Shared Flashcard Set

Details

Clin Med III
GYN Oncology
68
Medical
Graduate
08/21/2010

Additional Medical Flashcards

 


 

Cards

Term
What are the screening recommendations for Cervical Cancer?
Definition

Begin at age 21

 

Recommend every 2 yrs for women b/w age 21-29

 

Women over 30 with 3 consecutive negative screenings may extend to every 3 years, not high risk pts.

Term

What is this:

 

Triage for ASC-US

Women >30 yrs can use in conjuction w/ cytology

routine testing not recommended for women <30

Definition
HPV testing
Term

What is this:

 

HVP infection-esp subtype 16 & 18

 

early onset of sexual activity

multiple sexual partners, high risk sexual partners

hx of STI

Smoking

Immunocompromised (HIV)

low socieconomics

Definition

Risk Factors for CIN & Cervical cancer

 

CIN=cervical intrauterine neoplasia

Term
What virus can be detected 99.7% in cervical cancer?
Definition
Human Papilloma Virus
Term
What % of sexually active women will acquire a genital HPV infection by age 50.
Definition
80%
Term

T/F

 

Most women with intact immune system will not clear HVP infection in 8-24 months.

Definition
False, they will clear the infection
Term
What's the goal of Colposcopy?
Definition
Identify precancer & cancer lesions for early tx intervention
Term
What does acetic acid cause when applied to the cervix?
Definition
CIN lesion to become whiter than surrounding epithelium
Term

T/F

 

CIN lesions do not have specific characteristics?

Definition

False

 

Ex. Vascular pattern, aids in direction of biopys

Term

Will these findings require a colposcopy?

grossly visible or palpable abnormality of cervix

abnormal cervical cytology

+ screening test for neoplasia

 

cervical cytology unsatisfactory d/t unexplained inflammation

 

unexplained cervico-vaginal discharge

unexplained abn lower GI tract bleeding

hx lower GI neoplasia

 

Post tx surveillance

Definition
YES, all of them
Term
How common is cerival cancer world wide?
Definition
3rd most common malignancy
Term
What are the most common sx of cervical cancer?
Definition

abnormal vaginal bleeding

post coital bleeding

 

vaginal discharge that is:

 watery

mucoid/purulent

malodorous

Term

What are the physical findings of cervical cancer?

 

Definition

may or may not have cervical lesion

cervical lesion may be ulcerative or exophytic

usually very friable cervix, bleeds easily

Term
What's the treatment of cervical cancer?
Definition

Radical hysterectomy

Radiation therapy

Chemotherapy

Term

???

 

Removal of:

 uterus

adjacent portions of vagina

cardinal ligaments

uterosacral ligaments

bladder pillars

 

Definition
Radical hysterectomy
Term

Malignant tumors of____________ are uncommon.

 

Most are squamous cell carcinomas

Definition
Vulva
Term

These 2 types:  basaloid & warty types

 

Seen in younger pts

Related to HPV

Smoking

 

What type of cancer is this?

Definition
VIN & Vulvar cancer
Term

Which one is this:  Basoloid/Warty or Differentiated

 

Older pt

Unrelated to HPV & smoking

Long standing lichen sclerosis is common

 

 

Definition
Differentiated type of VIN & Vulvar Ca
Term
What's the Vulvar cancer presentation?
Definition

Pruritis

mass

Vulvar bleeding or discharge

Dysuria

Enlarged groin nodes-advanced

 

Asymptomatic

Term

This is what type of cancer?

 

Rare, 1% of all gyn cancers

Upper 1/2 of vagina involved in over 50% of cases

80-90% vaginal tumors metastatic

mean age 60-65 yrs

 

most primary vaginal adenocarcinoma related to DES exposure in utero

Definition
VIN & Vulvar cancer
Term
What is the most common solid pelvic tumor in women & the leading indication of a hysterectomy?
Definition

Leimyomyomas

 

AKA-Fibroids

Term
What are the 2 most common reasons women seek tx?
Definition

Abnormal uterine bleeding

&

Pelvic pressure/pain

Term

What is this called:

 

bleeding from the cervix, vagina, or perineum that is acute and occurs between expected periods

Definition
Intermenstrual bleeding
Term

Heavy or prolonged menses is the typical pattern for fibroids,

 

Is intermenstrual bleeding normal also?

