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128 Cards in this Set
- Front
- Back
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This organ is the essential organ of the female reproductive system |
Ovary |
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The Uterus is located posterior to the |
bladder |
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Which layer of the uterus is shed during mestruation |
Endometrium |
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The most inferior portion of the uterus is called |
cervix |
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the structure is anterior to the rectum |
vagina |
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The primary lymphatic drainage of the vulve are the |
inguinal lymphnodes |
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Hormone that promotes initial duct development in the breasts |
estrogen |
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Hormone that completes the duct development |
progesterone |
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Hormones released after birth to stimulate milk production |
prolactin and oxytocin |
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The upper portion of the uterus |
fundus |
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the middle portion of the uterus |
body |
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Where does the primary blood supply of the uterus come from |
uterine artery, a branch of the internal ilias arteries |
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the area at which the vagina meets the cervix |
vaginal fornix |
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the vulva alongside other external genitalia drain to |
inguinal lymph nodes |
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where do the other organs of the female reproductive system drain to? |
internal and external iliac chain, then the common iliac nodes and up to the para-aortic nodes |
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What are the primary lymphatics of the breast |
axillary levels 1-3 |
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Where are level 1 axillary nodes located |
under and laterla to the pectoralis minor muscle |
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where are level 2 axillary nodes located |
under the pectoralis muscle |
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where are level 3 axillary nodes located |
superior to the pectoralis muscle near the coracoid process of scapula |
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where are the internal mammary nodes located |
superficial and lateral to the sternum |
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What is the second most common gynecological cancers? |
Ovarian |
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what GYN cancer causes the most GYN cancer deaths per year |
Ovarian |
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what are the risk factors for cervical cancer |
HPV high number of sexual partners low socioeconomic status |
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What are the risk factors for ovarian cancer |
few or late pregnancies late menopause BRCA+ a diet high in fat |
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What increases the risk factor for clear cell vaginal cancer |
diethylstibestrol DES used by mother in uteri (during pregnancy) |
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What risk factor is linked to endometrial cancer |
early menarche |
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What is the most common GYN cancer |
uterus |
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Which GYN cancer presents with ascites |
Ovarian |
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Pap Smears are used to detect what |
cervical cancer |
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Which GYN cancers are the most uncommon |
Vulvar and Vaginal cancer |
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Patients with Ovarian cancer often present with |
abdominal pain ascites abdominal distension |
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What tests are used to diagnose cervical cancer |
pelvic exams colposcopy and biopsy CT and MRI of the pelvis |
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What is the most common histology of endometrial carcinoma |
adenocarcinoma |
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what is the most common histology of cancers of the cervix, vagina, and vulva |
squamous cell carcinoma |
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What is the most common histology of cancer of ovarian cancer |
90% are epithelial (from ovary surfaces) 7% are stromal 3% ovarian germ (include dysgerminomas) |
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Treatments of Ovarian cancer include |
1. surgery and postop chemotherapy (single agent or combination) Cisplatin and cyclophosphamide 2. phosphorous-32 wash (P-32) and whole abdominal radiotherapy. |
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What is a P-32 wash |
a colloidal solution placed into the peritoneal cavity. |
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Whole abdominal treatment for ovarian cancer is given a dose of how much |
25-28Gy with AP/PA fields |
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What are the borders of a whole abdominal treatment for Ovarian cancer |
Sup: 2cm sup to diaphragm, higher on Rt due to liver Inf: Bottom obturator foramen Lat: include peritoneum without flashing skin No liver blocking is necessary Kidney blocks needed at 18-20 Gy |
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Is there a pelvic boost for Whole Abdominal tx for Ovarian cancer |
yes, up to 50 Gy (1.8 Gy/Fx) |
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What are the signs and symptoms of cervical cancer |
postcoital bleeding increased menstrual bleeding discomfort with intercourse vaginal discharge |
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what is indicative of advanse stage of cervical cancer |
pelvic pain urinary and rectal symptoms malodorous discharge |
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Pruritis is a common sign in which cancer |
vulvar |
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can cervical cancers be asymptomatic |
