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Gynecologic Cancers
| Question | Answer |
|---|---|
| VIN presenting complaints | vulvar pruritus, chronic irritation, raised lesions (often white or grey), most frequent on posterior vulva and perineum, SIMILAR TO BENIGN VULVAR CONDITIONS -- BIOPSY! |
| VIN | Vulvar intraepithelial neoplasia |
| Treatment of VIN | Treat early by local cauterization; higher grade VIN wide local excision with or without laser. Sometimes simple vulvectomy |
| Fiery red lesions with white hyperkeratotic areas | Paget Disease. Age group over 65. Tx with wide local excision or vulvectomy |
| Raised, irritated, pruritic, pigmented lesion may be | Melanoma/Vulva. Only 5% of all vulvar malignancies. Tx: wide local excision. Excisional biopsy mandated with this type of lesion. |
| Tanning beds can cause | cancer and may trigger herpes (cold sores) |
| Vulvar cancer epidemiology | 4% of gynecologic malignancies, epidermoid most common, typically in postmenopausal women (but can occur in 30-40 year olds) |
| Vulvar Cancer pathophysiology | vulvar pruritus, red or white ulcerative or exophytic lesion may be present, posterior 2/3 of labium majus, remains localized for long periods then spreads lymphatically, inguinal lymphadenopathy |
| Workup for positive vulvar cancer biopsy | CXR, IVP, Cysto, procto, adjunctive postop radiation. |
| Most common gyn cancer | endometrial carcinoma. Estrogen-dependent vs estrogen-independent. Presents as abnormal bleeding |
| Estrogen Dependent endometrial cancer are more common in | younger peri-menopausal women. History of unopposed estrogen. Begins as endometrial hyperplasia, then atypia, then carcinoma. More favorable diagnosis |
| Is it okay for a woman not to have a period? | Not having your period is not okay, want to induce withdrawal bleed b/c lining can just grow and grow and precede a cancer. |
| Birth control's effect on uterine lining | thins it. |
| Estrogen Dependent endometrial cancer facts | unopposed estrogen not just through medication, can be endogenous unopposed estrogen, why "naturally not having a period" is not okay, Progestin withdrawal or OCs as treatment |
| Estrogen Independent endometrial cancer | Occurs spontaneously, thin, older postmenopausal women without unopposed estrogen. Atrophic endometrium, cancers less well-differentiated. Poorer prognosis |
| Any woman who is 35 or older who is experiencing abnormal bleeding | endometrial biopsy of the uterus |
| Evaluation of Endometrial Carcinoma | Transvaginal US to assess endometrial stripe, doppler flow. Greater than 5mm stripe, mass, fluid warrants biopsy. |
| Tx of Endometrial Carcinoma | Come back to |
| 2nd most common gynecologic malignancy | Ovarian Cancer. 90% are epithelial. Associated with repeated ovulation |
| Most common cause of death due to gyn cancer | Ovarian cancer |
| Risk factors for Ovarian Cancer | Family hx, hx of breast cancer, nulliparity or poor reproductive hx, infertility, early menarche, late menopause, PCOS, Genetic (BRCA, others), Endometriosis, Obesity |
| Protective Factors for Ovarian Cancer | Oral contraceptives, Multiparity (b/c the more times you are pregnant, the less time you are ovulating), Tubal ligation, breast feeding |
| Ovarian Cancer Sx | Very vague, pelvic pain, bloating, UTIs, clothes too tight, abdomen distended |
| Postmenopausal gyn exam | palpable adnexal mass, rectovaginal exam, US with doppler blood flow, CA 125, CT/MRI |
| Tx for Ovarian Cancer | Surgery: TAH/BSO (total abdominal hysterectomy, bilateral salpingo-oophorectomy), surgical staging, chemotherapy |
Created by:
ltm12