Definition

NO

 

This is not a characteristic of myomas & should be investigated to exclude endometrial pathology

Term
Can a uterine leimyomas cause difficulty with urination & defecation?
Definition
Yes depending on its size & location
Term

What is the PE for a uterine leiomyomas:

 

contour

&

 abdominal exam

Definition

contour:  IRREGULAR

&

 abdominal exam:  Large fibroid can be PALPATED

Term
What is the most gyn malignancy?
Definition
Endometrial cancer
Term

Which endometrial cancer is the most common:

 

Type I / estrogen dependent

or

Type II

Definition

Type I more common with good prognosis

 

Type II accounts for 10% of endometrial ca & is more aggressive with poorer prognosis

Term
What is the most significant risk factor for endometrial cancer?
Definition
Unopposed estrogen
Term

These are risk factors for which type of cancer?

age

obesity

DM

Late menopause, early menarche

nulliparity

Tamoxifen

Polycystic Ovary Syndrome

Hereditary nonpolyposis colorectal Ca syndrome

Estrogen secreting tumor

Definition
Endometrial Ca
Term
What 2 factors decrease Endometrial Ca?
Definition

OCP

&

Smoking

Term
What is the most common symptom of Endometrial Ca?
Definition

Abnormal vaginal bleeding

 

Postmenopausal bleeding is always abnormal & should be investigated.

Term

What is this:

 

HNPCC (Lynch 2 Syndrome)

Extended anovulatory cycles

 

Postmenopausal women with intact uterus taking unopposed estrogen therapy

Definition
High Index of suspicion for Endometrial Ca
Term
Who should be biopsied for Endometrial Ca?
Definition

Postmenopausal bleeding

 

Endometrial cells on Pap

 

Atypical Endometrial cells on Pap

Term
What are the PE findings for Endometrial Ca?
Definition

Obesity

&

HTN

 

Most are dx early therefore there are not a lot of findings. 

Normal uterus

Term
What organization stages Endometrial Ca?
Definition

FIGO

 

Federation of International Gynecologist & Obstretics

Term

What do these Endometrial stages mean?

 

Stage 1

Stage 2

Stage 3

Stage 4

Definition

 

Stage 1:  Ca confined to uterus

 

Stage 2:  Ca of cervical stroma but does not extend beyong uterus

 

Stage 3:  Local/regional spread of tumor

serosa of uterus, adnexa, vaginal, parametrial, lymph nodes

 

Stage 4:  Tumor invades bladder & bowel mucosa with distant metastates

More aggressive Ca

Term
Are most adnexal masses malignant or benign?
Definition
Benign
Term
What is the modality of choice for an adnexal mass study?
Definition
Transvaginal ultrasound
Term

If these conditions are present, what is likely:

 

prepubescent or postmenopausal women

complex or solid appearing mass on US

Known genetic predisposition

Presence in a female with non-gyn cancer

Ascites

Definition
Maligancy of adnexal mass
Term
For adnexal mass what do you want to know from an US?
Definition

Mass:

Size

Consistency (cystic, solid, mixed)

Bilateral or Unilateral

septations

Ascites

mural nodules

papillary projections

Term

Are these benign, malignant, non gyn

adnexal masses:

 

functional cyst

leiomyomata

Endometrioma

Tuboovarian cyst

Ectopic pregnancy

Mucinous cystadenoma

Hydrosalphinx

Definition
Benign Gyn Adnexal Mass
Term

Are these benign, malignant, non gyn

adnexal masses:

 

Germ cell tumor

Sex cord or stroma tumor

Epithelial carcinoma

Definition
Malignant adnexal mass
Term

Are these benign, malignant, non gyn

adnexal masses:

 

Divericular abscess

Appendicular abscess or tumor

Metastatic tumor-breast, colon, endometrium

Definition
Non-gyn adnexal mass
Term
What is the most common type of ovarian cancer?
Definition
Endometrial carcinoma
Term
What is alpha-fetoprotein level?
Definition
Tumor marker for germ cell tumor
Term
What is INHIBIN?
Definition
Tumor marker for granulosa cell tumor
Term

If on US a mass is found what do you do:

