Neoplasia Of Vulva And Vag; Cervical Cx Dx And Tx

Front 1

Squamous Cell Hyperplasia is aka

Back 1

hyperplastic vulvar dystrophy

Front 2

Squamous Cell Hyperplasia of vulva: tx and why?

Back 2

Steroids. It's a chronic inflammation.

Front 3

Lichen Sclerosis: tx

Back 3

topical steroids

Front 4

Squamous Cell Hyperplasia of vulva: why is it biopsied?

Back 4

To distinguish from VIN

Front 5

Vulvar Intraepithelial Neoplasia Classification

Back 5

VIN I: mild
VIN II: moderate
VIN III: severe

HPV related

Front 6

Vulvar Intraepithelial Neoplasia : sx

Back 6

itching, irritation, raised lesion, skin discoloration

Front 7

Two types of VIN

Back 7

1) HPV related: basaloid/warty. Pigmented, multi-focal, papillary, coalescent with adjacent condyloma acuminata

2) Differentiated (simplex) Usually unifocal white plaque like lesions, may be adjacent to invasive cancers. Frequently associated with dystrophic vulvar lesions.

Front 8

Vulvar Cancer: what age?

Back 8

7th-8th decade, but patients are getting younger

Front 9

90% of vulvar cancer is what type?

Back 9

squamous

Front 10

Etiology of vulvar cancer (3)

Back 10

1) Lichen dystrophy (50%)
2) HPV (25%): VIN
3) Idiopathic (25%)

Front 11

T/F Paget's disease of vulvar may be associated with a comcomitant malignancy (eg., colon, breast)

Back 11

T. 30% of time.

Front 12

What is the name of the vulvar cancer staging?

Back 12

FICO

Front 13

Stage I FIGO vulvar cancer

Back 13

Confined to vulva.

<2 cm lesion.

Negative nodes.

High survival.

Front 14

Stage II FIGO vulvar cancer

Back 14

>2 cm lesion

Negative nodes

Front 15

Stage III FIGO vulvar cancer

Back 15

Spread to vagina, urethra, anus, OR unilateral positive nodes.

Survival is better the fewer + nodes.

Front 16

Stage IVA FIGO vulvar cancer

Back 16

Spread to upper urethra, bladder, or rectal mucosa, OR bilateral groin nodes are positive

Front 17

Stage IVB FIGO vulvar cancer

Back 17

Distant metastases

Front 18

Most common and usual tx for vulvar cancer

Back 18

Surgery

Front 19

What type of vaginal cancer is associated with in utero DES exposure?

Back 19

Adenocarcinoma, Clear Cell variant.

Occurs in young women

Front 20

What is VAIN?

Back 20

Vaginal Intrepithelial neoplasia. Often associated with HPV.

Front 21

Tx for VAIN

Back 21

Excision

Topical 5-FU cream

CO2 laser ablation (rare these days)

Front 22

What part of HPV is Gardasil training immune system to recognize?

Back 22

The protein capsid

Front 23

What is the overall spontaneous regression rates of CIN?

Back 23

20-65%

Front 24

T/F CIN sometimes isn't present before carcinoma develops

Back 24

F. it is a necessary precursor lesion

Front 25

Sx of cervical cancer

Back 25

post-coital spotting

Advanced sx: pain, weight loss, hematuria

Front 26

T/F Low SES is protective for cervical cancer

Back 26

F

Front 27

T/F Pap smears are diagnostic for cancer

Back 27

F. It is a SCREENING tool for an asymptomatic patient. It will be normal in some cervical cancers

Front 28

What are 5 negative epidemiologic prognostic factors for cervical cancer?

Back 28

Young age

Anemia

Poor

AA

HIV+

Front 29

What are the cell types and %ages causing cervical cancer?

Back 29

Squamous: 80%
Adenocarc: 20%

BOTH are HPV related

Front 30

How does the cervical cancer tumor disseminate?

Back 30

Direct extension: into vagina, endometrium, parametria.

Also spreads lymphatically to regional nodes.

Then hematogenously to lung, liver, and bone.

Front 31

Protein of HPV that modulates apoptosis and activates telomerase

Back 31

E6

Front 32

Protein of HPV that induces transcription activation of several cellular promoters

Back 32

E7

Front 33

Any visible cervical lesion requires what?

Back 33

biopsy (Ie, Pap smear is NOT enough)

Front 34

omental cake: defn

Back 34

sign indicative of an abnormally thickened greater omentum.[1] Typically, it is caused by infiltration of metastatic tumours arising from the stomach, ovary and colon.

Front 35

T/F Cervical cancer staging is based on surgical findings

Back 35

F. It's clinically based

Front 36

Stage I Cervical cancer: defn

Back 36

Confined to cervix

Front 37

Stage II Cervical cancer: defn

Back 37

Local/regional spread (ie to vagina)

Front 38

Stage III Cervical cancer: defn

Back 38

Further regional spread (distal vagina, pelvic sidewall)

Front 39

Stage IV Cervical cancer: defn

Back 39

Distant spread

Front 40

What is the tx of choice for IB tumors?

Back 40

CHemo OR radiation

Front 41

Cervical cancer tx for Stage IIb-IVa:

Back 41

chemoradiation

Front 42

Cervical cancer tx for Stage IVb:

Back 42

Stage IVb: chemoradiation or clinical trials or palliative care

Front 43

Simple hysterectomy: defn

Back 43

uterus and cervix are removed, but the structures surrounding it are left behind.

Front 44

Radical hysterectomy: defn

Back 44

Radical hysterectomy refers to the excision of the uterus en bloc with the parametrium (ie, round, broad, cardinal, and uterosacral ligaments)

Front 45

trachelectomy: defn

Back 45

removal of cervix

Front 46

brachytherapy: defn

Back 46

Internal radiotherapy.

form of radiotherapy where a radiation source is placed inside or next to the area requiring treatment, commonly used for cervical cancer. Allowing local, high dose radiation

Front 47

T/F In radical hysterectomy, uterus, surrounding ligaments, and ovaries are removed.

Back 47

F. Ovaries are NOT necessarily removed.

Front 48

Radiation treatment complications

Back 48

Radiation cystitis/proctitis
Radiation enteritis
Malabsorption, malnutrition
Partial/complete small bowel obstruction
Incidence overall is 5-15%

Front 49

What are the long term risk rates of bowel and bladder toxicity from radiation?

Back 49

5-15%

Front 50

What is a late complication of radiation?

Back 50

sarcoma

Front 51

What is the best chemo drug for cervical cancer but requires adequate renal function?

Back 51

cisplatinum

Front 52

What there is inadequate renal function, what chemo can be used for cervical cancer?

Back 52

5FU

Front 53

How is cervical cancer treated in pregnancy?

Back 53

3rd trimester:delay treatment until delivery

1st trimester: treat as if not pregnant