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Clin med sem 2 > Womens- oncology > Flashcards

Womens- oncology Flashcards

1
Q

Endometrial Cancer- pathophysiology

A

Most common gynecologic malignancy
- 75%

Adenocarcinoma

Spread

  • direct extension
  • lymphatic mets
  • peritoneal implants
  • hematogenous spread
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2
Q

Endometrial Cancer- cause

A

Protective - OCPs, prego, breast feeding

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3
Q

Endometrial Cancer- epidemiology

A

Risk - 3%

Advanced age 
>45
7th decade
Lynch syndrome
Unopposed estrogen 
Tamoxifen
White females
DM
Nullparity/infertility
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4
Q

Endometrial Cancer- S/S & PE

A 
Abnormal uterine bleeding 
- 70-90% - how present 
- 6-19% - postmenopausal w/ bleeding -> all need to be worked up 
Abnormal vaginal discharge - clotting
Intermittent spotting 
Lower abdom cramps/pain

PE - Nl - can’t usually palpate anything

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5
Q

Endometrial Cancer- labs & imaging

A

Hgn/Hct - anemia?
Hcg - make sure not pregnancy
Tumor marker - CA125

Pap - incidentally endometrial cells

Pelvic US - transvaginal

  • most sensitive
  • endometrial thickening or stripe >4mm -> get biopsy

Endometrial biopsy - gold
- office vs hysteroscopy vs D&C

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6
Q

Endometrial Cancer- treatment

A

Refer to gyn!
Hysterectomy w/ salpingo-oophrectomy
Radiation
Chemo

Screening 
Routine of asymptomatic - not advised
- no good sensitive/specific test
- most present w/ symptoms and good prog
Lynch syndrome - 12-54% of getting in life
- Hysterectomy - preventative
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7
Q

Endometrial Cancer- prognosis

A

Overall good

- stage 3 + - not good

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8
Q

Cervical Cancer- pathophysiology

A

3rd most common gynecologic malignancy
- 2nd most common female maglignancy

Squamous cell

  • HPV 16 - 59%
  • HPV 18 - 13%
  • HPV 58, 33, 45 - 4-5%

Adenocarcinoma

  • HPV 16 - 36%
  • HPV 18 - 37%
  • HPV 45, 31, 33 - 2-5%
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9
Q

Cervical Cancer- cause

A

HPV - 99.7%

  • HPV 16&18
  • vaccines have dec this by 75%
  • can also cause vulvar, vaginal, penile, anal cancers, anogenital warts

HPV persists -> progresses to cancer

  • initial infection -> high grade cervical intraepithelial neoplasia -> invasive cancer
  • takes around 15yrs

HSV2 - coinfection

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10
Q

Cervical Cancer- epidemiology

A 
Early onset sexual activity
Multiple sex partners
High risk sexual partner 
Hx of STD
hx of vulvar/vaginal squamous intraepithelial neoplasia or cancer
Immunosuppression 
Smoking 
DES exposure
Long term OCP
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11
Q

Cervical Cancer- S/S & PE

A

Asymptomatic

Most common

  • irregular/heavy vaginal bleeding
  • postcoital bleeding
  • vaginal discharge

Advanced

  • pelvic/lower back pain
  • bowel or urinary symptom

PE - pelvic exam
- cervix - nl or lesion -> raised or friable = biopsy

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12
Q

Cervical Cancer- diagnosis

A 
Bethesda System 
Atypical Squamous Cells - ASC
- differ from nl cells - not premalignant
- ASC-US -> unknown significance
- ASC-H -> HSIL cannot be excluded
Cytologic findings
- squamous intraepithelial neoplasia (SIL) - premalignant 
- LSIL - low grade
- HSIL - high grade

Glandular cell

  • Atypcial Glandular cell (AG)
  • Adenocarcinoma in situ (AIS)
  • Adenocarcinoma

Histologic findings
- Cervical intraepithelial neoplasia (CIN) - premalignant

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13
Q

Cervical Cancer- labs & imaging

A

Cervical Cytology

  • pap smear - not diagnostic
  • sample cervical cells from transformation zone

Cervical biopsy

  • from area that looks most suspicious - avoid necrotic
  • unusually firm/expanded
  • hemostatic agents

Colposcopy

  • can’t visualize lesion - but hgh suspicion
  • visualize SCJ and transformation zone
  • application of acetic acid to aid visualization
  • w/ biopsy - most appropriate histologic tech

CT - ONLY if worried about mets

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14
Q

Cervical Cancer- treatment

A

LEEP - loop electrosurgical excision procedure
- frequently used to treat CIN II or III
- small fine, wire loop attached to electrosurgical generator or excise tissue of interest
- output
Core Biopsy
- conization - excision of cone shaped part of cervix -> more likely to lead to incompetent cervix

Therapy - must address primary tumor and adjacent tissue/lymph nodes
- depends on age, stage, pt/phys preference
Radical hysterectomy + pelvic lymphadenectomy, radion w/ concomitant chemo - combo?

