A 48-year-old woman had a biopsy of a friable, bleeding lesion on her cervix. She had not had a pelvic examination or Pap smear for about 12 years. The biopsy is reported as invasive squamous cell carcinoma of the cervix. On bimanual examination, there is induration to the side wall of her pelvis.Which of the following is the stage of her cervical cancer?
Answer(s): D
Cancer of the cervix that has not invaded cervical stroma is stage 0 carcinoma in situ. Cancer that has invaded the cervical stroma but has not spread beyond the cervix is stage I. Involvement of the upper vagina or parametria (but not to the pelvic sidewall) is stage II. Stage III is involvement of the lower third of the vagina (IIIA) or parametria to the pelvic sidewall (IIIB). Extension outside the reproductive tract is stage IV.
A 48-year-old woman had a biopsy of a friable, bleeding lesion on her cervix. She had not had a pelvic examination or Pap smear for about 12 years. The biopsy is reported as invasive squamous cell carcinoma of the cervix. On bimanual examination, there is induration to the side wall of her pelvis.To complete the staging of her cancer according o International Federation of Gynecology and Obstetrics (FIGO) standards, she should have hich of the following?
Answer(s): C
The intent of staging is to judge the results of various treatments and to compare treatment results worldwide. Because advanced procedures such as venography, lymphangiography, MRI or CT scans, and laparoscopy are not universally available, staging of cervical cancer remains primarily clinical. Such tests as cystoscopy, proctosigmoidoscopy, barium enema, IVP, and plain radiographs of the abdomen and chest are permitted. Evidence of mucosal cancer confirmed by biopsy at the time of cystoscopy changes her diagnosis to stage IV cervical cancer.
A 48-year-old woman had a biopsy of a friable, bleeding lesion on her cervix. She had not had a pelvic examination or Pap smear for about 12 years. The biopsy is reported as invasive squamous cell carcinoma of the cervix. On bimanual examination, there is induration to the side wall of her pelvis.Which of the following is the most important prognostic factor for 5-year survival after appropriate treatment of cervical cancer?
Answer(s): B
Stage of the cancer is the most important prognostic factor. Women with stage IA cervical cancer have a 95% 5-year survival. This decreases progressively to 80, 64, 38, and 14% for stages IB, II, III, and IV, respectively. The other choices are prognostic factors but relate to the stage of the cancer. Women with high-risk serotypes (strains) of HPV tend to develop cervical neoplasia at a younger age. More advanced stages of cervical cancer tend to have less differentiated tumors and a greater probability of pelvic and paraaortic lymph node metastasis. Pelvic lymph node metastasis will be found in 5% or fewer of women with stage I cervical cancer, with a progressive increase as the stage advances to 55% of women with stage IV cervical cancer
A 35-year-old G3P3 woman has been experiencing bilateral breast pain for the past year. Breast examination and mammography are normal. Conservative measures have failed. Which of the following medications is most likely to bring relief?
Breast discomfort is a problem premenstrually for many women. Simple palliative measures include administration of vitamin E, 600 units daily, and limiting methylxanthines by eliminating coffee and other caffeine-containing substances, although the mechanism of action is not well understood. Danazol (Danocrine), in doses of 200400 mg daily, is often effective in relieving breast pain. Clomiphene may have estrogenic side effects and worsen breast pain. Many women receiving progesterone note breast discomfort secondary to fluid retention. There is no evidence that diuretics such as hydrochlorothiazide relieve breast pain. In one comparison study, tamoxifen (a selective estrogen receptor modulator) was more effective than danazol.
A 23-year-old married woman consults you because she and her husband have never consummated their marriage because she has severe pain with attempts at vaginal penetration. Her pelvic examination is normal except for involuntary tightening of her vaginal muscles when you attempt to insert a speculum. Which of the following conditions would best be treated with the use of vaginal dilators?
Vaginismus is the painful, involuntary spasm of the musculature of the pelvis and lower third of the vagina.It may respond to properly administered dilator therapy, although there is a lack of conclusive evidence.Deepthrust dyspareunia is often the result of pelvic pathology, such as fibroids, endometriosis, ovarian cysts, pelvic adhesions, and others. Anorgasmia is usually a psychological disorder best dealt with by a psychologist or psychiatrist expert in sexual counseling and therapy. Sexual or physical abuse should be considered and the woman questioned about this possibility. Vulvar vestibulitis is an inflammatory condition of uncertain (perhaps multiple) etiology and is usually treated with topical glucocorticoids. Failure of medical therapy may require surgical excision of the affected area.
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Delayed the exam until December 29th.
A and D are True
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