Begin at age 21

Recommend every 2 yrs for women b/w age 21-29

Women over 30 with 3 consecutive negative screenings may extend to every 3 years, not high risk pts.

What is this:

Triage for ASC-US

Women >30 yrs can use in conjuction w/ cytology

routine testing not recommended for women <30

What is this:

HVP infection-esp subtype 16 & 18

early onset of sexual activity

multiple sexual partners, high risk sexual partners

hx of STI

Smoking

Immunocompromised (HIV)

low socieconomics

Risk Factors for CIN & Cervical cancer

CIN=cervical intrauterine neoplasia

T/F

Most women with intact immune system will not clear HVP infection in 8-24 months.

T/F

CIN lesions do not have specific characteristics?

False

Ex. Vascular pattern, aids in direction of biopys

Will these findings require a colposcopy?

grossly visible or palpable abnormality of cervix

abnormal cervical cytology

+ screening test for neoplasia

cervical cytology unsatisfactory d/t unexplained inflammation

unexplained cervico-vaginal discharge

unexplained abn lower GI tract bleeding

hx lower GI neoplasia

Post tx surveillance

abnormal vaginal bleeding

post coital bleeding

vaginal discharge that is:

 watery

mucoid/purulent

malodorous

What are the physical findings of cervical cancer?

may or may not have cervical lesion

cervical lesion may be ulcerative or exophytic

usually very friable cervix, bleeds easily

Radical hysterectomy

Radiation therapy

Chemotherapy

???

Removal of:

 uterus

adjacent portions of vagina

cardinal ligaments

uterosacral ligaments

bladder pillars

Malignant tumors of____________ are uncommon.

Most are squamous cell carcinomas

These 2 types:  basaloid & warty types

Seen in younger pts

Related to HPV

Smoking

What type of cancer is this?

Which one is this:  Basoloid/Warty or Differentiated

Older pt

Unrelated to HPV & smoking

Long standing lichen sclerosis is common

Pruritis

mass

Vulvar bleeding or discharge

Dysuria

Enlarged groin nodes-advanced

Asymptomatic

This is what type of cancer?

Rare, 1% of all gyn cancers

Upper 1/2 of vagina involved in over 50% of cases

80-90% vaginal tumors metastatic

mean age 60-65 yrs

most primary vaginal adenocarcinoma related to DES exposure in utero

Leimyomyomas

AKA-Fibroids

Abnormal uterine bleeding

&

Pelvic pressure/pain

What is this called:

bleeding from the cervix, vagina, or perineum that is acute and occurs between expected periods

Heavy or prolonged menses is the typical pattern for fibroids,

Is intermenstrual bleeding normal also?

NO

This is not a characteristic of myomas & should be investigated to exclude endometrial pathology

What is the PE for a uterine leiomyomas:

contour

&

 abdominal exam

contour:  IRREGULAR

&

 abdominal exam:  Large fibroid can be PALPATED

Which endometrial cancer is the most common:

Type I / estrogen dependent

or

Type II

Type I more common with good prognosis

Type II accounts for 10% of endometrial ca & is more aggressive with poorer prognosis

These are risk factors for which type of cancer?

age

obesity

DM

Late menopause, early menarche

nulliparity

Tamoxifen

Polycystic Ovary Syndrome

Hereditary nonpolyposis colorectal Ca syndrome

Estrogen secreting tumor

OCP

&

Smoking

Abnormal vaginal bleeding

Postmenopausal bleeding is always abnormal & should be investigated.

What is this:

HNPCC (Lynch 2 Syndrome)

Extended anovulatory cycles

Postmenopausal women with intact uterus taking unopposed estrogen therapy

Postmenopausal bleeding

Endometrial cells on Pap

Atypical Endometrial cells on Pap

Obesity

&

HTN

Most are dx early therefore there are not a lot of findings. 

Normal uterus

FIGO

Federation of International Gynecologist & Obstretics

What do these Endometrial stages mean?

