OBGYN - Gyn Cancers
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(Created page with '=Gyn Cancers= ==Cancers== *Ovarina / fallopian tube **Primary peritoneal cancer, looks the same, treated the same *cervical *Endometria *rare: **vulva **vagina **trophoblastic …')
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Revision as of 23:35, 12 December 2011
Gyn Cancers
Cancers
- Ovarina / fallopian tube
- Primary peritoneal cancer, looks the same, treated the same
- cervical
- Endometria
- rare:
- vulva
- vagina
- trophoblastic
Epidemiology
Adnexal mass and ovarian cancer
- 23k new cases / year
- breast cancer is 200k
- teal is the color of ribbon for ovarian
- 16k deaths / year
- 23% of gyn cancers are ovarian.
- 47% of deaths are caused by ovarian
Embryology / Oncology
- Gi-> ovary is a krukenburg
EOC
- Brenner is transitional
Decreased Risk
- Tying the tubes decreases one's risk, probably because there is decreased environmental exposure.
- Anything that makes the ovary quiescent will decrease the risk of ovarian cancer.
Increased Risk
- Family history of breast cancer increases the risk for ovarian cancer by 2 fold.
- A personal history makes the risk 10 fold higher!
- Diet is questionable.
Adnexal Mass Ddx
- PID can form a pretty big, complex mass on the ovary with fallopian tube involvement.
- How do we tell between good and bad?
- Good:
- fluid filled (not solid)
- usually younger
- asymptomatic
- Bad:
- pain or other vague symptoms
- ascites
- complex, solid
- omental cake
- adenopathy.
Evaluate the pt
- ROS:
- 65% of ovarian pts do have sympstoms but often vague
- Pin, GI symptoms, fatigue, weight change
- PE:
- Pleural effusion is frequent, ronchi, wheezes
- abdominal mass or fluid wave
- Rectovaginal exam; mass, nodularity
Adnexal mass ddx
- Pelvic exam
- US > CT
FIGO Staging
- Ovarian often goes to the lung.
- Surface of the liver is stage 3 but parenchymal liver mets is stage 4.
Survival
- down
Ovarianc cancer
- usually requires histology to know it is cancer.
Ovarian cancer treatment
Familial Ovarian cancer
- HBOC = hereditary breast ovarian cancer syndrome.
- BRCA is an example.
- If one person has breast and ovarian cancer, there is s90% chance that they carry brca mutations.
- Male breast cancer is so rare that if seen, suspect brca(2) mutation.
CA125 Serum Testing
- CA 125 does not detect ovarian cancer at an earlier stage.
Triage
Prophylactic Surgery
- These prophylactic surgeries (breast and ovary) are not completely protective because we just can't find every cell.
- After prophy, a 5% risk over 20 years for developing cancer (as a brca pt).
- But that's much better.
Abnormal Pap Smear and Cervical Cancer
Cervical Cancer screening
- Moved up to 21 b/c we were over treating.
- Coposcopy is magnifying the cervix to identify early microscopic changes.
- ASCUS = atypica squamous cells of undetermined significance
- AGUS = atypical ?
Colposcopy
- Use acetic acid to highlight abnormal spots; biopsy them.
- Must do a cone biopsy if you have an inadequate simple (cervical) biopsy.
Pyramid
- Treat red and yellow, wait on blue and green.
Cervical Cancer Staging
- Goal is to get a negative margin.
- Will irradiate the entire tumor.
- Try not to do sx if they will need radiation b/c radiation has more adverse effects if post-op.
- Even radical hysterectomy leaves the ovaries.
- Cervical cancer very rarely involves the ovaries.
Post-Menopausal Bleeding and Endometrial Carcinoma
Did not cover all topics.