16 18 6 11 you need to know this

Wright - OBGYN - Cancer Flashcards by Alice Richards

mc gynecological malignancy in developed countries

endometrial ca

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rf for endometrial ca

45 yo or older

lynch syndrome → 50% increased risk

unopposed estrogen

tomoxifen

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post menopausal woman w. uterine bleeding

endometrial ca until proven otherwise

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labs for endometrial ca

CBC → H/H

Hcg

tumor markers

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mc imaging for endometrial ca

pelvic US

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gs imaging for endometrial ca

office bx vs hysteroscopy vs D&C

need to have histology for dx

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endometrial thickening/stripe

US findings of endometrial ca

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tumor marker CA125

endometrial ca

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is there screening for endometrial ca

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endometrial cancer is same-same

uterine cancer

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third mc gynecologic malignancy and cause of death among gynecologic cancers in US

cervical ca

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2nd mc malignancy in the world where no access to screening or vaccination

cervical ca

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__ is detected in 99.7% of cervical ca

HPV

HPV causes cervical ca

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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

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dz burden of genital HPV infxn (5)

vulvar ca

vaginal ca

penile ca

anal ca

anogenital warts

head and neck cancers

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which types of HPV are found in >70% of all cervical cancers

16 and 18

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Gardasil 9 targets

you need to know this

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mc cervical ca

squamous

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less common type of cervical ca

adenocarcinoma

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__ infection is a cofactor in cervical ca pathogenesis

HSV2

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can cervical cancer occur in teenagers

no! pathogenesis is very slow moving

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if cervical ca is symptomatic, what are some early sx

irregular/heavy bleeding → mc

postcoital bleeding

+/- discharge

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advanced sx of cervical ca

pelvic/lower back pain

bowel or urinary sx

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when should you perform PE for cervical cancer

any woman w. symptoms suggestive of cervical ca

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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

**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

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

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