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128 Cards in this Set

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#1 gyn malig
endometrial ca
endometrial ca is strongly assoc w/ what?
high levels of unopposed estrogen
(HRT, tamoxifen, obesity, chr anov, early menarche/late menopause, ov granulosa cell tumor)
other factors: dm, nulliparity, htn, +FHx
peak age of endo ca
50-70
most tumors are what type of cells
adenocarcinomas
how do mets occur?
direct extension (cervix)
intraperitoneal seeding
lymphatic (aortic, pelvic nodes)
hematogenous (lungs, vagina)
most common sx of endometrial ca
POSTMENOPAUSE BL
MENORRHAGIA
METRORRHAGIA
lower abd pain
cramp
signs of mets
uterus fixed, if spread to adnexa, peritoneum
HSM
general LAD
abd masses
T or F
Pap smear may detect asx dz, and is very sensitive
F
may detect asx dz
BUT IS NOT VERY SENSITIVE**
*use u/s to R/O...
fibroids,
polyps,
endometrial hyperplasia
What does ECC and EMB show**
glandular cell hyperplasia/anaplasia w/ invasion into stroma/myometrium/bl vessels
if ecc, emb sample is inadequate, what alternative can be used to obtain better sample
d/c
Surgical staging is based on what procedures to determine extent of spread
abd exploration
peritoneal washing
tah-bso
selective pelvic-periaortic node sampling
Stage or Grade is key prognostic factor for endo ca
GRADE GRADE GRADE for endo ca*
what need to do as tx plan for cervical, extrauterine spread
adjuvant radiation
how tx stage 1*
hormone therapy (high dose progestins)
how tx advanced and recurrent dz?
chemo (doxorubicin, cisplatin)
what used to dx endo ca
ecc, emb
what is key prog factor for endo ca
grade
postmenopausal woman shows up with bleeding, should you assume it is atrophic vaginitis?
NO! SAMPLE it! to r/o ca
#1cz of gyn ca deaths*
ovarian ca
ovarian ca:
most common in what groups of females
post-menopausal
pre-pubescent
RF of ovarian ca
*FHx of br or ov ca
*chr uninterrupted ovulation (nulliparity, infertility, delayed childbear, late menopause)
ovaries constant breakage and repair
rf involve constant breakage and repair of ovaries, so what would supress ovulation to have protective effect?
OCPs have protective effect on ovarian ca by suppress ovulation
primary ovarian tumors are categorized by site of origin, are made up by what type of cells
epithelial (outside) (serous cystadenocarcinoma)
germ (dysgerminoma)
sex cord-stromal (func)
most common cell type of ovarian tumors, most common age group for that cell type
epithelial
>20yo
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
PE 3 findings* of ov tumor
1. solid, fixed, nodular pelvic mass
2. ascites
3. pleural effusion
DDx of ov tumor
fibroids (should not enlarge after menopause)
ectopic (fertile)
pelvic kidney (young)
Ca: krukenberg, retroperitoneal, colorectal
PID, ovarian cyst, endometriosis
menopause
fertile
young child
gyn
Best way to eval adnexal mass
pelvic u/s*
(pos ct or mri)
4 serum tumor markers for ovarian tumor
CA-125*
a-fetoprotein
LDH
hCG
T or F
serum tumor markers are used to detect and to monitor
F
low specificity=no good for screen
Surgical staging, as w/ endo ca, involves 3 procedures
1. TAH-BSO
2. omentectomy
3. tumor debulk
what tx is effective for dysgerminomas
radiation
what tx is good for epithelial cell tumors
post-surg CHEMO (carboplatin, paclitaxel)
epithelial cell tumors are
a. low recur, good prog
b. hi recur, poor prog
hi recur, poor prog*
women w/ strong FHx should have annual screen w/ what 2 tools
1. CA-125*
2. transvaginal u/s (adnexal mass)
pt w/ hx ovarian ca, after childbirth, what prophylactic procedure recommend?
prophylactic oophorectomy
what tx/med would help with prevention, dec risk of ovarian tumor?
