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128 Cards in this Set
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#1 gyn malig
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endometrial ca
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endometrial ca is strongly assoc w/ what?
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high levels of unopposed estrogen
(HRT, tamoxifen, obesity, chr anov, early menarche/late menopause, ov granulosa cell tumor) other factors: dm, nulliparity, htn, +FHx |
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peak age of endo ca
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50-70
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most tumors are what type of cells
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adenocarcinomas
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how do mets occur?
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direct extension (cervix)
intraperitoneal seeding lymphatic (aortic, pelvic nodes) hematogenous (lungs, vagina) |
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most common sx of endometrial ca
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POSTMENOPAUSE BL
MENORRHAGIA METRORRHAGIA lower abd pain cramp |
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signs of mets
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uterus fixed, if spread to adnexa, peritoneum
HSM general LAD abd masses |
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T or F
Pap smear may detect asx dz, and is very sensitive |
F
may detect asx dz BUT IS NOT VERY SENSITIVE** |
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*use u/s to R/O...
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fibroids,
polyps, endometrial hyperplasia |
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What does ECC and EMB show**
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glandular cell hyperplasia/anaplasia w/ invasion into stroma/myometrium/bl vessels
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if ecc, emb sample is inadequate, what alternative can be used to obtain better sample
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d/c
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Surgical staging is based on what procedures to determine extent of spread
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abd exploration
peritoneal washing tah-bso selective pelvic-periaortic node sampling |
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Stage or Grade is key prognostic factor for endo ca
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GRADE GRADE GRADE for endo ca*
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what need to do as tx plan for cervical, extrauterine spread
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adjuvant radiation
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how tx stage 1*
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hormone therapy (high dose progestins)
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how tx advanced and recurrent dz?
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chemo (doxorubicin, cisplatin)
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what used to dx endo ca
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ecc, emb
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what is key prog factor for endo ca
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grade
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postmenopausal woman shows up with bleeding, should you assume it is atrophic vaginitis?
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NO! SAMPLE it! to r/o ca
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#1cz of gyn ca deaths*
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ovarian ca
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ovarian ca:
most common in what groups of females |
post-menopausal
pre-pubescent |
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RF of ovarian ca
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*FHx of br or ov ca
*chr uninterrupted ovulation (nulliparity, infertility, delayed childbear, late menopause) |
ovaries constant breakage and repair
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rf involve constant breakage and repair of ovaries, so what would supress ovulation to have protective effect?
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OCPs have protective effect on ovarian ca by suppress ovulation
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primary ovarian tumors are categorized by site of origin, are made up by what type of cells
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epithelial (outside) (serous cystadenocarcinoma)
germ (dysgerminoma) sex cord-stromal (func) |
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most common cell type of ovarian tumors, most common age group for that cell type
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epithelial
>20yo |
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sx course of ovarian tumor
(gi, gu, systemic) |
asx until late in dz
sx: abd pain, bloat, early satiety, constip, ur freq, pelvic press, vag bl, systemic sx (malaise, tired, wgt loss) |
inc pressure, pressure pushing on organs
pressure-->satiety, constip-->wgt loss |
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PE 3 findings* of ov tumor
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1. solid, fixed, nodular pelvic mass
2. ascites 3. pleural effusion |
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DDx of ov tumor
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fibroids (should not enlarge after menopause)
ectopic (fertile) pelvic kidney (young) Ca: krukenberg, retroperitoneal, colorectal PID, ovarian cyst, endometriosis |
menopause
fertile young child gyn |
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Best way to eval adnexal mass
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pelvic u/s*
(pos ct or mri) |
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4 serum tumor markers for ovarian tumor
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CA-125*
a-fetoprotein LDH hCG |
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T or F
serum tumor markers are used to detect and to monitor |
F
low specificity=no good for screen |
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Surgical staging, as w/ endo ca, involves 3 procedures
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1. TAH-BSO
2. omentectomy 3. tumor debulk |
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what tx is effective for dysgerminomas
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radiation
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what tx is good for epithelial cell tumors
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post-surg CHEMO (carboplatin, paclitaxel)
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epithelial cell tumors are
a. low recur, good prog b. hi recur, poor prog |
hi recur, poor prog*
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women w/ strong FHx should have annual screen w/ what 2 tools
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1. CA-125*
2. transvaginal u/s (adnexal mass) |
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pt w/ hx ovarian ca, after childbirth, what prophylactic procedure recommend?
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prophylactic oophorectomy
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what tx/med would help with prevention, dec risk of ovarian tumor?
