GYN Cancer Adult Med: Tianna (Nobel 367 374 & lecture) Breast Cancer Description Screening recommendations

ns - > 50 = Every year - 40-50 = or every other year Risk Factors Age -Risk of developing breast cancer with age -Most ca are post menopausal, but can occur before -HRT risk of breast cancer Family History -May risk of developing breast cancer -Lack of it does not r/o risk -BRAC 1 & 2 = 80% > chance of developing ca Reproductive History -No or late pregnancy = risk -Use of oral contraception = risk Menstrual History -Early Menses or late menopause Benign Breast Dz History -Most do not risk BUT some do risk -Hyperproliferation of epithelium w/out atypia Ductal hyperplasia Sclerosing adneosis = minimal risk Papilloma Previous Malignant History Benefits of Mammography screening Age > 50years Atypical ductal hyperplasia & LCIS = risk is high -Hx of colon, endometrial, lymphoma & metastic melanoma = risk of breast cancer development -There is a documented reductions in breast cancer mortality 20 30% -To prevent one death from breast cancer need to screen 1, 588 women

Other Info If have a 1st degree relative begin testing 10 yr befor their dx At age 40 yr the incidence begins to jump and then continually rises with age

Exposure to more estrogen increases risk of Breast cancer Lecture says: Cannot always tell which ductal carcinoma with progress to cancer. About 1/3 will progress. Can only be picked up on mammogram

- - 1% per year

In 50s 1 in 400 women will get breast cancer

Age 40 49 years Disadvantages/Limitations

Clinical Breast Exam

-Studies are controversial Each women should decide for herself -If 1st degree relative w/premenstrual breast cancer screening should begin 10 years prior to their dx -Varability in mammography readings by radiologist -False negatives (especially with dense breasts which occur during HRT, or menses) -False positive (1 in 10 women will get this) This causes anxiety, extra costs, risks of biopsy -May miss some that clinical breast exam picks up -Should take 10 minutes to do a very thorough one -Simple, inexpensive & allows teaching of self breast exam -Detects 3-45% of ones missed on mammography -Should do in a methodic organized way to not miss lumps -Need to be preformed at right time of month (10-14 days) -False positives occur creating anxiety -NO evidence that it lowers cancer mortality rate -Instruct pt how to do a proper exam

Self Breast Exam Limitations Role of Clinician

Cervical Cancer Roles of : Pap Smear

Coloposcopy

Biopsy

(Nobel 378-384 & lecture) Description Other info -Used to detect premalignant conditions of the cervix - risk of death from cervical -Sample should be taken from the squamocolumnar junction & cancer by 80% should contain endocervical cells (this area is used because there is - Good at detecting squamous a high rate of repair occurring, so risk for mutations to occur dysplasia -There are false negative results - NOT good at detecting glandular dysplasia (so poor Can also detect: lower genital tract dysplasia & cancer predictor of adenocarcinoma) Upper genital tract lesions Sometimes urological malignancies Used as a work-up of an abnormal pap Magnifies the cervical epithelium. Application of Acetic acid solution is used to highlight areas of abnormal vascular patterns or thickening. **Biopsy can also be done at same time Used w/colposcopty Not to be used w/pregnant patients ***Good flow chart of what to do w/abnormal paps in lec notes.

Ovarian Cancer (Nobel 384-386) Symptoms

Description Early: Most ovarian cancers are usually asymptomatic When presents: -Acute abdominal/pelvic pain or chronic discomfort -Fever, Abnormal menses & dysmenorrhea -symptoms of pregnancy -changes in bowel habits or uninary habits or back pain Advanced: ***Most common symptom*** -Abdominal swelling or discomfort -HPV may be associated with VIN (premalignancy) -Squamous cell carcinoma of vulva & other premalignant neoplasm of anogenital mucosa suggests a role for HPV

Other info -Highest mortality rate of GYN cancers -2/3 of patients present with advanced with dz. -Any mass in post menopausal women is cancer until proven otherwise (because the ovaries are normally so small at this point)

Association of HPV w/Vulvar cancer

Endometrial Cancer (Nobel 381 & lecture) Roles of: Pap Smear

Office Endometrial Biopsy Transvaginal Ultrasound

Description -inspection of the vulva, vagina & cervix for any gross lesions -Any gross lesions should be biopsy -The uterus may be normal or enlarged, irregular, soft or firm -If any endometrial cells are found = alert to an underlying pathology (in postmenopausal women) -If found in premenopausal women need to see if they are correlated with menstral cycle -Should be done yearly in women on unopposed estrogen -Starting point for evaluating abnormal uterine bleeding -Used in post menopausal women -Looks for: Fluid in endometrial cavity and/or thickening endometrial strip ( < 5mm is low risk)

Other info Risk factors: Obesity, nulliparity, unopposed estrogen, DM, FH, anovulatory cycles, & tamoxifen therarpy (tx for breast cancer) Detection: Post menopausal bleeding, bleeding out of phase on HRT, irregular bleeding after after age 35-40 that is uncorrected by cyclic progesterone Prevention: HRT & BCP