OME Gynecology
Premenstrual girls RF reproductive age RF post menopause
*(+) maternal toxin* exposure: ovulation, estrogen, sex, virus exposed: lifetime of estrogen & toxins; lost protection of progesterone b/c no more ovulation
what are the exceptions to regular Pap smear screening? (2)
-If HIV+ -> q1year -If over 30yo, Pap + HPV testing -> q5year
Woman has ASCUS on Pap smear...next step?
-repeat Pap q3month (age 21-24) or -HPV DNA (age >25)
complete hydatidiform mole - consists of?
1 sperm+ anucleated egg-> normal fertilization (46) All genetic materials is of the sperm no fetal parts
MC Cancers
1-Breast/prostate 2- Lung 3-Colon
Mortality of MC Cancers
1-Lung 2-Breast/prostate 3-Colon
MC Gyn Cancers
1. Endometrial 2. Cervical 3. Ovarian
Mortality of MC Gyn Cancers
1. Ovarian 2. endometrial 3. cervical
If a mass is identified on cervical exam...what do you do?
1. biopsy 2. clinically stage (colpo, rectal and vaginal exams)
HPV subtypes that causes cancer
16, 18, 31, 33, 45
incomplete hydatidiform mole - consists of?
2 separate sperms + 1 normal egg -> 69 chrom some fetal parts
which stage of cervical cancer is cured surgically?
2a or better
which stage of cervical cancer is treated with debulking or chemo?
2b or worse
HPV subtypes that causes genital warts
6, 11
what is the tumor marker for endometrial sinus (yolk sac)?
AFP
Pregnant woman has ASCUS on Pap smear...next step?
Colpo or cone biosy - 6wks postpartum
ASCUS and + repeat at 3mo...next step?
Colposcopy
ASCUS and HPV+...next step?
Colposcopy
A pelvic ultrasound is useful to avoid a ______; it can be done if the endometrial thickness is _____
D&C < 5mm
which ovarian teratoma type is chemo-receptive?
Dysgerminoma (benign) Tx- unilateral oophorectomy
A postmenopausal woman has vaginal bleeding...what is the next step?
Endometrial sampling or D&C endometrial sampling = endometrial biopsy
Hydatidiform moles are cancerous. True or False?
False. They are potentially premalignant
Name the ovarian stomal cell tumors and what they produce
Granulosa-Theca -> estrogen Sertoli- Leydig -> testosterone
which genetic mutations increase the risk for ovarian cancer?
HNPCC BRCA1> BRCA2
Vaginal cancer...name the etiology, precancerous name, cancer type, symptoms, screen
HPV dysplasia, carcinoma in situ invasive squamous cell CA Black Vulvar, pruritic Lesion (melanoma) No screen
Vulvar cancer...name the etiology, precancerous type, cancer type, symptoms, screen
HPV dysplasia, carcinoma in situ invasive squamous cell CA Red Vulvar Lesion (Paget's) No screen
Thin, postmenopausal woman on hormone replacement therapy... why is she at increased risk of endometrial cancer?
HRT increases risk
what is the tumor marker for dysgerminoma?
LDH respond well to Paclitaxel chemo
NEXT:
NEXT:
NEXT: MOLES
NEXT: MOLES
what is the typical presentation of a patient with endometrial cancer?
Obese+ post-menopausal
which agents are protective against endometrial cancer?
PROgesterone is PROtective OCPs
Start+ stop date for cervical cancer screening
Pap smear start @21. Stop @65
Post-menopausal bleeder has Endometrial sampling/biopsy performed. It shows atypical hyperplasia or adenocarcinoma. what is next step?
TAH + BSO Total Abdominal Hysterectomy (gets the cancer) Bilateral Salpingo-oophorectomy (gets the stimulus)
Post-menopausal bleeder has Endometrial sampling/biopsy performed. It shows mets. what is next step?
TAH + BSO + chemo (carboplatin and paclitaxel)
Postmenopausal woman is dx with Stage 3 epithelial ovarian cancer..what is the next best step?
TAH + BSO -> Paclitaxel
Pt presents with adnexal mass..what do you do?
TVUS
if you suspect ovarian cancer, what is the next step in workup?
TVUS + MRI or CT scan (confirms dx and stage)
which abnormalities of cervix on colposcopy is worrisome of cancer? (4)
abnormal vessels punctate hemorrhages acid-white changes mosaicism
endometrial ca
adenocarcinoma
what are the screening recommendation for women with BRCA1 mutation?
annual CA-125 + TVUS
Young patient with PCOS... why is she at increased risk of endometrial cancer?
anovulation -> increased estrogen exposure + it prevents progesterone secretion
what are the risk factors for endometrial cancer in decreasing order of risk?
anovulation ➡ (unopposed estrogen) - MOST potent - PCOS obesity ➡ increased peripheral conversion of estrogen Tamoxifen ➡ estrogen agonist in uterus, antagonist in breast (for breast cancer) age ➡ more lifetime exposure nulliparity ➡ estrogen shuts off during pregnancy early menarche/ late menopause -> more years of estrogen
what is the tumor marker for choriocarcinoma
b-hCG
extent of stage 4a cervical cancer
bowel/bladder
extent of stage 4b cervical cancer
distant mets
what is the pathology of precancer. How should you manage it?
dysplasia, carcinoma in situ Local resection is CURATIVE
which 2 types of sampling can you get with a colposcopy?
