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110 Cards in this Set
- Front
- Back
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most common invasive GYN cancer
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endometrial cancer
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RF: unopposed estrogen
Tamoxifen therapy >2 yrs High fat diet History of pelvic radiation |
endometrial cancer
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symptoms of unusual bleeding PM or spotting, vaginal discharge
pelvic mass or pain weight loss |
endometrial cancer
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is routine screening recommended for endometrial cancer
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no
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what is positive on pap for endometrial cancer
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endometrial cells on PM or not taking hormones
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if suspect endometrial cancer, what tests do you order
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TV US - strip < 5mm in PM and < 16mm in premenopausal women,
refer for biopsy |
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How to diagnose endometrial cancer
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biopsy
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for very high risk women of endometrial cancer, what screening should be done
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annual biopsy >35 years
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prevention of endometrial cancer
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progesterone to ET
normal weight increased pregnancies OCP Breast feeding Low fat diet exercise |
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RF: nulliparous, PCOS, obese, early menses, late menopause, history of other GYN cancers
increased age, jewish and caucasian |
endometrial and ovarian
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what screening should you do for a women with family history of nonpolyposis colon cancer
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yearly endometrial biopsy over 35 years and colonoscopy every 1-3 years over 25 years
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what is the average 5 year risk of breast cancer and lifetime risk
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1.67%
12% |
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most common cause of cancer in women and 2nd cause of death
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breast
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race most common of breast cancer
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caucasian, higher mortality in AA
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number one cause of cancer death
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lung
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What are major risk factors for breast cancer
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increased age
personal history of breast cancer personal history of proliferative breast disease and atypical hyperplasia on biopsy FH - breast cancer, young Genetic - BRCA |
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what is the percent of breast cancer not related to family history or genetics
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80%
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what percent of breast cancer has autosomal dominant gene
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1-2%
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Genetic Testing: T or F
two - first degree relatives with breast cancer, one under 50 |
true
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Genetic Testing T or F
male relative with breast cancer |
true
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Genetic Testing T or F
Jewish women with on first degree relative with breast or ovarian cancer or 2 - second degree relatives on same side of family with breast or ovarian cancer |
true
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genetic testing T or F
first degree relative with cancer of both breasts |
true
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genetic testing T or F
first degree relative with both breast and ovarian cancer |
false - must be in first and second degree relatives
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what are some risk factors for breast cancer
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nulliparity
first child after 30 early menarche late menopause increased breast density caucasian, jewish ETOH 2-5 drinks per day DES exposure obesity Breast radiation 10-30 years |
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What reduces risk of breast cancer
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lactation - 2 years
exercise 4 hours per week Tamoxifen Evista Motrin 2 tabs/wk x 10 years removal of both ovaries mastectomy |
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does evista increase endometrial cancer
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no - just tamoxifen
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what are signs and symptoms that are common with breast cancer
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new lump or mass - hard and painless, uneven edges
swelling breast pain skin irriation and dimpling nipple pain or DC, inward turning, reddness, scaling, thickening of skin lump in axillae |
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what are the 6 questions in the GAIL model
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race
age age of menarche age of first birth FH of breast cancer Breast biopsy - atyipcal hyperplagia, proliferative benign breast disease |
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at what age to do you perform every 3 years CBE
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starting at age 20, until 40 years
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at 40 years what are the breast screening recommendations
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CBE and Mammogram yearly
SBE monthly can get baseline mammogram at 35 years |
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when to educate on SBE
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in 20's, monthly
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what percent of breast cancers and deaths occur in women over 65 years
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45%
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if you feel a palpable lesion of the breast, what should you do
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always biospy - get mammogram
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What is the recommendation for annual MRI screening for breast cancer
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BRCA mutation
First degree relative with BRCA Lifetime risk >20% Others: chest radiation 10-30 years Li-Fraumeni syndrome and first degree relative Cowden and Bannayan Riley syndrome and first degree relative |
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if someone has personal history of breast cancer including DCIS, ALH, or ADH, should you get annual MRIs
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no - because of high false positive
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how many years to palpate breast lesion, how many years seen on mammogram
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6 years mammogram
9 years palpation |
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when would you order a diagnostic mammogram
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lump
induration nipple discharge lymphadenopathy of axilla skin changes, discoloration erythema unresolved with antibiotics new onset focal pain |
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how do hormone receptors affect treatment of breast cancer
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ER and PR respond better to HRT treatment, HER2 - promote growth, these cancers grow faster, spread, and increase reoccurrance - 20%
2/3 have hormone receptors |
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what is triple negative breast cancer
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no presence of hormone receptors or HER2, difficult to treat, chemo only works
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what homrone therapy is used for breast cancer prevention and early diagnosis
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aromatase inhibitors
tamoxifen - prevention, ER and PR toremifene - for metastatic ER fulvestrant - ER responcive, use when tamoxifen doesnt work herceptin - HER2 patients |
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what lab tests should you order for breast cancer surveillance
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none
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how often should you perform history and physical, mamogram and paps after diagnosis of breast cancer
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every 3 months for 3 years, every 6-12 months for years 4 and 5.