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OCP
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pap smear has dec the incid and mortality of this gyn ca
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cervical ca
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pap smear tests cervical cells
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1. most common gyn malig
2. 2nd most common 3. 3rd most common 4. 4th most common |
1. endometrial ca
2. ovarian ca (lead death since asx til late) 3. cervical ca 4. vulvar ca |
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RF for cervical ca
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smoking*
STD* HPV* (16,18,31) early onset sex mult sex partners imcpd state (hiv) |
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how are asx pts dx w/ cervical ca?
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pap, colposcopy, bx
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routine screen, and follow ups if pos
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what sx do pts w/ cervical ca have?
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post-coital bl*
meno/metrorrhagia (bl!) pelvic pain vaginal d/c* |
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PE of cervical ca shows?
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cervical discharge/ulcer*
pelvic mass or fistula |
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DDx of vaginal bl, d/c
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cervicitis, vaginitis, std, actinomycosis
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how dx cervical ca
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bx lesions
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when should pt undergo endocervical curettage (ECC) and colposcopy
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paps showing:
dysplasia squamous intraepithelial NEOplasia 2 consec atypical sq cells of undermined signif (ASCUS) |
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2 ways of categorizing cervical ca
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1. cervical intraepithelial neoplasia (CIN)
2. invasive cervical carcinoma (dep >3mm, wid >7mm) |
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how are the two categories of cervical ca related
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LSIL (low grade sq intraepi lesions) = CIN I (mild dysplasia)
HSIL= CIN II (mod), CIN III (sev) |
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is staging for cervical surgical or clinical?
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clinical
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procedures for staging (2)
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1. pelvic exam under anesthesia--eval invasion into adjacent struc
2. CXR, IVP--eval mets |
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T or F
CT/MRI can be used for staging |
F!!* CT/MRI CANNOT BE USED FOR STAGING!
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Tx of CIN I
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most regress spon
observe*: pap, colpo q3mo for 1yr |
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Tx of CIN II/III
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cryosurgery*
LEEP* (loop electrocautery excision procedure) laser |
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T or F
Cold knife conization of the cervix has a lower rate of complic than LEEP or cryo |
F
cold knife conization has HIGHER rate of complic |
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when is cold knife conization used?
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1. lesion not fully visualize
2. discrep b/w bx, hi-grade cytology 3. adenocarcinoma in situ 4. positive ECC 5. microinvasive SCC |
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tx of Invasive CA if early
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radical hysterectomy and lymph node dissection
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all stages of invasive ca can be tx w/...
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radiation and chemo**
(or less radical surg) |
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what tx improves survival in bulky tumors or adv dz?
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radiation +/-chemo
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which gyn ca peaks after menopause? (60 yo)
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vulvar ca
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90% of vulvar ca is which cell type
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squamous cell carcinoma SCC
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RF for vulvar ca
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DM
obesity HTN vulvar dystrophies HPV 16,18 |
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Most common sx of vulvar ca
Usu sx of vulvar ca |
vulvar pruritus
usu asx in early stages |
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PE look for 2
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1. erythema, ulcer vulvar lesion
2. palpable vulvar mass |
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how dx vulvar ca
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bx
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staging clinical or surgical
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surgical
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what is staging based on?
TNM |
tumor size
invasiveness nodal involve distant mets |
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tx primary tumor (2)
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wide local excision
regional lymph node dissection |
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how is radiation used in vulvar ca (2)
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1. reduce tumor burden
2. mets or recur dz |
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most common BENIGN* gyn lesions
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fibroid/uterine leiomyoma (smooth muscle)
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which race and age group most common w/ fibroids
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bl
>35 |
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T or F
fibroids are responsive to hormones. grow in preg. regress in menopause. |
T
hormonally responsive* |
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T or F
malignant transformation to leiomyosarcoma is very common |
F
very RARE* (.1-.5%) |
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usu sx of fibroids
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asx
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pt may complain of... if have fibroids
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abn uterine bl**-->anemia
pelvic press dysmenorrhea ur freq pain (vasc compromise) infertility (uncommon) |
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PE of uterus reveals...
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lumpy-bumpy** uterus: firm, non-tender irreg enlarged uterus
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DDx of fibroids
abn bl |
carcinoma (cervical, endo, ov)
preg endometriosis adenomyosis |
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T or F
a mass that cont to grow during menopause is fibroid |
F
hormone responsive fibroid does not grow during hormone dec in menopause |
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what tool to confirm dx of fibroids
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u/s
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how tx asx fibroids
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expectantly w/ serial exams and u/s to monitor growth*
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Tx of fibroids w/ sev sx or exhibit post-menopausal growth
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hysterectomy or myomectomy* (to preserve fertility)
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which group of women should use medical therapies for fibroids
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peri-menopausal women about to have menopause
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what are some examples of medical therapies for fibroids
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medroxyprogesterone
danazol GnRH agonist |
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Common cz of bl nipple d/c
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intraductal papilloma
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Most common benign br disorder in premenopausal women**
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fibrocystic change*
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what causes fibrocystic change
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exag stromal resp to hormones and growth factors
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common sx of fibrocystic change
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cyclic, premenstrual b/l br pain/tender/swell
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PE of fibrocystic change reveals
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excessive tissue nodularity
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Dx fibrocystic change w/ what two tools
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FNA
cytologic exam of dominant lesion |
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Tx involves
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dec nicotine, caffine
vit E supp hormonal tx (progestin, danazol, tamoxifen) diuretics for premen mastalgia |
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T or F
fibrocytic change has inc risk for br ca |
trick!