 

simple cyst of 5 cm or less

 

>5 cm or complex

 

Definition

 

simple cyst of 5 cm or less:   OBSERVE

 

>5 cm or complex:  CA 125 marker needed

Term

What is this:

 

Serous & mucinous cystadenoma

Endometrioma

Mature cystic tertoma-Dermoid cyst

 

Most commone ovarian tumor in 2nd & 3rd decade of life

Definition
Common Benign Ovarian Neoplasm
Term

What is this:

 

Usually asymptomatic

Most resolve in a few weeks

Usually < 2.5 cm

Some can be large but < 10 cm

 

Definition
Physiologic or Functional CYST
Term
This is the 4th leading cause of  cancer death in women?
Definition
Ovarian Cancer
Term

What type of factors are these:

 

OC use

Pregnancy

Breast feeding

Tubial ligation

Hysterectomy/Removal of both ovaries

 

Definition
Decreased risk factors for Ovarian Cancer
Term

What type of cancer is this:

 

Unexplained change in bowel & bladder

GI upset

Unexplained Wt gain or loss

Pelvic/Abdominal pain/discomfort

Pelvic/Abdominal bloating, swelling

Constant feeling of fullness

Fatigue

Abnormal / postmenopausal bleeding

Dyspurenia

 

Definition
Ovarian Ca
Term

These will be the finding on PE for which type of cancer?

 

Abdominal mass

Ascites

decreased breath sounds if pleura effusion present

FIXED, IRREGULAR, SOLID  MASS on pelvic exam

Definition
Think OVARIAN Ca
Term

What marker is elevated in Ovarian Ca, but can also be elevated in:

 

Metastatic Ca

Peritonitis

menses

Pregnancy

Cirrhosis

CHF

Endometriosis

Fibroids

Definition
CA 125
Term
How is Ovarian Ca dx, staged, & treated?
Definition
SURGERY done by Gynecologist Oncologist
Term

What do the FIGO staging of ovarian cancer mean:

 

Stage I

Stage II

Stage II

Stage IV

Definition

 

Stage I: tumor limited to ovaries

 

Stage II:  tumor involves 1 or both ovaries with  pelvic extension

 

Stage II:  tumor involves 1 or both ovaries with microscopically confirmed peritoneal metastasis outside pelvis

 

Stage IV:  Distant Metastatis

Term

What stage is this:

 

tumor limited to ovaries

Definition
Stage I
Term

What stage is this:

 

tumor involves 1 or both ovaries with  pelvic extension

Definition
Stage II
Term

What stage is this:

 

tumor involves 1 or both ovaries with microscopically confirmed peritoneal metastasis outside pelvis

Definition
Stage III
Term

What stage is this:

 

Distant Metastatis

Definition
Stage IV
Term

What are the hereditary risk for:

 

Hereditary Ovarian Ca Syndrome

 

Known BRCA 1 or BRCA 2 mutation

Definition

Hereditary Ovarian Ca Syndrome:  40%

 

Known BRCA 1 or BRCA 2 mutation:  35-65 %

Term
What % of ovarian cancers are hereditary?
Definition
10%
Term
Most germ line mutations are due to which gene?
Definition
BRCA 1 or BRCA 2 gene
Term
Hereditary syndromes are associated with what?
Definition

Lynch II syndrome

 

AKA-Nonpolyposis Colorectal Ca Syndrome HNPCC

 

Colon, endometrial, ovary, breast, stomach, pancreas Ca

Term

What type of testing are these pts a candidate for:

Breast & Ovarian Ca in the same individual

 

Pt who has Ovarian Ca or relative with Ovarian Ca or premenopausal breast Ca or both

 

Women w/ ovarian Ca of Ashkenazi Jewish ancestry

 

Close relative with BRCA mutation

 

Pt w/ breast Ca at age 50 or < & close relative w/ ovarian Ca or male breast Ca at any age

Definition
Genetic Testing
Term
Women with BRCA 1 or BRCA should be offered???
Definition
risk reducing salpingo-oopherectomy by age 35 or when child bearing is complete
Term

T/F

 

Still a small risk for primary peritoneal cancer after prophlytactic Bilateral salpingo oophrectomy.

Definition
TRUE
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