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53 Cards in this Set
- Front
- Back
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State which Gyn cancer is most commonly occuring in US women
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endometrial ca
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State whether the incidence of endometrial ca is increasing or decreasing
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has been increasing over the past 20 years
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Discuss the cure rate of endometrial ca
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cure rate is very high because these tumors tend to be well differentiated and localized
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List and discuss the risk factors for endometrial cancers and give the peak age of incidence
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Most commonly affects postmenopausal women: 75% of cases occur after 50, only 4% before 40 and peaks at 58-60
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list the most common symptoms for the Gyn ca discussed
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abnormal bleeding, occurs 80% of pts.
-other symptoms- leg and back pain, bladder or rectal symptoms, weight loss, and general weakness |
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Give the most common histological type of cancer for each of the areas discussed
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endometrial- adenocarcinoma
vaginal- epidermoid squamous carcinoma (90%) fallopian tubes- adenocarcinoma vulva- squamous cell |
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State the definitive procedure for diagnosing carcinoma of the endometrium
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-history- including menstration, hormone ingestion, hypertension, diabetes, obesity, and infertility
-pelvic exam -fractional D & C (dilation and curettage)- provides tissue for bx, specimans from endocervix and endometrial cavity |
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Give the most reliable prognostic factor for endometrial ca
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Fractional D & C
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Give the name of the grading system most commonly used for endometrial ca and state which grade is the worst in terms of cure
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Broder's Grading:
Grade I- well differentiated Grade III- poorly differentiated |
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Discuss treatment of the various ca discussed
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endometrial- hysterectomy, bilateral salpingo-oopherectomy, w/wo RT, adj RT
Vaginal- RT** then surgical excision of vagina if RT fails fallopian tubes- surgery vulva- surgery (vulvectomy +RT) |
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Discuss "heyman's capsules vs tandum and ovoids. Discuss their use
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Heymans capsules are preloading stainless steel cylinders with retention wires attached to the ends. Usually 10-15 capsules, advantage is if uterine cavity is distorted or enlarged. disadvantage- preloaded and capsule can easily perforate uterus if pushed thru fundus wall 6000-7000 cGy
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Discuss the role of hormonal therapy in tx of gyn ca
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-endometrium- hormonal-progestin for regression of mets to lung in 1/3 pts, chemo- for poorly differntiated tumors, adriamycin and 5FU
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Endometrium is disease of _____, and cervix is disease of ______
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suburbia
inner city |
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Generally endometrium are _____________ women
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affluent, obese, nulliparous white women
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The use of oral ______ containing ____ and ____ combo actually reduces endometrial ca by _____
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contraceptive
estrogen progesterone half |
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Predisposing factors for endometrial ca (4)
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1. family history of
2. race- Japan-rare, black less common 3. endometrial hyperplasia- may be precurser 4. functional ovaian tumors- related estrogen secretion |
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Spread of endometrial ca
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local invasion
-directly to myometium to lung or bone thru blood vessels and lymphatic system. |
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Spread- upper lesions drain to
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illiacs
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Spread- lower lesions drain to
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inguinal nodes
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What is the least frequent of all malignant female genital tract
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fallopian tube
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Spread- fallopian tube ca to
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pelvic peritoneum, including broad ligament and omentum
distant spread to intestine, lung, and liver |
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How do you diagnose vulvar ca
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Biopsy- Keyes cutaneous punch
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How does vulvar ca spread
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primarily- lymphatic dissemination
or direct |
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Endometrial ca is probably linked to
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aging population, high calorie and high fat diets
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Predisposing factors of endometrial ca include
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-obesity
-Stein-Leventhal syndrome (pollysystic ovaries) -diabetes -hypertension -infertility -history of irregular periods -menopause beyond age 52 |
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most common endometrial histology is
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adenocarcinomas
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endometrial adenocarcinoma mainly spreads by
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local invasion
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What % of endometrial ca are at stage I
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75%
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Heyman's capsules are used for ____ ca
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endometrial
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all boost are ___-__ Gy
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45-50 Gy
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The overall 5 year survival for endometrial ca is ____ and are at stage
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75-78%
stage I |
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At what age do most vaginal ca occur
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over the age of 50, with the 6th and 7th decades being the most common time of presentation
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Over __% of all vaginal tumor are
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epidermoid squamous carcinomas
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Vaginal ca occurs most commonly on the
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posterior wall of the uper third of the vagina
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What is the best way to detect vaginal ca
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pap smear
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Vaginal ca may spread by ____ and to where
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direct extention along the vaginal wall to involve the cervix or vulva
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In squamous cell carcinoma of the vagina mets to the ___ or ____ tend to occur late
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lungs or supraclavicular nodes
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What is considered to be the tx of choice for vaginal ca
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XRT
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Rates for vaginal ca are up to ___% for stage I
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90%
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The etiology of fallopian tube ca is ____ however may be linked to (3)
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-nulliparous
-infertility -salpingitis |
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What is the most common histologic type of primary ca of the fallopian tube
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adenocarcinoma
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Where is the most freq site of spread of fallopian tube ca
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pelvic peritoneum, including the broad ligament and omentum
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What is the primary tx of ca of the fallopian tube
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surgery
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Fallopian tube ca has no 5 yr survival rate
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because of limited cases
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What is the median age for insitu of the vulva
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48 yrs
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Most cases of invasive ca of the vulva are seen after age
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60
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Etiology for vulva include (7) and which is most important.
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Diabetes *** most important
-hypertention -cadiovascular disease -obesity -venereal disease (genital warts) -HPV -Ca of breast, endometrium, and cervix also |
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What is the most common histology of vulvar ca and what %
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90% are squamous cell
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What is the most common symptom of the vulva
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presence of mass or growth
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Vulvar ca spread primarily by
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lymphatic dissemination or direct
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What is the tx of choice for vulvar ca
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surgery- radical vulvectomy w/ node dissection, RT is seldom used alone
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What is the major prognostic factor for vulvar ca
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lymph node involvement
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The overall 5 yr survival rate for pt with squamous cell ca of the vulva is about __%
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46%
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