yearly mammograms yearly paps if on tamoxifen |
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what are the msot common metastatic sites for breast cancer
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bone
liver lung brain sub-q tissue |
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what are prevention recommendations for breast cancer
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exercise
loose weight low fat - high f and v no ETOH tamoxifen or evista |
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is cervical cancer increasing or decreasing
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decreasing
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what is the average age of diagnosis of cervical cancer
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48 years
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what race is most prevelant in cervical cancer
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hispanic and AA
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what are precancerous lesions on the cervix
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SIL - HGSIL or LGSIL
CIN |
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risk factors for cervical cancer
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HPV, condylomata
multiple sex partners history of GU neoplasia History of STD, SIL family history passive smoker early pregnancy, multiple pregnancies low socioeconomic LT OCP use DES exposure |
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what types of HPV are high risk of cancer
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16 - 50 to 60%
18 - 10 to 20% 31,45 3 to 5% each |
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what are signs and symptoms of cercial cancer
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abnormal vaginal bleeding
pain with intercourse bleeding PM, after pelvic exam, spotting, longer or heavier menses |
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what are the symptoms of early cervical cancer
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none
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benefits of cervical screening
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decrease risk of cancer
every 2-3 years does not increase risk of cancer |
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when do you need to screen a patient with a hysterectomy
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if had cancer or pre-cancer with hysterectomy
CIN DES |
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what are the screening guidelines for cervical cancer
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over 21 years every 2 years
every 3 years after 30 years if 3 normal can stop after 70 years with 3 normal |
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If a patient has a positive HPV when do you retest
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12 months
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if a patient has two positive HPV what do you test
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colposcopy
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when do you retest with positive HPV and negative cytology
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12 months
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what do you order for positive HPV and ASCUS
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colposcopy
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when do you retest for ASCUS and negative HPV
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at 6 and 12 months
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if adolescent has ASCUS when do you retest
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12 months
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if adolescent has HSIL what do you test
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colposcopy
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what is the percentage of squamous cell carcinoma and adenocarcinoma in cervical cancer
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Squamous - 90%
Adenocarcinoma - 10% |
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what is the prognosis of cervical cancer preinvasive, early invasive and overall
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100%
92% 72% |
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what are the prevention recommendations for cervical cancer
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Gardasil - HPV 16,18,6,11
Cerverax vaccine - HPV 16,18, 33,45 PAPs annual pelvic quit smoking barrier methods |
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accounts for the most GYN cancer deaths
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ovarian
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what percentage of ovarian cancers are epithelial verse nonepithelial
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90% vs 10%
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what is the 5 year survival of ovarian cancer
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46%
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2/3 of cases of ovarian cancer are at what stage
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3 or 4
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what increases risk of ovarian cancer
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repeat ovulation
high androgens - infertility, obesity, PCOS inflammation high age first degree family BRCA HNPCC personal history of endometrial, breast, or colon cancer clomid >1 year nulliparity FH breast or colorectal cancer HT caucasian or jewish |
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how to decrease risk of ovarian cancer
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OCP
increased pregancy - esp >30 years breast feeding tubal ligation low fat diet hysterectomy |
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early symptoms of ovarian cancer
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vague - fullness, abdominal discomfort, bloating, indigestion, pelvic masses, dull back pain, change in bowel habits, constipation, bleeding between menses or PM
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late symptoms of ovarian cancer
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n/v/a/
increased abdominal girth wieght changes persistent abd or pelvic pain |
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what is the recommended screening for ovarian cancer
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no effective screening tool
bimannual exam twice per year with family history TV US Color Doppler Imaging |
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when would you order a CA 125
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to check progression of cancer, if feel mass, get US and CA 125, not for screening
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prevention of ovarian cancer
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OCP - esp with family history
annual pelvic exam BF increased late parity tubal hysterectomy |
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number one prevention of cancer
