PANCE Blueprint Reproductive System (7%)

Neoplasms of the breast and reproductive tract (PEARLS)

Breast Cancer Most common malignancy in women

  • Risk factors (increased exposure to estrogen):
    • Menarche before age 12
    • Old age of first full-term pregnancy, no pregnancies
    • Menopause after age 52
  • Breast mass- immobile, irregular
  • Nipple retraction, bloody nipple discharge

Most common type - Infiltrating Intraductal Carcinoma (IIC) 80%

  • Infiltrating lobular (10%) frequently bilateral
  • Paget's disease of the nipple (1%) chronic eczematous itchy, scaling rash on the nipples and areola
  • Inflammatory breast cancer (2%) red swollen, warm and itchy breast often with nipple retraction and peau d'orange (NO LUMP)

Tumors may be Estrogen receptor (ER) positive 75%, Progesterone receptor (PR) positive 65% as well as HER2 positive 25%

USPSTF guidelines for breast cancer screening: 

Baseline mammogram every 2 years from age 50-74

Every 2 years beginning at age 40 if increased risk factors – 10 years prior to the age the 1’st degree relative was diagnosed. 

  • Clinical breast exam every 3 years in women age 20-39 years then annually after age 40
  • Breast self-exam monthly beginning at age 20 – immediately after menstruation on days 5-7 of the menstrual cycle

TX:

  • Segmental mastectomy (lumpectomy) followed by breast irradiation in all patients and adjunctive chemotherapy in women with positive nodes stage I and stage II with tumors less than 4 cm in diameter
  • Anti-estrogen Tamoxifen is useful in tumors that are ER-positive – binds and blocks the estrogen receptor in the breast tissue
  • Aromatase inhibitors are useful in postmenopausal ER-positive patients with breast cancer – reduces the production of estrogen
  • Monoclonal AB treatment is useful in patients with HER2 positivity (Human Epidermal Growth Factor Receptor)
Cervical cancer Cervical cancer is the third most common type of cancer, squamous-most common (90%)

  • Patient is often asymptomatic or will often present with postcoital bleeding
  • Friable, bleeding cervical lesion

HPV is 99% of the reason for cervical cancer, types that cause cancer are 16,18,31 and 33. Especially types 16, 18. Associated with cigarette smoking

Transformational zone most commonly affected

TX: Resect and/or chemotherapy and radiation

Ovarian Cancer Population: 40-60 years of age, ascites, abdominal pain

Tumor Marker CA-125

Second most type of GYN cancer in women (first is endometrial cancer)

  • 75% diagnosed at an advanced stage
  • 90% are epithelial tumors
  • Germ cell tumors are more common in patients < 10 years old

Diagnose with ultrasound then biopsy

TX: Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) plus selective lymphadenectomy, Chemo, monitor CA-125 afterward to assess disease progress

Risk factors: nulligravidity (or infertility), early menarche, late menopause, endometriosis

Endometrial cancer Presentation: Postmenopausal vaginal bleeding

  • One-third of women with postmenopausal bleeding have endometrial CA
  • Bleeding in postmenopausal women is CA until proven otherwise

Most often adenocarcinoma

Diagnosis: Endometrial biopsy is indicated in all postmenopausal women vaginal bleeding

TX: Usually total hysterectomy and bilateral salpingo-oophorectomy, pelvic radiation therapy with or without chemotherapy for stage II or III cancer

Vaginal and Vulvar cancer Vaginal Cancer

  • Rare: 1% of gynecological malignancies and is usually secondary to other cancer
  • Peak incidence at 60-65 years of age
  • Squamous cell represents 95% caused by HPV
  • Adenocarcinoma caused by DES exposure
  • Usually presents as changes in menstrual period and/or abnormal vaginal bleeding

TX: with radiation therapy

Vulvar Cancer

  • Peak incidence is at 50 years old
  • Vaginal pruritus is the most common presentation (70% will present with this symptom)
  • 90% are squamous cell cancers and melanoma. Risks include HPV subtypes 16, 18, and 31 – pruritic black lesions

TX: Vulvectomy and lymph node dissection

Paget’s – pruritic red lesions

TX: Local resection

Dysfunctional uterine bleeding (Lecture) (Prev Lesson)
(Next Lesson) Breast Cancer (Lecture)
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