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15
Q

Cervical Cancer- staging

A

Staging
CIN1 - mild dysplasia - disordered growth of lower third of epithelial lining
CIN2 - Moderate dysplasia - abnormal maturation of lower 2/3 of lining
CIN3 - Severe dysplasia - >2/3 of epithelial thickness
CIS - cervical cancer, carcinoma insitu
- full thickness
- 25-30
Cervical cancer
- >40
0 - Carcinoma in situ - some of cells of cervix have cancer
I - cervix carcinoma confined to uterus
II - carcinoma invades beyond uterus but not to pelvic wall or to lower third of vagina
III - tumor extends to pelvic wall and/or causes hydronephrosis or nonfunctioning kidney
IV - tumor extends beyond true pelvis or involves bladder or rectum

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16
Q

Cervical Cancer- screening

A 
Screening
Age <21 - no screening recommended
Age 21-30 
- pap every 3yr
- consider reflex to HPV testing
Age 30-65
- Pap and HPv every 5yrs   OR
- Pap every 3yrs
Age >65
- disc if not abn cells - 3neg paps in a row or 2 neg w/in 10yrs and most recent was 5yrs ago
Annual if - HIV, immunocompromised, exposure to DES, prev treated for cervical cancer
Continue screening post hysterectomy - hx of CIN2, CIN3, cervix is still present

F/U

  • every 3m for 5yr - high risk
  • every 6m for 5yr - low risk
  • Pap test yearly
  • recurrence suspected? - CT/PET
Screening Adolescents
Most LSIL/CIN1 - regress spontaneously 
- 61% in 1 yr
- 91% in 3yr
Treat lesions that would resolve w/out therapy 
treat for CIN - LEEP - inc risk of 
- preterm birth 
- low birth weight 
- preterm premature rupture of membranes

HPV Vaccine
Gardasil 9
- against HPV
- 9-26yo

17
Q

Breast Cancer- pathophysiology

A

Screening

  • 15% - not detected on mammogram
  • 30% w/ mass in interval b/t mammograms
18
Q

Breast Cancer- cause

A

“nfiltrating ductal carcinoma - most common of invasive
Infiltrating lobular carcinoma - 8% of invasive
Mixed ductal/lobular carcinoma - mixed invasive - 7%
Other - metaplastic, mucinous, tubular, medullary, papillary carcinomas - 5%

Ductal Carcinoma in situ (DCIS)

  • heterogeneous group of precancerous lesions - confined to breast ducts/lobules - precurosr lesion to invasive
  • size of lesion, nuclear grade, presence and extent of comedo necrosis, architectural pattern
19
Q

Breast Cancer- S/S & PE

A

Hard, immobile single dominant mass

Local advanced dis

  • axillary adenopathy
  • erythema, thickening, dimplings of skin - peau d’orange -> inflammatory breast cancer

Met dis
- bone, liver lungs

20
Q

Breast Cancer- diagnosis

A

Mammgogram findings

  • soft tissue mass or density
  • spiculated, high density mass

Breast U/S
- hypoechogenicity, internal calcifications, shadowing, spiculated/indistinct/angularg margins

Breast MRI
- irregular or spiculated mass margins, heterogeneous internal enhancement, enhancing internal septa

21
Q

Breast Cancer- labs & imaging

A

Inc alk phos or bone pain -> bone scan
Inc liver enzymes -> CT abdomen/pelvis
Pulm symptoms -> CT chest
Stage III or higher -> whole boday PET/CT

Receptor testing
- ER pos/neg - estrogen
- PR pos/neg - progesterone
- HER-2 pos/neg - human pidermal growth factor 2
Triple neg breast cancer - poor prognosis
- 13%

22
Q

Breast Cancer- treatment

A 
Screening 
Age <40
- no recommended screening 
Age 40-75
- screening mammogram ev 2 yrs
Age 75
- screening mammogram ev 2yrr if life expectance >10yr

