Wright - OBGYN - Cancer Flashcards
mc gynecological malignancy in developed countries
endometrial ca
rf for endometrial ca
45 yo or older
lynch syndrome → 50% increased risk
unopposed estrogen
tomoxifen
post menopausal woman w. uterine bleeding
endometrial ca until proven otherwise
labs for endometrial ca
CBC → H/H
Hcg
tumor markers
mc imaging for endometrial ca
pelvic US
gs imaging for endometrial ca
office bx vs hysteroscopy vs D&C
need to have histology for dx
endometrial thickening/stripe
US findings of endometrial ca
tumor marker CA125
endometrial ca
is there screening for endometrial ca
no
endometrial cancer is same-same
uterine cancer
third mc gynecologic malignancy and cause of death among gynecologic cancers in US
cervical ca
2nd mc malignancy in the world where no access to screening or vaccination
cervical ca
__ is detected in 99.7% of cervical ca
HPV
HPV causes cervical ca
rf for cervical ca (6)
early onset sexual activity
multiple sexual partners
high risk sexual partner
hx of STDs
hx of vulvar/vaginal squamous intraepithelial neplasia or ca
immunosuppression
dz burden of genital HPV infxn (5)
vulvar ca
vaginal ca
penile ca
anal ca
anogenital warts
head and neck cancers
which types of HPV are found in >70% of all cervical cancers
16 and 18
Gardasil 9 targets
16
18
6
11
you need to know this
mc cervical ca
squamous
less common type of cervical ca
adenocarcinoma
__ infection is a cofactor in cervical ca pathogenesis
HSV2
can cervical cancer occur in teenagers
no! pathogenesis is very slow moving
if cervical ca is symptomatic, what are some early sx
irregular/heavy bleeding → mc
postcoital bleeding
+/- discharge
advanced sx of cervical ca
pelvic/lower back pain
bowel or urinary sx
when should you perform PE for cervical cancer
any woman w. symptoms suggestive of cervical ca
indication for bx for cervical ca PE findings
anything raise or friable
diagnostic testing for cervical ca
cervical cytology → PAP
cervical bx → most useful
colposcopy
+/- CT for staging
for cervical ca bx, use sample from suspicious area, but avoid
grossly necrotic tissue
cervical ca screening recs for < 21 yo
no screening recommended
cervical ca screening rec for 21-30 yo
pap q 3 years
+/- hpv testing
cervical ca screening recs for 30-65 yo
pop and hpv q 5 years
OR
pap q 3 years
cervical ca screening recs for > 65 yo
d.c screening if no hx abnormal cells or 3 negative paps in a row
why might you adjust cervical ca screening recs for a patient
known hpv infxn
2nd mc cancer worldwide
breast
leading cause of cancer death in women worldwide
2nd mc cause of cancer death in US
brest ca
rf for breast ca
personal or fam hx ovarian ca, peritoneal, or breast ca
genetic predisposition
chest wall xrt btw 10-30 yo
mc presentation of breast ca in countries w. screening
abnormal mammogram
describe breast ca mass
hard, immobile, single dominant
signs of locally advanced breast ca
axillary adenopathy
erythema, thickening, dimpling of skin → peau d’orange
3 mc sites of metastasis in breast ca
bone
liver
lungs
if breast ca that has spread to lymph considered metastatic
no
hypoechogenicity, calcifications, shadowing, spiculated/indistinct/angular margins
US findings of breast ca
what is this showing
“spiculated” appearance → breast ca
breast ca imaging if elevated alk phos or bone pain
bone scan
breast ca imaging if elevated liver enzymes
CT abd/pelvis
breast ca imaging if pulmonary sx
CT chest
breast ca imaging if stage III or higher
whole body PET
2 types of breast ca pathology
ductal vs lobular
mc type of invasive breast ca
infiltrating ductal carcinoma
8% of invasive breast ca
infiltrating lobular carcinoma
mixed invasive carcinoma
mixed ductal/lobular
rare
heterogeneous group of precancerous lesions confined to the breast ducts and lobules
ductal carcinoma in situ (DCIS)
hormone positive breast cancers
ER positive/negative
PR positive/negative
HER-2 positive/negative
triple negative
poor prognosis receptor testing marker for breast ca
triple negative
breast ca screening rec for < 40 yo
none for average risk pt
breast ca screening rec for 40-49 yo
mammography q 2 years
breast ca screening for 50-74 yo
mammorgaphy q 2 years
breast ca screening recs for high risk
MRI vs US
+/- self breast exams monthly
2nd mc gynecologic malignancy in US
ovarian
mc cause of gynecologic cancer death in US
ovarian
avg age of ovarian ca dx
63 yo
rf for ovarian ca
age
BRCA
hereditary cancer syndromes
infertility
nulliparity
ovarian ca protective factors
multiparity
breastfeeding
oral contraceptives
salpingo-oophrectomy
tubal ligation
hysterectomy
mc ovarian ca
epithelial carcinoma → serous
ovarian ca is typically asymptomatic; what is the acute presentation
advanced dz →
pleural effusion
bowel obstruction
venous thromboembolism
subacute presentation of ovarian ca
adenxal mass
pelvic/abdominal sx → bloating, urinary urgency, or frequency, early satiety, pelvic/abd pain
dx for ovarian ca
full surgical removal
CT abd/pelvis and/or US
CA-125
is screening recommended for ovarian ca
no
4th mc gynecologic malignancy
vulvar ca
rf for vulvar ca
vulvar or cervical intraepithelial neoplasia (VIN)
hx cervical ca
smoking
immunodeficiency
northern european
HPV
which types of HPV cause vulvar ca
16
33
18
mc presentation of vulvar ca
abnormal finding on labia majora
sx of vulvar ca
vulvar pruritis
vulvar bleeding/pain
dysuria, dyschezia, rectal bleeding, enlarged lymph node in groin, LE edema
dx for vulvar ca
bx
mc type of vulvar ca
squamous cell
sqamous cell carcinoma vulvar ca is not related to
hpv
which type of vulvar ca is related to hpv 16, 18, 33
classic warty or bowenoid type
2nd mc vulvar ca
melanoma
type of vulvar ca w. poor prognosis
sarcoma
