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41 Cards in this Set
- Front
- Back
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What are the symptom and sign of GTD? (6)
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- Vaginal bleeding
- Uterus large for dates - Hyperemesis - Pre-eclampsia - Theca Lutein Cyst - Hyperthyroidism |
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What are the risk factors for molar pregnancy? (4)
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- Extremes of maternal age (<20 or >40)
- Previous molar pregnancy - ?Diet - ?Geography |
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After removal of mole what do you follow up with?
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- bhCG (Weekly until normal x3 and monthly x1year)
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What are the different types of gestational trophoblastic tumours? (3)
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- Invasive mole
- Choriocarcinoma - Placental site trophoblastic tumour |
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For mole follow up, when should you referral to oncologist? (3)
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- b-hCG plateaus x 3
- b-hCG rises - Abnormal CXR |
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What are signs of high risk GTN?
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Five F's
- Antecedent Full term pregnancy - Far away mets (Live, brain) - b-hCG > 40,000 - Failed low risk chemo - >4 months since pregnancy |
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How do you treat low risk GTN?
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Methotrexate and/or Actinomycin D
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How do you treat high risk GTN?
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Combination chemotherapy
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What are the estrogen-related risk factor for type I endometrial cancer? (5)
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- Obesity
- Anovulatory cycles (PCOS) - Type 2 diabetes - Unopposed estrogen - Tamoxifen |
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What are the different types of endometrial hyperplasia?
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- Gland architecture (Simple, Complex)
- Cellularity (Nuclear atypia, none) |
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What are the DDx for premenopausal vaginal bleeding? (5)
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- Fibroids
- Polyps - Dysfunctional uterine bleeding - PCOS - Cervical cancer |
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What are the DDx for postmenopausal vaginal bleeding? (5)
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- Atrophy (50%)
- Polyps - Cervical Cancer - Endometrial hyperplasia - Endometrial cancer (10%) |
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How do you stage endometrial cancer?
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Stage I: Confined to uterus
Stage II: Cervix Stage III: Adnexae, uterine serosa, vagina, lymph nodes Stage IV: Bowel, bladder, distant |
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What is the treatment for endometrial cancer?
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- Surgery: Hysterectomy + bilateral salpingo-oophorectomy
- Adjuvant therapy (Pelvic radiation, chemotherapy, hormone therapy) |
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What are the prognostic factors in endometrial cancer? (3)
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- Grade
- Depth of myometrial invasion (>50%) - Cervical stromal involvement |
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What cancer is associated with endometrial cancer?
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- Breast Cancer (2x)
- Colorectal cancer (3-7x) |
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What are the guideline for breast cancer screening?
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- Mammography every 2 years
- Age 40-79 |
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What are the guideline for colorectal cancer screening?
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- Fecal occult blood test every year
- Age 50-75 |
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HNPCC increase what lifetime cancer risks? (7)
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- Colorectal
- Endometrial - Gastric - Small bowel - Ureter - Renal pelvis |
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What is the amsterdam criteria for HNPCC?
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- 3 cancers, including endometrium colon
- 2 generations - 1 < age 50 |
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What do you do for risk reduction in lynch syndrome?
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- Endometrial cancer (Hysterectomy @ age 40)
- Colorectal cancer (Screen every year after 40) |
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What decreases risk of endometrial cancer?
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- Multiparity (>3)
- OCP - Exercise (2.5hr/wk) - Smoking - Coffee |
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What pelvic cancer is radiotherapy used for?
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Vulva/lower vagina:
- Surgery preferred, unless sphincter is comprised - RT used for adjuvant Cervix/upper vagina: - RT for higher Stage - RT for adjuvant (Dec relapse for moderate risk) Endometrium: - > Stage II = radiotherapy + chemotherapy - Adjuvant: Local control but no survival benefit Fallopian tube/ovary: - Not used - Adjuvant, may further reduce relapse risk |
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How do you character adnexal masses? (6)
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- Size
- Laterality - Cystic/solid - Mobility - Texture/surface - Relationship to other structures |
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What is adenxa?
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Fallopian tubes, broad ligaments, ovaries
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What are characteristics of physiologic cysts?
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- Usually < 8cm
- Cycle dependent - Should not occur on OCPs |
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What do you do for adenexal mass in reproductive age?
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- Repeat pelvic exam in 6 weeks
- Ultrasound |
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What adenexal mass in reproductive should you be suspicious of? (5)
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- >8 cm
- Complex (Solid & cystic) - Bilateral - Associated with ascities - Solid |
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What are the subtypes of ovarian neoplasm? (5)
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- Coelomic epithelium
- Sex cord stromal tumour - Germ cell tumour - Non-gynecologic stroma - Metastatic |
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What are the subtypes of ovarian adenocarcinoma? (5)
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- Serous (Low/High grade)
- Mucinous - Endometriod - Mesonephroid - Undifferentiated |
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What are the subtypes of ovarian sex cord stromal tumours? (4)
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- Granulosa-theca cell tumour
- Sertoli-Leydig - Gyneandroblastoma - Lipid Cell Tumours |
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What are the subtypes of ovarian germ cell tumours? (7)
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- Seminomas
- Teratomas (Dermoid) - Struma/Carcinoid - Endodermal Sinus - Embryonal - Choriocarcinoma - Gonadooblastoma |
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What are the subtypes of ovarian non-gynecologic stroma? (7)
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- Fibroma
- Hemangioma - Leiomyoma - Lipoma - Lymphoma - Sarcoma |
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What are the common metastatic neoplasm to ovary? (4)
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- GI Tract
- Breast - Endometrium - Lymphoma |
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What are the methods of spread for ovarian cancer?
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- Direct
- Hematogenous - Lymphatic - Transperitoneal |
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What are the staging for ovarian cancer?
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Stage I: Confined to the ovary
Stage II: Confined to the pelvis Stage III: Confined to the abdomen Stage IV: Distant disease |
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What mutation is linked with ovarian cancer?
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-BRCA 1 & 2 with High grade Serous ovarian adenocarcinoma
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What are the acute side effects of radiation therapy?
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- Inflammation (Enteritis, cystitis, dermatitis)
- Bone marrow supression - Fatigue |
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What are the late side effects of radiation therapy? (6)
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- Ovarian ablation (100%)
- Bowel/bladder function (25%) - Rectal bleeding (10%) - Strictures/fistulas (<5%) - Pelvic fractures (1%) - 2nd maligancies (<0.1%) |
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What changes occur during placental maturation? (3)
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- Increased surface area available for exchange
- Closer approximation of maternal and fetal circulations - Increased uterine blood flow |
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What stroma surrounds the umbilical cord?
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Wharton’s jelly
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