Stage 1

Stage 2

Stage 3

Stage 4

Stage 1:  Ca confined to uterus

Stage 2:  Ca of cervical stroma but does not extend beyong uterus

Stage 3:  Local/regional spread of tumor

serosa of uterus, adnexa, vaginal, parametrial, lymph nodes

Stage 4:  Tumor invades bladder & bowel mucosa with distant metastates

More aggressive Ca

If these conditions are present, what is likely:

prepubescent or postmenopausal women

complex or solid appearing mass on US

Known genetic predisposition

Presence in a female with non-gyn cancer

Ascites

Mass:

Size

Consistency (cystic, solid, mixed)

Bilateral or Unilateral

septations

Ascites

mural nodules

papillary projections

Are these benign, malignant, non gyn

adnexal masses:

functional cyst

leiomyomata

Endometrioma

Tuboovarian cyst

Ectopic pregnancy

Mucinous cystadenoma

Hydrosalphinx

Are these benign, malignant, non gyn

adnexal masses:

Germ cell tumor

Sex cord or stroma tumor

Epithelial carcinoma

Are these benign, malignant, non gyn

adnexal masses:

Divericular abscess

Appendicular abscess or tumor

Metastatic tumor-breast, colon, endometrium

If on US a mass is found what do you do:

simple cyst of 5 cm or less

>5 cm or complex

simple cyst of 5 cm or less:   OBSERVE

>5 cm or complex:  CA 125 marker needed

What is this:

Serous & mucinous cystadenoma

Endometrioma

Mature cystic tertoma-Dermoid cyst

Most commone ovarian tumor in 2nd & 3rd decade of life

What is this:

Usually asymptomatic

Most resolve in a few weeks

Usually < 2.5 cm

Some can be large but < 10 cm

What type of factors are these:

OC use

Pregnancy

Breast feeding

Tubial ligation

Hysterectomy/Removal of both ovaries

What type of cancer is this:

Unexplained change in bowel & bladder

GI upset

Unexplained Wt gain or loss

Pelvic/Abdominal pain/discomfort

Pelvic/Abdominal bloating, swelling

Constant feeling of fullness

Fatigue

Abnormal / postmenopausal bleeding

Dyspurenia

These will be the finding on PE for which type of cancer?

Abdominal mass

Ascites

decreased breath sounds if pleura effusion present

FIXED, IRREGULAR, SOLID  MASS on pelvic exam

What marker is elevated in Ovarian Ca, but can also be elevated in:

Metastatic Ca

Peritonitis

menses

Pregnancy

Cirrhosis

CHF

Endometriosis

Fibroids

What do the FIGO staging of ovarian cancer mean:

Stage I

Stage II

Stage II

Stage IV

Stage I: tumor limited to ovaries

Stage II:  tumor involves 1 or both ovaries with  pelvic extension

Stage II:  tumor involves 1 or both ovaries with microscopically confirmed peritoneal metastasis outside pelvis

Stage IV:  Distant Metastatis

What stage is this:

tumor limited to ovaries

What stage is this:

tumor involves 1 or both ovaries with  pelvic extension

What stage is this:

tumor involves 1 or both ovaries with microscopically confirmed peritoneal metastasis outside pelvis

What stage is this:

Distant Metastatis

What are the hereditary risk for:

Hereditary Ovarian Ca Syndrome

Known BRCA 1 or BRCA 2 mutation

Hereditary Ovarian Ca Syndrome:  40%

Known BRCA 1 or BRCA 2 mutation:  35-65 %

Lynch II syndrome

AKA-Nonpolyposis Colorectal Ca Syndrome HNPCC

Colon, endometrial, ovary, breast, stomach, pancreas Ca

What type of testing are these pts a candidate for:

Breast & Ovarian Ca in the same individual

Pt who has Ovarian Ca or relative with Ovarian Ca or premenopausal breast Ca or both

Women w/ ovarian Ca of Ashkenazi Jewish ancestry

Close relative with BRCA mutation

Pt w/ breast Ca at age 50 or < & close relative w/ ovarian Ca or male breast Ca at any age

T/F

Still a small risk for primary peritoneal cancer after prophlytactic Bilateral salpingo oophrectomy.