Most Common cancers
| Men | Women |
| 1-Prostate 2- Lung 3-Colon | 1-Breast 2- Lung 3-Colon |
Most Common cancers with the greatest mortality rate
| Men | Women |
| 1-Lung 2-Prostate 3-Colon | 1-Lung 2-Breast 3-Colon |
Ovarian cancer
Endometrium cancer
- Presentation:
- Screening:
- Phases of hyperplasia
- Risk factors (decreasing order):
- anovulation ➡ (unopposed estrogen) – MOST potent – PCOS
- obesity ➡ increased peripheral conversion of estrogen
- Tamoxifen ➡ estrogen agonist in uterus, antagonist in breast (for breast cancer)
- age ➡ more lifetime exposure
- nulliparity ➡ estrogen shuts off during pregnancy
- early menarche/ late menopause -> more years of estrogen
- anovulation ➡ (unopposed estrogen) – MOST potent – PCOS
- Increased Risk:
Chorio cancer
Cervical cancer
| Presentation | HPV dysplasia, carcinoma in situ invasive squamous cell CA post-coital bleeding in reproductive age |
| Screening | pap screening (colposcopy) 2 types: – ectocervical biopsy – endocervical curettage Exceptions to regular pap screening: -If HIV+ -> q1year -If over 30yo, Pap + HPV testing -> q5year |
| Abnormal cervix on colposcopy | abnormal vessels punctate hemorrhages acid-white changes mosaicism |
| Abnormal Pap (not ASCUS)..next step | Reflexive colposcopy On colpo, if ecto+ and endo-, problem: outside of cervix Treatment: local therapy (LEEP, Cryo, or laser) On colpo, if ecto- and endo+, problem: endocervix Treatment: cone biopsy |
| Woman has ASCUS on Pap smear…next step | – repeat Pap q3month (age 21-24) or – HPV DNA (age >25) |
| Pregnant woman has ASCUS on Pap smear…next step | Colpo or cone biosy – 6wks postpartum |
| ASCUS and HPV+…next step | Colposcopy |
| ASCUS and HPV-…next step | repeat q3y |
| ASCUS and + repeat at 3mo…next step | Colposcopy |
| ASCUS and – repeat at 3mo…next step | repeat q3y |
| If a mass is identified on cervical exam | 1. biopsy 2. clinically stage (colpo, rectal and vaginal exams) Stage: physical exam + CT scan option 1: clinically stage – colpo, rectal, vaginal exam option 2: physical exam rectal and vaginal, CT scan stage 1a – microscopic stage 1b – macroscopic stage 2a – upper 2/3 vagina stage 2b – parametrial (involves cardinal ligament) stage 3a – lower 1/3 vagina stage 3b – sidewall stage 4a – bowel/bladder stage 4b – distant mets b classification – involvement of cardinal ligament or pelvic sidewall Treatment: 2a or better – Surgical 2b or worse – debulking or chemo |