ectocervical biopsy endocervical curettage
On colpo, if ecto- and endo+, where is the problem, management?
endocervix cone biopsy
which ovarian cancer has the highest mortality and late presentation?
epithelial ovarian cancer
Adeno-carcinoma procession from estrogen
estrogen -> hyperplasia -> adenoCA
Cervical, Vaginal and Vulvar Cancers (similarities)
etiology: HPV Precancer: dysplasia, carcinoma in situ Cancer: invasive squamous cell CA screen: pap screening (only cervical)
chorio cancer...name the etiology, precancerous type, cancer type, symptoms, screen
etiology: gestational trophoblastic dz cancer: chorio CA symptoms: elevated b-hCG despite delivery or abortion - hyperemesis gravidarum, hyperthyroid, size/date discrepancy screen: b-hCG while on OCP
who should get the HPV vaccine (Gardasil)?
everyone (including males!)
What is the etiology of Endometrial cancer?
exposure to estrogen
Endometrium cancer...name the etiology, precancerous type, cancer type, symptoms, screen
exposure to estrogen preca: dysplasia or atypia cancer: adeno CA pt: post-menopausal bleeding no screen Postmenopausal bleeding No screen
HPV is definitively recommended for which age groups?
females 11-26 males 11-21
ovarian tumor cell types
germ, stromal, epithelial cell cancer
Another medical name for "hydatidiform mole"
gestational trophoblastic disease (GTD)
what tumors can increase risk of endometrial cancer?
granulose-theca tumors of ovary (estrogen secreting tumors)
Post-menopausal bleeder has Endometrial sampling/biopsy performed. It shows simple hyperplasia. what is next step?
high dose progesterone
Cervical cancer..etiology, transmission
human papilloma virus carried in asx males infects a woman during sex
what are the phases of hyperplasia in endometrial cancer?
hyperplasia ➡ cystic ➡ adenomatous ➡ atypical ➡ adenoCA
what is the criteria for cancer? How should you manage it?
invasion of BM (sarcoma, adeno) Debunking and chemo
what does "b" classification in staging cervical cancer denote?
involvement of cardinal ligament or pelvic sidewall
define complex (malignant) ovarian cyst
large (> 7cm) irregular, and loculated
what factors increase ovulations?
low parity delayed child bearing early menarche
extent of stage 3a cervical cancer
lower 1/3 vagina
extent of stage 1b cervical cancer
macroscopic
extent of stage 1a cervical cancer
microscopic
Risk factors for cervical cancer
multiple sexual partners HPV Hx of STDs smoking
no
no
what is the tumor marker for teratoma?
no marker struma ovarii
difference btwn cervical, vag, vulvar ca
only symptoms: cervical: postcoital bleed reproductive age vaginal: black vulvar lesion (melanoma) vulvar: red vulvar lesion (Pagets)
On colpo, if ecto+ and endo-, where is the problem, management?
outside of cervix local therapy (LEEP, Cryo, or laser)
which cancer is the leading cause of reproductive-aged cancer death?
ovarian cancer
extent of stage 2b cervical cancer
parametrial (involves cardinal ligament)
a woman has post-coital bleeding..what do you do next
pelvic exam + stage clinical staging = colpo, rectal and vaginal exams
how does epithelial ovarian cancer spread?
peritoneal seeding
how can you stage cervical cancer?
physical exam + CT scan (option 1: clinically stage - colpo, rectal, vaginal exam) option 2: physical exam rectal and vaginal, CT scan
A woman is dx with BRCA1 mutation..what should you advice her?
prophylactic TAH+ BSO @35 (after she is done having kids)
Woman has abnormal Pap (not ASCUS)..next step?
reflexive colposcopy
Classic presentation of patient with epithelial ovarian cancer
renal failure small bowel obstruction ascites
ASCUS and - repeat at 3mo...next step?
repeat q3y
ASCUS and HPV-...next step?
repeat q3y
hyperemesis gravidarum
severe N/V, weight loss, dehydration, electrolytes disturbances
extent of stage 3b cervical cancer
sidewall
define simple (benign) ovarian cyst
small (< 7cm) smooth, and not loculated
cervical (ecto,endo), vaginal and vulvar ca
squamous cell carcinoma
Screening recommendations for cervical cancer
start at 21 q1 yr after age 30 if 3 normal paps: can reduce to pap q3y or pap+ HPV DNA q5y stop at 65
In which age groups is germ cell tumors occurs in?
teenage reproductive girls benign
what is the use of CA-125?
to follow cancer recurrence after therapy Not for diagnosis!
Etiology of gyn cancers...what is it, management?
toxins, hormones, viruses Identify+modify risk factors
explain how ovulation increase risk for ovarian cancer
trauma of ovulation causes inflammation -> cancer
Ovarian cancer...name the etiology, precancerous type, cancer type, symptoms, screen
trauma to epithelial layer from Ovulation don't biopsy can't screen epithelial/germ/stromal CA presents as late stage: Ascites pelvic mass small bowel obstruction renal failure from obstructive hydroureter
why are ovarian germ cell tumors are often found early at Stage 1?
tumor gets big (weight gain) before they get dangerous
extent of stage 2a cervical cancer
upper 2/3 vagina
Postmenopausal women with post-coital bleeding..what is the likely cause?
vaginal atrophy