yes |
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primary lymphatic drainage of cervical cancer is through |
obturator and iliac nodes |
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Treatments for cervical cancer include |
Tandem and ovoid brachytherapy TAHBSO External radiation therapy to the pelvis |
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What is not a treatment option for cervical cancer |
whole-abdominal radiation therapy |
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What is conization |
cone shaped excision of the cervix to remove cells, could be done for biopsy or therapeutically |
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when would conizatin be used |
limited to cerviz stage Ia1 for women who desire to have children |
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Medically inoperable women with cervical cancer receive what type of treatmen |
tandem and ovoids with 45-55 Gy |
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Whole pelvis dose for Cervical cancer |
45-50 Gy, four field |
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What are the borders of whole pelvis treatments for cervical cancer |
Sup: top or bottom of L5 Inf: inferior aspect of obturator foramen lat: 1.5-2 cm lateral to pelvic side wall in AP/PA plane |
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What is referred to as point A in the treatment of cervical cancer |
Intrauterine Tandem - small, hollow, curved cylinder that fits through the cervical os and into the uterus |
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What is referred to as point B in the treatment of cervical cancer |
Vaginal Colpostats - two golf club shaped hollow tubes placed laterally to the tandem into the vaginal fornices |
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Where is point A defined at |
2 cm sup of Cervical Os and 2 cm laterla to the endocervical canal |
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Where is point B defined at |
3 cm lateral to point A or, 2 cm superior to the cervical Os and 5 cm lateral to the endocervical canal |
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Acute cystitis of the bladder occurs at what dose |
as low as 30 Gy |
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Chronic cystitis of the bladder occurs at what dose |
50-60Gy |
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What is the whole organ tolerance of the rectum |
50 Gy |
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What is the most common presentation of endometrial cancer |
abnormal bleeding |
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When treating a patient with a four field pelvis what are the organs at risk |
bladder rectum small bowel femoral heads ovaries kidneys |
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what technique could be used to decrease the dose to the small bowel |
place the patient in a prone position |
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Acute toxities when treating the pelvis for GYN cancers include |
diarrhea skin changes fatigue urinary symptoms myelosuppression |
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Late toxities when treating the pelvis for GYN cancers include |
fibrosis stenosis fistulas enteritis |
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direct spread of endometrial cancer includes |
extension through the parametrium cervix bladder vagina rectum |
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lymphatic spread of endometrial cancer |
internal and external iliac nodes distant spread to lung and liver |
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Primary lymph drainage of the vulva |
superficial inguinal nodes |
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What is the most common cancer in women |
breast cancer |
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What is the most common histology of breast cancer |
infiltrating ductal carcinoma |
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What is helpful to distinguish between a cyst and a mass in breast cancer |
ultrasound |
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What are two common hormonal therapies for breast cancer |
tamoxifen adn herceptin |
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When are supraclavicular fields added |
when the patient has four or more lymph nodes involved |
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when is a PAB field used |
when level 3 Axillary nodes are not getting adequate dose, or when patients have extensive nodal spread. |
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Tangent field borders of breast |
Sup: first intercostal space inf: 1.5 cm below breast tissue medial: midline Lat: midaxillary line |
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With supraclavicular fields the gantry is angled |
10-15 degrees away from th affected side to avoid esophagus and spinal cord |
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What are the borders of SCV |
Sup: don't flash skin inf: match sup border of tangents, half beam block to match divergence med: 1 cm past midline lat: bisect humeral head |
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treatment dose for breast and nodal involvement |
45-60Gy boost to total dose of 60-66 Gy |
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When treating breast cancers organs at risk include |
lung heart humeral head esophagus spinal cord brachial plexus contralateral breast |
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Acute toxicities of treating breast cancer |
skin reactions fatigue esophagitis |
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late toxicities of treating breast cancer |
telangectasis pneumonitis heart disease brachialplexopathy |
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What is the overall prognosis of breast cancer |
89% |
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Risk factors for breast cancer include |
increased age increased estrogen exposure (nulliparity, early menarche, late menopause) family history (BRCA1 and BRCA2) |
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DES is associated with what histology of cancer |
clear cell adenocarcinoma |
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diabetes and hyepertension increases the risk for |
endometrial cancer |
