From Iusmicm

Contents 1 Gyn Cancers 1.1 Cancers 1.2 Epidemiology 1.3 Adnexal mass and ovarian cancer 1.3.1 Embryology / Oncology 1.3.2 EOC 1.3.3 Decreased Risk 1.3.4 Increased Risk 1.3.5 Adnexal Mass Ddx 1.3.6 Evaluate the pt 1.3.7 Adnexal mass ddx 1.3.8 FIGO Staging 1.3.9 Survival 1.3.10 Ovarianc cancer 1.3.11 Ovarian cancer treatment 1.3.12 Familial Ovarian cancer 1.3.13 CA125 Serum Testing 1.3.14 Triage 1.3.15 Prophylactic Surgery 1.4 Abnormal Pap Smear and Cervical Cancer 1.4.1 Cervical Cancer screening 1.4.2 Colposcopy 1.4.3 Pyramid 1.4.4 Cervical Cancer Staging 1.5 Post-Menopausal Bleeding and Endometrial Carcinoma

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.