class 8

most common type of cervical cancer

squamous cell carcinoma

precursors of cervical cancer

cervical dysplasia (mild, moderate or severe)

what lesion is reffered to as carcinoma in situ

when full thickness of epithelium composed of undifferentiated neoplastic cells

why are papsmears important

they detect abnormalities regarding cervical cancer because most early lesions are symptomatic

Is advanced cervical cancer evident?

yes

second most common gynecological malignancy

carcinoma of the cervix

when in life does cervical carcinoma occur

third to fourth decade of life

risk factors of cervical cancer

HPV, early sexual activity, multiple partners, smoking weak immune system, geography

symptoms of cancer of the cervix

abnormal vaginal discharge, postcoital bleeding,low back pain, bladder irritability, uteral obstruction

what does a cone biopsy do regarding cervical cancer

preserve fertility

treatment for cancer of the cervix could be

radiotherapy

extra cervical spread treatment for cervical cancer

surgery or chemotherapy

The american cancer society recommends what prevention for cervical cancer

gardasil (70% reduction)

Who is gardasil given to

prebuscent and adolescent females before they become sexually active

what is hematometra caused by 

cervical stenosis

in early stages of cervical cancer what would it look like

echogenic and possible hematometra

Stages 3 and 4 of cervical cancer would look like:

bulky cervix, bladderinvasion, hydronephrosis, liver mestasis

what kind of women does cervical cancer affect

menstrual age

clinical findings with vagina regarding cervical carcinoma

bleeding and discharge

sonographic findings of cervical carcinoma

retrovesical mass, obstruction of ureters, and invasion of bladder

whats a uterine leiomyosarcoma

rare, solid tumor arising from myometrium and endometrium

wheres uterine leiomyosarcoma most commonly found

in fundus of uterus

in what kind of women will you find uterine leiomyosarcoma

40-60 years of age

does uterine leiomyosarcoma grow rapidly

yes

whats a sarcoma botryoides

very rare condition in children characterized by grapelike clusters of tumor mass

sonographic findings of  uterine leiomyosarcoma may resemble 

myomas or endometrial carcinoma  with feautures of solid or  mixed-solid and cystic texture

whats the most common  gynecological malignancy in north america

endometrial carcinoma 

endometrial carcinoma usually happen in what kind of women

postmenopausal

most common clinical presentation of endometrial cancer

uterine bleeding (10%)

what has a strong association with replacement estrogen therapy

endometrial cancer

what are risk factors for perimenopausal women regarding endometrial cancer

anovulatory cycles and obesity

endometrial carcinoma is not only associated with abnormally thick endo but also with

polyps and endometrial hypertrophy

whats the earliest change in endometrial carcinoma

endometrial thickness

what exam is helpful for screening early changes in endometrial hyperplasia or carcinoma

transvaginal (measures thickness of endo)

if the endometrium measures greater then ___ it should be considered cancer

5mm

endometrial carcinoma is associated with ________ stimulation

estrogen

clinical presentations of endometrial carcinoma

postmenopausal women bleeding, pain, and uterine distention

when in life would endometrial cancer most likley occur

sixth or seventh decade of life

sonographic findings of endometrial carcinoma

prominent endometrial complex, enlarged uterus with irregular areas of low-level echoes, abnormal vascularity in endo

risk factors of endometrial cancer

obesity, nulliparity, late menopause, adenmatous polyps, family history, unopposed estrogen

what decreases the risk of endometrial cancer

smoking and oral contraceptives

what are predisposing factors of endometrial cancer

breast cancer (tamoxifen)

what does a total hysterectomy include

uterus, tubes and ovaries

endometrial cancer treatments:

1. total hysterectomy

2. 2. chemotherapy/ radiation therapy

3. lymphadenectomy

why are endovaginals important for diagnosing endometrial cancer 

for endo thickness and texture

stage 1 and 2 of endometrial carcinoma

confined to the uterus

stage 3 and four of endometrial cancer

extends beyond the uterus, bladder/ rectum infiltration, adjacent mass, ureteral obstruction

endometrial cancer will have increased flow in cancer lesions so the R. i. would be