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What is the fifth leading cause of women with cancer |
ovarian cancer |
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GYN cancer staging systems |
FIGO and AJCC |
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what does FIGO stand for |
Internal Federation of Gynecologists and Obstetrics |
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What does AJCC stand for |
American Joint Committee of Cancer |
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Detection and Diagnosis of Vulva done by |
Biopsy history and physical CBC and chemistries Urinalysis Chest x-ray, IVP, CT (pelvic) Cystourethroscopy Liver and Bone scans sigmoidoscopy |
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what is IVP |
intravenous pyelogram-used to visualize abnormalities of the urinary system, including the kidneys, ureters, and bladder |
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what is cystourethroscopy |
procedure that allows the visual examination of the inside of your bladder and urethra |
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What is the major histology of vulvar cancer? |
SCC |
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Surgical treatment of vulvar cancer |
wide local excision |
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Where is the most common presentation for vaginal cancer |
posterior upper third of vagina |
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lower 1/3 of vagina may involve which LN |
inguinal |
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occurance rate of vaginal cancer |
rare- 2% of GYN cancer |
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Presenting symptoms of vaginal cancer |
vaginal bleeding painful intercourse |
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Detection and diagnosis for vaginal cancer |
biopsy cytologic examination H & P CBC and chemistries urinalysis chest x-ray, IVP, abdominal pelvic CT cystourethroscopy proctosigmoidoscopy |
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proctosigmoidoscopy |
is an internal examination of the lower large bowel (colon), using an instrument called a sigmoidoscope |
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What is the treatment of choice for vaginal cancer |
radiation therapy |
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how are small superficial vaginal lesions treated |
brachytherapy |
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how are invasive vaginal lesions treated |
entire pelvis treated 45-50 Gy |
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What is the dosing for brachytherapy tx of vaginal cancers |
60 Gy with a vaginal cylinder |
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what isotope is used with vaginal cylinders |
Cs - 137 |
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HDR afterloaders may use what isotope |
Ir 192 |
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Detection and Diagnosis for Cervical cancer |
Pelvic examination and Pap smear biopsy of suspicious lesion history: physical examination under anesthesia D &C to assess uterine involvement CBC and chemistries, urinalysis Chest x-ray, BE, IVP (CT) Abdominopelvic CT and MRI Cystoscopy and proctoscopy PET Laparoscopic or CT directed biopsy (now PET) |
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Tamoxifen increases the risk for which cancer |
endometrial |
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What are the doses for radiotherapy of endometrial cancer |
60-70 Gy with brachytherapy 45-50 Gy for nodes and implants can bring the total dose to 80 Gy |
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when the uterus is still present what techniques can be used for treatment? |
Heyman capsule and intrauterine tandem |
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How much dose can the uterus tolerate |
75-90 Gy |
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What is the most common side effect from the radiation when treating cervix cancer |
Anemia |
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Fine superficial blood vessels caused from radiation in the areas of the vagina and cervix |
telangiectasis |
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The opening of the pevlis where the baby's head enters |
pelvic inlet |
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What is the most radiosensitive GYN structure |
Ovaries |
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The posterior border of a lateral pelvic field |
S3 |
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Patient position for the tx of vulva cancer |
frog-leg |
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Painful or difficulty urination |
dysuria |
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What's the most prevalent GYN cancer |
endometrial |
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What is the shielding block used to eliminate dose to the bladder and rectum |
Midline |
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What is the point tolerance for Bladder and rectal cancer |
75 Gy |
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The connective tissue immediately lateral to the uterine cervix |
parametrium |
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A patient having abdominal pain adn distention, and/or nonspecific gastrointestinal symptoms could be symptomatic to |
ovarian cancer |
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Cervical cancer is more prevalent that other GYN cancers with younger women this is mainly because of |
intraepithelial neoplasia |
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What is the normal hemoglobin range |
12-16 g/dL |
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what would be prescribed to alleviate diarhhea |
Diphenoxylate (lomotil) |
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If a pt. with cancer of cervix has periaortic nodal involvement, there is a 35% increase risk for spread to |
supraclavicular area |
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Dietary guidlines for patients recieving pelvic irradiation may include |
baked, broiled, or roasted meats cooked vegetables peeled apples and bananas |
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The most radiotolerant structure of the GYN organs is |
uterine canal |
