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Gyn Neoplasm
Gynecology
| Question | Answer |
|---|---|
| CIN 1 = | Cervical intraepithelial neoplasia 1: low grade lesion, mild dysplasia in lower 3rd of epithelium; LSIL |
| CIN 2 = | high grade lesion; mod dysplasia, atypical changes in basal 2/3 of epithelium; HSIL |
| CIN 3 = | high grade lesion, severe dysplasia/ ca in situ; >lower 2/3 of epi plus full thickness lesions; HSIL |
| CIN & HPV | HPV 6&11: LSIL, warts; benign; HPV 16 & 18: HSIL, ca |
| Uterine fibroid sx | Dysmenorrhea; Dyspareunia; Urinary frequency; Lower back pain |
| Most common symptom of endometrial neoplasia: | AUB (90% of pts) |
| endometrial cancer risk factor | Post or late menopause; FH/PMH ca (ov, BrCa, colon, endomet); Tamoxifen; PCOS; Obesity; nulliparity; Estrogen Tx w/o progestin; Prior Endometrial Hyperplasia; DM, HTN |
| Simple/Complex Endometrial Hyperplasia: causes unopposed estrogen: Premenopause etio: | Obesity; PCOS; eating disorders; Thyroid; Herbals; other anovulation |
| Simple/Complex Endometrial Hyperplasia: causes unopposed estrogen: Postmenopause etio: | Obesity; HRT; herbals w/estrogen (soy); Ovar/ adrenal estrogen producing tumor |
| Postmenopausal, dyspareunia, thin vaginal discharge, atrophic vulvar changes, vaginal petechiae | Atrophic vaginitis; Tx = topical estrogen |
| 20 yo female w/ rubbery, firm, well-circumscribed, non-tender breast lesion, doesn’t change w/ cycle | Fibroadenoma |
| Firm irregular shaped, NONTENDER enlarged uterus | Leiomyoma |
| Softened, tender, diffusely globular uterine enlargement | Adenomyosis |
| Postmenopausal vaginal bleeding | Endometrial cancer: do endometrial biopsy |
| Postmenopausal adnexal mass | Ovarian Ca |
| Adenomyosis = | implantation of endometrial tissue in myometrium; tender, symmetrically enlarged boggy uterus |
| ovarian cysts in postmenopausal women are presumed to be: | malignant until proven otherwise |
| OCPs are protective against cancer of: | endometrial, ovarian; not against ovarian cysts |
| 2 forms hereditary ovarian cancer | BOC (BR & ov); HNPCC |
| Vulvar malignancy epidemiology & pathology | Rarest of Gyn cancers. Usually SCC. Slow growing. |
| in utero exp to DES = | risk of clear cell adenocarcinoma of vagina |
| vulvar malignancy comorbidities | obesity, DM, HTN, arteriosclerosis; in younger F, also SMK & HPV |
| VIN pathology | 85% SCC, other adeno, sarcoma, melanoma. Upper third of vagina most common site of mets; middle third mets to inguinal or deep pelvic LN; lower third mets to inguinal |
| fibroadenoma s/s | round firm smooth discrete mobile nontender |
| Risk factors for cervical cancer | Smoker, HPV 16&18, OCP/hormones, multiple sexual partners, sex before 18, immunocompromised pt |
| Effective methods to prevent cervical cancer | Routine pap tests, avoid smoking, condom use, limit partners, HPV vaccine |
| Cervical polyp clinical features | Soft smooth fragile red lesion 1cm x 2cm in canal or protruding from cervix. Usually benign (0.5-1% malig / dysplasia) |
| Degeneration = | 2/2 ischemia when fibroid outgrows its blood supply. Painful, may present as acute abdomen. Sarcomatous (malignant) degeneration is rare. |
| Follicular cysts = | mature follicle that fails to rupture |
| Corpus luteum cyst = | result of bleeding into center of corpus luteum |
| Theca lutein cysts = | associated with elevated HCG levels (possibly also hydatidiform mole, choriocarcinoma) |
| Cervical cancer screening | Paps start at age 21. Q2 years for pt 21-29 yo if paps are neg. 30 yo+: Q3 years if pt had 3 consecutive neg paps & no hx of CIN 2 or 3; or if combined with HPV testing. Stop at 65-70 yo if 3 neg tests & no hx for 10 yrs. |
| Annual pap smear reduces invasive cervical ca incidence by: | 95% |
| ASCUS result on Pap: | HPV neg: repeat 1 yr. HPV pos: colposcopy. |
| LGSIL result on Pap: | colposcopy, bx, and tx. Repeat Pap at 6 months & 1 yr OR HPV testing in 1 yr. |
| HGSIL result on Pap: | colposcopy, bx, and tx. Close follow-up for 2 years. |
| SCC on Pap: | refer to Gyn for colposcopy & tx |
| Reactive / Reparative changes on Pap: | If cytology is neg, follow up in 2-3 years |
| Cervical cancer pathology | 80% SCC (95% are within transformational zone). 20% adenocarcinoma, adenosquamous, undifferentiated |
| Cervical cancer mets | Lungs, mediastinal, inguinal, axillary, supraclavicular LN, bones, liver |
| VIN mgmt | Surgery +/- XRT. Follow up: early lesion Q3 month x2 yrs, then Q6 months x3 yrs, annually thereafter |
| Protective factors against ovarian cancer | OCP, multiparity, breastfeeding, tubal ligation |
| Ovarian cancer risk factors | W > AA. BrCa 1&2, Lynch syndrome. HNPCC, colon ca. Nulliparity. FH Gyn ca. Endometriosis. Age |
| Ovarian cancer histologic classes (3) | Epithelial (80-90%). Stromal (10%). Germ cell (5% - young women). |
| Uterine cancer risk factors | Triad: obesity, HTN, DM. Hx of unopposed estrogen. Nulliparity. FH. Tamoxifen. Lynch syndrome. |
| Leiomyoma location | submucosal / myometrium |
| Endometriosis location | outside uterus |
| Gyn adenocarcinomas | Ovarian (highest M&M), endometrial (post-menopausal bleeding). Prostate |
| Gyn SCCs | vulvar, vaginal |
Created by:
Abarnard
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