only if cellular atypia present |
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Name most common br lesion in women <30yo
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fibroadenoma
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T or F
fibroadenoma is a benign, slow-grow tumor w/ epithelial and stromal components |
T
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PE shows fibroadenoma as...
discrete? mobile? tender? solitary? |
round, firm, discrete, mobile, nontender soiltary mass
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how dx fibroadenoma
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surgical excision--dx and tx
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T or F
recurrence is uncommon in fibroadenoma |
F
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what subtype of fibroadenoma is not slow-growing but fast growing and large? is it malig?
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Phyllodes tumor* (fast, lg)
rarely malig (cystosarcoma phyllodes) |
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what is the most common ca?
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breast ca
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what is the most common of ca death in women? second most common cz of ca death?
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lung ca
br ca |
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RF for br ca
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F, old
prev hx br ca br ca 1st degree relative hx fibrocystic change w/ cellular atypia (exposure to estrogen:)nulliparity, early menarche, late menopause first full-term preg >35yo |
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T or F
late menarche assoc w/ dec risk br ca |
T
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what two mutations assoc w/ early-onset, familial br & ov ca
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BRCA-1,-2
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how does breast ca lesion feel on pe?
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HARD, IMMOBILE, IRREG, PAINLESS MASS
pos nipple d/c adv dz: skin change (dimple, red, ulcer, edema), axillary adenopathy |
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T or F
some br ca may be asx and nonpalpable, thus only found on mammogram |
TRUE!!**
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most common location of br ca
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upper outer quad
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common met sites of br ca
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lymph nodes
brain bone lung liver |
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T or F
dx of br ca can be based on: palpable mass mammogram abn (microcalcif, hyperdense region) u/s |
T
MAMMOGRAM ABN U/S |
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if br w/ cystic lesion (fluid filled), what tool used to eval? when excise?
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FNA
excise if not resolve, bl, or recurs |
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if br w/ solid lesion, what do to eval?
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bx
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what are 3 dif types of bx for br ca
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1. stereotactic core bx (nonpalp lesion)
2. direct needle core bx (palp lesions) 3. open surg bx w/ needle localization (nonpalp) |
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What two prognostic factors can you test for?
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estrogen/progesterone receptors (if +, GOOD!)
herzneu amplication |
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Name special form of br ca.
highly aggressive, rapid grow ca, invade lymph, skin inflam. poor prog. |
inflam br ca
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ductal carcinoma in situ of the nipple. burn, itch, nipple erosion (look like infection).
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paget's dz
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b/l br ca is more common in OLD or YOUNG women, w/ DCIS or LCIS.
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b/l br ca more common in
young lobular carcinoma |
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Stage or Grade is impt prognostic factor for br ca
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Stage
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T or F
lobular carcinoma in situ inc risk of invasive carcinoma in both br |
T
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T or F
Carcinoma in situ (CIS) is classified as Lobular (LCIS) or Ductal (DCIS) |
t
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T or F
pts w/ LCIS d/t hi risk of invasive ca in both br, should have close f/u or b/l mastectomy (hi risk) |
T
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DCIS tx if sm tumor?
if lg tumor? |
sm: local excise, f/u
lg: wide excise+XRT or simple mastectomy (no node disect) |
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Invasive ca can be lobular or ductal. which one more common?
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ductal
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staging is based on what three factors?
tnm |
tumor size
nodes mets (bone scan, cbc, serum ca, cxr) |
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how tx localized invasive ca?
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LUMPECTOMY + AXILLARY NODE DISSECTION + XRT
or MODIFIED RADICAL MASTECTOMY (simple mast + ax node disect) |
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T or F
all pre-menopausal women w/ pos nodes get chemo, regardless of estro-R status |
T
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T or F
post-menopausal women w/ +nodes get chemo only if neg estro-R status |
T
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T or F
if pt has mets, use chemo |
T
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T or F
if pt has recur dz, use chemo |
T
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T or F
if pt has +estro-R, tx pt w/ hormone therapy (tamoxifen) |
T
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what med can pts w/ herzneu amplication and mets get?
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herceptin
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