OCP
pap smear has dec the incid and mortality of this gyn ca
cervical ca
pap smear tests cervical cells
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
RF for cervical ca
smoking*
STD*
HPV* (16,18,31)
early onset sex
mult sex partners
imcpd state (hiv)
how are asx pts dx w/ cervical ca?
pap, colposcopy, bx
routine screen, and follow ups if pos
what sx do pts w/ cervical ca have?
post-coital bl*
meno/metrorrhagia (bl!)
pelvic pain
vaginal d/c*
PE of cervical ca shows?
cervical discharge/ulcer*
pelvic mass or fistula
DDx of vaginal bl, d/c
cervicitis, vaginitis, std, actinomycosis
how dx cervical ca
bx lesions
when should pt undergo endocervical curettage (ECC) and colposcopy
paps showing:
dysplasia
squamous intraepithelial NEOplasia
2 consec atypical sq cells of undermined signif (ASCUS)
2 ways of categorizing cervical ca
1. cervical intraepithelial neoplasia (CIN)
2. invasive cervical carcinoma (dep >3mm, wid >7mm)
how are the two categories of cervical ca related
LSIL (low grade sq intraepi lesions) = CIN I (mild dysplasia)

HSIL= CIN II (mod), CIN III (sev)
is staging for cervical surgical or clinical?
clinical
procedures for staging (2)
1. pelvic exam under anesthesia--eval invasion into adjacent struc
2. CXR, IVP--eval mets
T or F
CT/MRI can be used for staging
F!!* CT/MRI CANNOT BE USED FOR STAGING!
Tx of CIN I
most regress spon
observe*: pap, colpo q3mo for 1yr
Tx of CIN II/III
cryosurgery*
LEEP* (loop electrocautery excision procedure)
laser
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
when is cold knife conization used?
1. lesion not fully visualize
2. discrep b/w bx, hi-grade cytology
3. adenocarcinoma in situ
4. positive ECC
5. microinvasive SCC
tx of Invasive CA if early
radical hysterectomy and lymph node dissection
all stages of invasive ca can be tx w/...
radiation and chemo**
(or less radical surg)
what tx improves survival in bulky tumors or adv dz?
radiation +/-chemo
which gyn ca peaks after menopause? (60 yo)
vulvar ca
90% of vulvar ca is which cell type
squamous cell carcinoma SCC
RF for vulvar ca
DM
obesity
HTN
vulvar dystrophies
HPV 16,18
Most common sx of vulvar ca
Usu sx of vulvar ca
vulvar pruritus
usu asx in early stages
PE look for 2
1. erythema, ulcer vulvar lesion
2. palpable vulvar mass
how dx vulvar ca
bx
staging clinical or surgical
surgical
what is staging based on?
TNM
tumor size
invasiveness
nodal involve
distant mets
tx primary tumor (2)
wide local excision
regional lymph node dissection
how is radiation used in vulvar ca (2)
1. reduce tumor burden
2. mets or recur dz
most common BENIGN* gyn lesions
fibroid/uterine leiomyoma (smooth muscle)
which race and age group most common w/ fibroids
bl
>35
T or F
fibroids are responsive to hormones. grow in preg. regress in menopause.
T
hormonally responsive*
T or F
malignant transformation to leiomyosarcoma is very common
F
very RARE* (.1-.5%)
usu sx of fibroids
asx
pt may complain of... if have fibroids
abn uterine bl**-->anemia
pelvic press
dysmenorrhea
ur freq
pain (vasc compromise)
infertility (uncommon)
PE of uterus reveals...