High risk - MRI, U/S
Self-breast exam - monthly, controversial if effective

23
Q

Ovarian Cancer- pathophysiology

A

2nd most common gynecologic malignancy

Most common cause of gynecologic cancer death

Avg age - 63

Epithelial Carcinoma - 95%
1. Serous - most common
- from ovarian tissue 
- filled w/ watery or mucous material 
- grow large enough to fill abdominal cavity - usually smaller than mucinous 
2. Mucinous 
- GI origin - appendix and met to ovary
- filled w/ opaque, thick, mucoid material 
- largest tumor 
Germ cell/sex cord stromal tumors - 5%
24
Q

Ovarian Cancer- cause

A

Protective

  • multiparity
  • breast feeding
  • oral contraceptives
  • salpingo-oophorectomy
  • tubal ligation
  • hysterectomy
25
Q

Ovarian Cancer- epidemiology

A 
Age
BRCA mutation - 2-3%
Hereditary cancer syndromes
- lynch syndrome
Infertility
Nullparity
Less risky risk factors 
- endometriosis, PCOS, postmenopausal hormone therapy, obesity, smoking, asbestos
Smoking
26
Q

Ovarian Cancer- S/S & PE

A

Acute

  • usually already advanced
  • pleural effusion
  • bowel obstruction
  • venous thromboembolism

Subacute

  • Adenxal mass
  • Pelvic/abdominal symptoms - bloating, urinary urgency/frequency, early satiety, pelvic/abdominal pain
27
Q

Ovarian Cancer- diagnosis

A

Majority diagnosed at an advanced stage

  • confined primary site - 15%
  • spread to regional lymph nodes - 17%
  • distant mets - 6%
  • unstaged - 7%
28
Q

Ovarian Cancer- labs & imaging

A

Full surgical removal PREFERED - don’t just get a biopsy

CT A/P or Pelvic U/S

CA -125

29
Q

Ovarian Cancer- screening

A

Screening
No recommendations for screening
- high false pos
- low prevalence

Risk stratification - preventive measures

30
Q

Ovarian Cancer- prognosis

A

5yr survival

  • stage 1 - >90%
  • regional dis - 75-80%
  • distant met - <25%

Overall 5yr survival in women w/ ovarian cancer <45%
- due to spread at time of diagnosis

31
Q

Ovarian Cancer- staging

A

Staging
1 - tumor limited to one or both ovaries
2 - tumor involves one or both ovaries w/ pelvic extension
3 - tumor involves one or both w/ confirmed peritoneal mets - outside pelvis and/or regional lymph node mets
4 - distant mets

32
Q

Vulvar Cancer- pathophysiology

A

4th most common gynecologic malignancy

Squamous cell carcinoma - 75%
Keratinizing, differentiated, simplex 
- older, not associated w/ HPV 
- associated w/ vulvar dystrophies
Classic/warty/bowenoid
- young
- HPV 16, 18, 33

Verrocous - variant of squamous cell
Basal cell - non met
Melanoma - 2nd most common
Sarcoma - poor prognosis
Paget dis of vulva - intraepithelial carcinoma
Bartholin gland carcinoma - most often adeno or squamous cell
- can be transitional, adenosquamous, adenoid cystic

33
Q

Vulvar Cancer- cause

A

HPV

  • intraepithelial - 87%
  • Invasive vulvar cancer - 29%

HPV 16 -23%
HPV 33 - 7%
HPV 18 - 5%”

34
Q

Vulvar Cancer- epidemiology

A 
VIN 
Piror hx of cervical cancer
Cigarette smoking
Vulvar lichen sclerosu
Immunodeficiency syndromes
Northern European ancestry
HPV infect
35
Q

Vulvar Cancer- S/S & PE

A

Abnormal findings on labia majora - most common

  • Unifocal vulvar - plaqu, ulcer, mass
  • Fleshy, nodular, warty

Vulvar pruritis
Vuvlar bleeding/pain
Dysuria, dyschezia, rectal bleeding, enlarged lymph node in groin, lower extremity edema

36
Q

Vulvar Cancer- diagnosis

A

Biopsy

37
Q

Vulvar Cancer- prognosis

A

Diagnosed at an early stage
Confined to primary site - 59%
Reginal dis - 30%
Distant met - 6%

5yr survival - 72%

Med age of death - 78yr

Clin med sem 2 (30 decks)

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