocyst, which provides nutrients to the embryo, and develops into a large part of the placenta
1) The most common form of GTD is called what?
2) How common is it? Is it cancerous?
1) Hydatidiform mole (molar pregnancy)
2) Rare, develops in the early stages of pregnancy; non-cancerous
Complete hydatidiform mole: 15-20% may transform into __________________, a malignant form of GTD.
choriocarcinoma
1) Define partial hydatidiform mole
2) What is the karyotype?
1) develops when two sperm fertilize a normal egg.
2) 69, XXX or 69 XXY karyotype
Contain some fetal tissue.
Partial mole:
1) What is it important to know?
2) What do most patients need?
3) What do partial moles rarely develop into?
1) That it is RARE that a viable fetus is being formed.
2) Only a small percentage of patients with partial moles need further treatment after initial surgery.
3) Malignant GTD.
Molar pregnancy: Symptoms
Which type does bleeding occur a little less often in, complete or incomplete?
Occurs a little less often with incomplete (partial) moles.
Almost all women (97%) with ___________ hydatidiform moles have irregular _____________ during pregnancy.
complete; vaginal bleeding
List and describe the Sx of molar pregnancy other than bleeding
1) Abdominal swelling
2) Vomiting: Hyperemesis
3) Painless 2nd trimester bleeding
4) Preeclampsia (HTN, proteinuria, possible hyperreflexia)
Unlike third trimester in normal pregnancy, can occur during the first or second trimester
Severe HTN before 20 weeks = suggestive of molar pregnancy
5) Potentially signs of metastasis
Vaginal bleeding (vaginal mets), cough, hemoptysis (lung), HAs, syncope (brain)
Most common metastasis location: lungs
Describe GTD/ molar pregnancy Tx
1) Prompt evacuation of the uterine contents.
-D&C or hysterectomy
-Monitoring weekly serum hCG levels to make sure levels f-fall to zero (may take 6 months) then monthly for at least a year.
2) Rh negative patients should be given Rh immunoglobulin.
3) Reliable contraceptive method
4) Chemotherapy if levels plateau or rise after falling
-High cure rates, even with metastatic disease
5) If not interested in preserving fertility: hysterectomy +/- chemo
Invasive GTD:
1) Is it histologically different from a complete mole?
2) What does this category include?
1) Histologically identical to complete mole
2) This category includes GTD not cured by D&C.
Differentiate the different odds of trophoblastic disease b/t partial and complete moles
1) ~150-200/1000 cases of complete molar pregnancy develop trophoblastic disease that keeps growing after the mole is removed (20%)
2) ~50/1000 cases of partial molar pregnancy develop trophoblastic disease (5%)
1) Persistent (or invasive) mole diagnosed when?
2) When can it occur?
3) What is your first step when investigating this?
1) If the quant hCG decreases but then levels off or starts to rise again (never gets to zero)
2) Often diagnosed after a molar pregnancy but can occur after a normal pregnancy as well
3) Order a quant hCG
Risks for Persistent GTD include what?
1) Long time (more than 4 months) between the time menses stopped and treatment started
2) Very large uterus
3) Woman > 40yo and < 21yo
4) Fam Hx of GTD (possible genetic component?
Persistent GTD: Dx & Treatment:
What do you need to look at when reexamining the pt (first step)?
1) Chest x-ray
2) Transvaginal US
3) Possibly CT of head, abdomen/pelvis and liver scan.
Persistent GTD: Dx & Treatment
Describe chemotherapy (after reexamining the pt)
1) Ordered based on the + hCG rather than on tissue samples.
2) Nonmetastatic persistent GTD treated by single-agent chemotherapy (i.e., methotrexate)
3) Metastasis treated with a number of meds (that we will not cover here)
Describe choriocarcinomas (malignant GTD)
1) Rare (1 in 20,000-40,000 pregnancies)
2) Sub-types: Gestational vs non-gestational
3) Most often develops from a complete hydatidiform mole
4) Can also occur after a normal pregnancy or one where the fetus is lost early in pregnancy.
5) Metastasis more common
What is a trophoblastic tumor?
Large, hemorrhagic, cystic and solid endometrial mass invading the myometrium