0.42 +- 0.20

endometrial cancer technique:

endo thickness

endo volume

power doppler

when regarding endometrial cancer the diagnoses criteria would include

fluid, vessel architechure, vessel branching pattern, subendometrial halo irregularity

if you have endometrial cancer what suspected neoplasms should you image

liver, kidneys, abdominal viscera, and para-aortic

what should you pay attention with the uterus and and cervix when you have endometrial cancer

the echogenicity

3% of uterine tumors are

leiomyosarcoma

risk factors of leiomyosarcoma

being over 50 yo, obesity, pelvic radiation, tamoxifen exposure, nulliparity

leiomyosarcomas originate where

in smooth muscle

is metastasis common regarding leiomyosarcomas 

yes

where are leiomyosarcomas usually

intramural

gross appearance of leiomyosarcomas:

flashy, hemorrhagic/ necrotic, and infiltrative borders

clinical diagnoses of leiomyosarcoma

vaginal bleeding, mri, biopsy, pelvis or abdominal pain, rapid increase in size

treatment of leiomyosarcomas

total hysterectomy, peritoneal washings, nodule sampling, radiotherapy

sonographic features of leiomyosarcoma

rapid growing heterogenous mass, acoustic enhancement, increased intratumoral flow

less than 1% of gynecological tumors would be

fallopian tube carcinoma

when in life would fallopian tube carcinoma occur

6th decade of life

true or false

fallopian tube carcinoma an aggressive tumor

true

risk factors of fallopian tube carcinoma

infertillity, nulliparity, low parity, PID, family hx of ovarian cancer

most common histology of fallopian tube carcinoma

adenocarcinoma

what could cause fallopian tube cancer

myomas, endometrisosis, pregnancy, PID

clinical findings of fallopian tube cancer

vaginal bleeding, palpable mass, watery discharge, asymptomatic to abdominal girth

treatment for fallopian tube cancer

total hysterectomy, peritoneal biopsy, lymphnode sampling, radiation/ chemotherapy

sonographic findings of fallopian tube cancer

solid or cystic adnexal mass, sausage shaped, hydrosalpinx

if you have fallopian tube cancer and pelvic neoplasm is suspected, you should also image

renals, liver and abdominal vicsera

what sonographic exam will detect fallopian tube cancer?

transvaginal

types of gestational trophoblastic neoplasm (you do not have a baby)

invasive mole, choriocarcinoma, PSTT, hydatiform pole

clinical findings of invasive mole (gestational trophoblastic neoplasm)

elevated HCG, contains chorionic villi, heavy bleeding, focal invasion

choriocarcinoma would occur after:

still birth, normal pregnancy, spontaneous abortion, ectopic pregnancy, complete or partial mole

placental site trophoblastic tumor(PSTT) arrives from:

nonvillus trophoblast

PSTT infiltrates what:

ovary, bladder/rectum, and parametrium

when after birth could you present with PSTT

months to years after delivery

when you have PSTT youll have. a mild elevation of what hormone

HCG

rarest variant of PSTT

epithelioid trophoblastic tumor

epithelioid trophoblastic tumor presents how long after delivery of pregnancy

6-7 years after term pregnancy

gestational trophoblastiic disease affect what organ

ovary

theca lutien cysts are seen in how many that have gestational trophoblastic disease

25%

gestational trophoblastic neoplasia increases risk of ___________________ disease

post molar trophoblastic

symptoms of gestational trophoblastic disease

cough,hemoptysis, nuerlogical distrubances

clinical diagnoses of invasive molar

high B-hCG titters, vaginal bleeding and evacuation of hydatidiform

treatment of gestational trophoblastic neoplasm

multidrug chemo, methotrexate with or without folinic acid

sonographic appearance of an invasive mole

focal areas of increased echogenecity

sonographic appearance of choriocarcinoma

focal, hemmorrhagic nodule with endometrium, secondary masses to vagina or cervix and metastasis to liver

sonographic appearances of placental site trophoblastic tumor

irregular uterine mass, patient history, marked hypervascularity, chaotic color flow pattern