lumpy-bumpy** uterus: firm, non-tender irreg enlarged uterus
DDx of fibroids
abn bl
carcinoma (cervical, endo, ov)
preg
endometriosis
adenomyosis
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
what tool to confirm dx of fibroids
u/s
how tx asx fibroids
expectantly w/ serial exams and u/s to monitor growth*
Tx of fibroids w/ sev sx or exhibit post-menopausal growth
hysterectomy or myomectomy* (to preserve fertility)
which group of women should use medical therapies for fibroids
peri-menopausal women about to have menopause
what are some examples of medical therapies for fibroids
medroxyprogesterone
danazol
GnRH agonist
Common cz of bl nipple d/c
intraductal papilloma
Most common benign br disorder in premenopausal women**
fibrocystic change*
what causes fibrocystic change
exag stromal resp to hormones and growth factors
common sx of fibrocystic change
cyclic, premenstrual b/l br pain/tender/swell
PE of fibrocystic change reveals
excessive tissue nodularity
Dx fibrocystic change w/ what two tools
FNA
cytologic exam of dominant lesion
Tx involves
dec nicotine, caffine
vit E supp
hormonal tx (progestin, danazol, tamoxifen)
diuretics for premen mastalgia
T or F
fibrocytic change has inc risk for br ca
trick!
only if cellular atypia present
Name most common br lesion in women <30yo
fibroadenoma
T or F
fibroadenoma is a benign, slow-grow tumor w/ epithelial and stromal components
T
PE shows fibroadenoma as...
discrete?
mobile?
tender?
solitary?
round, firm, discrete, mobile, nontender soiltary mass
how dx fibroadenoma
surgical excision--dx and tx
T or F
recurrence is uncommon in fibroadenoma
F
what subtype of fibroadenoma is not slow-growing but fast growing and large? is it malig?
Phyllodes tumor* (fast, lg)
rarely malig (cystosarcoma phyllodes)
what is the most common ca?
breast ca
what is the most common of ca death in women? second most common cz of ca death?
lung ca
br ca
RF for br ca
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
T or F
late menarche assoc w/ dec risk br ca
T
what two mutations assoc w/ early-onset, familial br & ov ca
BRCA-1,-2
how does breast ca lesion feel on pe?
HARD, IMMOBILE, IRREG, PAINLESS MASS
pos nipple d/c
adv dz: skin change (dimple, red, ulcer, edema), axillary adenopathy
T or F
some br ca may be asx and nonpalpable, thus only found on mammogram
TRUE!!**
most common location of br ca
upper outer quad
common met sites of br ca
lymph nodes
brain
bone
lung
liver
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
if br w/ cystic lesion (fluid filled), what tool used to eval? when excise?
FNA
excise if not resolve, bl, or recurs
if br w/ solid lesion, what do to eval?
bx
what are 3 dif types of bx for br ca
1. stereotactic core bx (nonpalp lesion)
2. direct needle core bx (palp lesions)
3. open surg bx w/ needle localization (nonpalp)
What two prognostic factors can you test for?
estrogen/progesterone receptors (if +, GOOD!)
herzneu amplication
Name special form of br ca.
highly aggressive, rapid grow ca, invade lymph, skin inflam. poor prog.
inflam br ca
ductal carcinoma in situ of the nipple. burn, itch, nipple erosion (look like infection).
paget's dz
b/l br ca is more common in OLD or YOUNG women, w/ DCIS or LCIS.
b/l br ca more common in
young
lobular carcinoma
Stage or Grade is impt prognostic factor for br ca
Stage
T or F
lobular carcinoma in situ inc risk of invasive carcinoma in both br
T
T or F
Carcinoma in situ (CIS) is classified as Lobular (LCIS) or Ductal (DCIS)
t
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
DCIS tx if sm tumor?
if lg tumor?
sm: local excise, f/u
lg: wide excise+XRT or simple mastectomy (no node disect)
Invasive ca can be lobular or ductal. which one more common?
ductal
staging is based on what three factors?
tnm
tumor size
nodes
mets (bone scan, cbc, serum ca, cxr)
how tx localized invasive ca?
LUMPECTOMY + AXILLARY NODE DISSECTION + XRT
or
MODIFIED RADICAL MASTECTOMY (simple mast + ax node disect)
T or F
all pre-menopausal women w/ pos nodes get chemo, regardless of estro-R status
T
T or F
post-menopausal women w/ +nodes get chemo only if neg estro-R status
T
T or F
if pt has mets, use chemo
T
T or F
if pt has recur dz, use chemo
T
T or F
if pt has +estro-R, tx pt w/ hormone therapy (tamoxifen)
T
what med can pts w/ herzneu amplication and mets get?
herceptin