GYN Cancers (Prevention and Screening)

no

Is there a screening for uterine cancer?

s/s of uterine cancer

non specific s/s

-abnormal vaginal discharge/bleeding (esp postmenopausal bleeding), pelvic pain/pressure

endometrial

Most uterine cancers are __________ cancers

risk factors for uterine cancers

age >50 (ave. age of diagnosis=60); obesity; diabetes; PMOS; infertility; unopposed estrogen; tamoxifen; close FH of uterine, colon, or ovarian cancer (or personal hx of breast, colon, or

ovarian CA); genetics (BRCA1, BRCA2, Lynch syndrome)

use of COCs or progestin IUD, maintain healthy weight, physical activity, EPT

What results in a lower risk of uterine cancers?

lowers

Fewer menstrual cycles _______ risk of uterine cancers

ovarian cancer presentation

-Frequently asymptomatic or appears like bowel or bladder issue

-Abdominal/pelvic pain/pressure, difficulty eating/feel full, urinary

changes (urgency, frequency), bowel changes, unexplained

vaginal bleeding, unexplained weight changes, extreme fatigue

-Red flags: appearance of new-onset irritable bowel-syndrome

or overactive bladder in women over 50 (rule out ovarian cancer)

metastasized

Typically when ovarian cancer is found it has __________ outside of ovaries to liver/lungs

ovarian cancer

This cancer is also known as the "silent killer"

90%

5-yr survival if local of ovarian cancer:

10-30%

advanced survival of ovarian cancer:

declining

Rates of ovarian cancer are _________

63

What is the median age of ovarian cancer?

risk factors for ovarian cancer

FH (especially younger age of family member's dx or multiple family members); BRCA1, BRCA2 mutations; menopausal ET; nulliparity/infertility; early menarche/late menopause; hx endometriosis; hx breast, uterine, colorectal CA; have Eastern European or Ashkenazi Jewish background

potentialexposure to asbestos and or/talcum powder in the perineal area; diet high in animal fat/meat/galactose

There is potential risk for ovarian cancer with:

decreased ovulation can decrease risk

How can you prevent ovarian cancer?

67%

Oophorectomy or bilateral salpingo-oophorectomy in pts that are very high risk (FH or BRACA1 mutation) has a _______ reduction in risk of ovarian cancer

oral contraceptives

reduce ovulation so may decrease risk of ovarian cancer but can increase risk of breast cancer

13%

Aspirin has a _______ reduction in risk of ovarian cancer

no

Are there recommendations for ovarian cancer screening for the general pop?

NO

Can cervical screening detect ovarian cancer?

unlikely

Routine pelvic exams are _________ to detect smaller ovarian cancers

Transvaginal ultrasound (TVUS

nonspecific screening for ovarian cancer

CA-125

nonspecific inflammatory antigen (also elevated in

endometriosis, diverticulitis, PUD) used to screen for ovarian cancer

USPSTF

F: potential harms of screening outweigh benefits of TVUS or CA-125 if asymptomatic without hereditary cancer syndrome

annual TVUS, CA-125 test every 6 months

For high risk pts for ovarian cancer what is the recommended screening?

highest

MS has the _________ cervical cancer mortality in the US (6th highest incidence)

30 yo

What is the avg age of dx of cervical precancer?

49

What is the avg age of dx of cervical cancer?

80%

What % of ppl will get an HPV infection in their lifetime?

skin to skin contact

How does HPV spread?

risk factors for HPV

smoking; long-term use of CHCs, HIV/other immune diseases, giving birth to >3 children

Cervical CA Presentation

*Adequate screening should prevent need to diagnose based on presentation*

-Asymptomatic in dysplasia/HPV

-Advanced cancer: vaginal bleeding or discharge

-Post-coital bleeding (pre-menopause)

-Any vaginal bleeding (post-menopause)

no

If a pt was previously vaccinated with an older Gardasil vaccine do they need to revaccinate?

HPV 16 and 18

responsible for 70% of cervical cancers

HPV 31, 33, 52, 58

responsible for additional 10-20% of cervical cancers

Gardasil 9

covers all numbers of strains of HPV

2 doses

Ages 9-10 HPV doses:

2 doses

Ages 11-12 HPV doses:

2 doses

Ages 13-14 HPV doses:

3 doses

Ages 15-26 HPV doses:

9

What is the youngest age you can give the HPV vaccine?

45

What is the last age that can get the HPV vaccine?

12-13

The HPV vaccine has the highest efficacy in what age?

2 dose series at 0, 6-12 month (min 5 months)

ages 9-14 HPV vaccination schedule:

3 dose series at 0, 1-2 mo, 6 mo

Ages 15 and older at initial dosing of Gardasil:

no

Do you need to restart HPV series if interrupted?

3 dose series regardless of initial age

Immunocompromised (including HIV) vaccination schedule:

after

For preg pts you should wait until ________ preg to get the HPV vaccine

Gardasil 9

-IM in deltoid or anterolateral area of thigh

-Storage: refrigerator (FYI: excursions up to 72 hours outside of

8-25 degrees Celsius)

-Shake vial well before use

-C/I: hypersensitivity (including severe reaction to yeast)

-Serious AE: syncope (observe x15 min). Tonic-clonic movements and seizure-like activity have been reported after HPV vaccination

-Common SE: injection site-pain, swelling, erythema, HA

-No age limit for Pharmacist vaccinations in MS

cervical cancer screening

start at 21 or 25 and stop at 65 if tests have been WNL

1) papanicolaou test (PAP) cytology

2) primary HPV test (high risk HPV test)

3) co testing (HPV + cytology)

What are the 3 types of cervical screenings?

cytology every 3 yrs

USPSTF 2018 ages 21-29:

Cytology Q3 years

Or hrHPV Q5 years (AKA "primary HPV testing")

Or hrHPV plus cytology (co-testing) Q5 years

USPSTF 2018 ages 30-65:

cytology every 3 yrs

2026 ACOG ages 21-29:

Preferred: hrHPV Q5 years (AKA "primary HPV testing")

If unavailable: contesting q5 years, self-collected

hrHPV q3 years

If not available: cervical cytology alone q3 years

2026 ACOG ages 30-65:

Beginning at age 25, clinician-collected primary HPV test Q5 years.

Alternative (average risk only): self-collect q3 years

Last test no younger than 65 yoa

2020 ACS, 2026 update on cervical cancer screenings:

PAP

specific but not sensitive (misses 1/2 of all lesions)

HPV

high neg predictive value

-Hx total hysterectomy but ONLY if hysterectomy wasn't related to cervical abnormalities (pre-cancer or cancer)

-Pts with supra-cervical hysterectomy should continue to have screenings

-Age

Who does not need a cervical cancer screening?

cervical, vulvar, vaginal

What cancers are HPV related?

ovarian (some high risk) and cervical

What cancers have screenings recommended?

uterine

What GYN cancer is most common?