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41 Cards in this Set
- Front
- Back
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What is the most common gynec cancer?
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Endometrial
- 3/4 post-menopausal |
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What are the two types?
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Type I: Estrogen Dependent
Type II: Non estrogen dependent |
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Screening: Endometrial
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None.
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Findings: Warning Signs
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Metromenorrhagia
Post-menopausal bleeding Abdo / bowel symptoms Post-coital bleeding |
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What is the best choice for diagnosis?
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Pipelle biopsy. 90% sensitive.
NOT U/S. Role for U/S is in work-up for AUB. |
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Role of surgery (hysterectomy - BSO)
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Diagnosis
Staging Treatment Facilitate adjuvant therapy |
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FIGO Staging
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I: uterus
II: involves cervix III: involves pelvis and nodes IV: bladder / bowel or mets |
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Prognosis
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Type I: 90% 5YSR
Type II: 10% %YSR |
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Cervical Cancer:
cause and co-factors |
Cause = HPV
Cofactors: smoking, immunocomprosise |
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Types
- warts - cancer |
Warts: 6, 11
Cancer: 16, 18 |
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Primary prevention:
Secondary: |
Primary: avoid getting HPV
Secondary: Pap, Colposcopy |
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How sensitive is Pap?
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50-90%
Repetition necessary! |
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What are the types of irregular results in a pap?
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Sqamous: ASC - US, ASC-H, LSIL, HSIL, Carcinoma
Glandular: AGC, AGC favour neoplasia, Adenocarcinoma |
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What is the next step when irregular result returned?
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Except for ASC-US, do COLPOSCOPY
ASC-US is the only indication for HPV testing. |
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Tx: Dysplasia
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Excision or Ablation
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What are some cervical cancer warning symptoms?
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POST - COITAL BLEEDING
Pain, d/c Terrible Triad: flank pain, sciatica, lower limb edema |
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What do you do if you find a gross lesion on pelvic exam?
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BIOPSY
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How is cervical cancer staged?
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Clinically. Imaging may help with Tx but does not determine staging.
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FIGO Stages: Cervical Cancer
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I: Cervix
II: upper vagina / parametrium III: lower vagina, pelvic sidewall, ureters IV: bladder / bowel / mets |
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Tx Cervical Cancer
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> 1B2: Chemoradiation; no surgery
< 1B2: radical hysterectomy + nodes |
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Prognosis: Cervical Cancer
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Early stage: 2/3 5ysr
Later stage: 1/3 5 ysr |
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Ovarian Tumours: Types
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Germ (good-- chemosensitive)
Stromal (bad) Epithelial (ugly) |
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Risk factors
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Excessive ovulation
- nulliparity - early menarche / late menopause - OCPs protective |
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Hereditary Syndromes
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- Breast / Ovarian: BRCA 1/ 2
- Lynch (HNPCC) - Earlier onset, better outcome |
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Screening
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NONE. Ca-125 does not work.Do screening for those with BRCA or HNPCC.
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Warning Signs: Ovarian Cancer
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Bloating
Abdo / gut / bladder Irregular vaginal bleeding (uncommon) Ascites, frozen pelvis |
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Dx
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Pelvic or TVUS
CT no good P/E !!! |
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Markers for Ovarian Tumours
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Epithelial, non-mucinous: Ca-125
Germ cell: none for immature teratoma; others Stromal, granulosa type: Inhibin |
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What is the use fo CA-125?
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No use in premenopausal but high PPV in postmenopausal
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What is the RMI?
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Risk of Malignancy Index
RMI = U x M x CA > 200 = gyno referral U/ S (1 or 3 points) 1 for 0, 1 points; 3 for 2-5 points: multilocularity, bilaterality, solid components, ascites, mets M = 3 for menopausal, 1 for pre CA = serum Ca 125 |
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FIGO Staging
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I: ovaries
II: pelvis III: abdomen, pelvis, nodes IV: pleural effusion, liver, mets |
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Tx: ovarian cancer
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Surgery. Also helps with staging.
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Prognosis
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Most not diagnosed till later, so bad outcome.
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Vulvar Cancer: most common subtype
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squamous cell carcinoma
22% are actually secondaries. |
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What are the two categories of vulvar cancer?
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HPV related (Type I) - similar risk factors (smoking, IC etc) to cervical cancer
Non-HPV related (Type II), eg with lichen sclerosus Age = major risk factor (disease of older people) |
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Warnings Signs
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Itching, burning, bleeding, lesion
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Investigation:
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Colposcopy (if no lesion visible) and biopsy
Pap Smear-- No! |
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Tx
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Surgery with adjuvant and neoadjuvant chemoradiation
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FIGO Staging
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I: vulvar tumour < 2cm
II: vulvar tumour > 2cm III: urethra, anus, vagina, nodes IV: bladder / bowel, bones, mets |
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Outcome
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Very good at early stage. Only 18% at Stage IV.
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STUDY SUMMARY SLIDES
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STUDY SUMMARY SLIDES
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