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smoking
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what else increases risk of cancer
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diet, lack of exercise, sun exposure, smoking
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are cancers genetic
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yes, because mutations occur in our body, and when protoconcogens mutate and make oncogens, unable to fix mutations - lead to cancer
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are tumur markers used for diagnosis or screening of cancer
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no, only to see progression, check therapy, or check tissue of orgin, follow clinical course
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what is alpha feto protien positive in
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liver, testes and ovaries
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what is PSA elevated in
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prostate cancer, prostatits, or trauma, negative in up to 40%
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what non-cancers increase CEA tumor marker
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smoking, ETOH, cirrhosis, UC, COPD, bile duct obstruction, PUD, renal failure
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what cancers elevate CEA tumor marker
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gastric, pancreatic, lung, breast, ovary
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what cancer elevates CA 125
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ovarian, can be seen with liver or pancreatic disease
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this is an opacity seen on CXR, 30% are malgnant, usually <3cm
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solitary pulmonary nodule
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this is a benign lesion seen on CXR, usually bulls eye, diffuse or popcorn-like
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calcification
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how can you differential a benign nodule from a malignant
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benign are slow growing, dont double in size in less than 2 years, malignancy grows at constant rate about every 120 days it doubles in size
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with pneumonia, when do you recheck CXR
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6 weeks
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when do you start screening for colon cancer with a family history of FAP
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12 years, sigmoid every 1-3 years, have multiple polyps, 50% risk by age 40 years old.
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When do you start screening for HNPCC
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after 25 years old, colonoscopy every 1-3 years, annual endometrial biopsy, annual pelvic to assess ovaries, account of 10% percent of colon cancer
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what is the average age of testicular cancer
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20-35 years
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is testicular cancer increasing or decreasing
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increasing
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what are risk factors for testicular cancer
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cryptochordism
hiv des |
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what are the symptoms of testicular cancer
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painless enlargement
heaviness acute testicular pain with hemmorhage gynocomastea mets - hemoptysis back pain High HCG, dont check tumor markers |
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how to diagnose testicular cancer
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non-transilluminating mass on testes, US and urology consult for orchiectomy
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what is the number one cause of cancer death in both men and women
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lung
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what is the survival rate in lung cancer
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5 to 10% 5 year survival
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what are risk factors for lung cancer
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smoking
asbestos radon gas uranium nickel chromate |
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what is CDT Lung blood test
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looks at antigens in the blood, lung cancer produces abnormal antigens
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what are symptoms of lung cancer
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weight loss
clubbing bronchitis hemoptysis cough CP DVT hoarseness Fever Pneumonia Paraneoplastic symptoms |
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how to diagnose lung cancer
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CXR
Chest CT PET Biopsy Rule out TB and sputum culture |
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what are the two types of lung cancer
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small cell - 20%, rapid, early mets, central with mediasternal lymphadenopathy, paraneoplastic - HCG, SIADH, Cushing
Non-Small Cell - 80%, squamous, endo-bronchial, late mets, adenocarcinoma - early mets, Large cell |
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this is the 3d leading cause of cancer death in both men and women
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colon cancer
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what are risk factors of colon cancer
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age
smoker history of other cancer IBS poor diet truncal obesity +villous adenoma polyps first degree relative |
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what are symptoms of colon cancer
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weight loss
fatigue LBP or abdominal pain iron deficiency anemia change in BM Rectal bleeding, melena perferation |
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when should you start screening for colon cancer
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50 years - FOBT yearly
Sigmoid or Barium q 5 yrs Colonoscopy q 10 years DNA mutation yearly DRE yearly |
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what is lynch syndrom
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most common colon cancer - genetic, increased risk of ovarian and endometrial cancer, arise from polyps,
chemo does not work |
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benign or malignant colon cancer?
under 48 years nonsmoker less than 8mm lesion nodule edge type I doubles great than 2 years |
benign
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what causes false positive blood on FOBT
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ASA
NSAID rare red meat cantalope horseradish uncooked veggies high vitamin C |
