Gynecologic Cancers
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| 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!
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| VIN | Vulvar intraepithelial neoplasia
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| Treatment of VIN | Treat early by local cauterization; higher grade VIN wide local excision with or without laser. Sometimes simple vulvectomy
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| Fiery red lesions with white hyperkeratotic areas | Paget Disease. Age group over 65. Tx with wide local excision or vulvectomy
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| 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.
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| Tanning beds can cause | cancer and may trigger herpes (cold sores)
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| Vulvar cancer epidemiology | 4% of gynecologic malignancies, epidermoid most common, typically in postmenopausal women (but can occur in 30-40 year olds)
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| 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
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| Workup for positive vulvar cancer biopsy | CXR, IVP, Cysto, procto, adjunctive postop radiation.
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| Most common gyn cancer | endometrial carcinoma. Estrogen-dependent vs estrogen-independent. Presents as abnormal bleeding
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| 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
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| 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.
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| Birth control's effect on uterine lining | thins it.
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| 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
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| Estrogen Independent endometrial cancer | Occurs spontaneously, thin, older postmenopausal women without unopposed estrogen. Atrophic endometrium, cancers less well-differentiated. Poorer prognosis
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| Any woman who is 35 or older who is experiencing abnormal bleeding | endometrial biopsy of the uterus
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| Evaluation of Endometrial Carcinoma | Transvaginal US to assess endometrial stripe, doppler flow. Greater than 5mm stripe, mass, fluid warrants biopsy.
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| Tx of Endometrial Carcinoma | Come back to
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| 2nd most common gynecologic malignancy | Ovarian Cancer. 90% are epithelial. Associated with repeated ovulation
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| Most common cause of death due to gyn cancer | Ovarian cancer
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| 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
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| 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
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| Ovarian Cancer Sx | Very vague, pelvic pain, bloating, UTIs, clothes too tight, abdomen distended
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| Postmenopausal gyn exam | palpable adnexal mass, rectovaginal exam, US with doppler blood flow, CA 125, CT/MRI
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| Tx for Ovarian Cancer | Surgery: TAH/BSO (total abdominal hysterectomy, bilateral salpingo-oophorectomy), surgical staging, chemotherapy
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