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View Full Version : OB/GYN Chat: Gyn Neoplasia



Asclepius1
02-07-2005, 10:16 AM
02/6/05 19:04:58 [USMLE_Step_2] strug: hi lanny and sanz
02/6/05 19:04:59 [USMLE_Step_2] lanny: thanks i got your message y day
02/6/05 19:05:11 [USMLE_Step_2] lanny: was y days chat posted
02/6/05 19:05:21 [USMLE_Step_2] lanny: hi strug
02/6/05 19:05:31 [USMLE_Step_2] strug: gynaec neoplasia today
02/6/05 19:05:56 [USMLE_Step_2] lanny: yes
02/6/05 19:06:42 megs Logs in
02/6/05 19:06:45 [USMLE_Step_2] strug: shall we begin or wait?
02/6/05 19:06:45 megs Joins Subroom USMLE_Step_2
02/6/05 19:06:50 [USMLE_Step_2] sanz: hey guys!
02/6/05 19:06:56 [USMLE_Step_2] megs: hi all
02/6/05 19:07:08 [USMLE_Step_2] strug: hi sanz hi megs
02/6/05 19:07:09 [USMLE_Step_2] megs: hi sanz strug and lanny
02/6/05 19:07:21 [USMLE_Step_2] lanny: i saw you lefthi megs
02/6/05 19:07:22 [USMLE_Step_2] megs: i think we logged at same time
02/6/05 19:07:31 [USMLE_Step_2] lanny: was y days chat posted
02/6/05 19:07:57 [USMLE_Step_2] strug: megs yesterday i was going to write something about u the way i wrote for dua and sanz but u left
02/6/05 19:08:09 [USMLE_Step_2] strug: i dunno lanny i didnt look
02/6/05 19:08:18 [USMLE_Step_2] sanz: strug, that was fun
02/6/05 19:08:53 [USMLE_Step_2] sanz: we should write sth for you... but my brain is too blocked
02/6/05 19:08:56 [USMLE_Step_2] lanny: see you left off at mnemoniv for child dev can someone let me know it plz
02/6/05 19:09:34 [USMLE_Step_2] sanz: lanny, i think the admin will post the transcript in a day or so...
02/6/05 19:09:51 [USMLE_Step_2] lanny: ok.. thx sanz
02/6/05 19:09:58 dua_frank Logs in
02/6/05 19:10:00 dua_frank Joins Subroom USMLE_Step_2
02/6/05 19:10:01 [USMLE_Step_2] strug: megs is a gynecologist so we will have a good chat today...with the expert
02/6/05 19:10:07 [USMLE_Step_2] dua_frank: hi
02/6/05 19:10:14 [USMLE_Step_2] dua_frank: megs an obgyn? great
02/6/05 19:10:25 [USMLE_Step_2] strug: hi dua :)
02/6/05 19:10:30 [USMLE_Step_2] sanz: yup megs... i'm counting on you to tell me things... i'm so useless with OG
02/6/05 19:10:30 [USMLE_Step_2] dua_frank: hey strug :)
02/6/05 19:10:40 [USMLE_Step_2] sanz: hey dua
02/6/05 19:10:44 [USMLE_Step_2] dua_frank: hey sanz :)
02/6/05 19:10:49 [USMLE_Step_2] megs: yeah hope i can help
02/6/05 19:11:01 [USMLE_Step_2] sanz: ok... let's start
02/6/05 19:11:05 [USMLE_Step_2] megs: might be u people know better than me...
02/6/05 19:11:16 [USMLE_Step_2] sanz: i might go away now and then to see the SuperBowl... but i'll try to concetrate
02/6/05 19:11:22 strug Disconnects
02/6/05 19:11:27 strug Logs in
02/6/05 19:11:27 strug Joins Subroom USMLE_Step_2
02/6/05 19:11:28 [USMLE_Step_2] dua_frank: you too sanz lol
02/6/05 19:11:46 [USMLE_Step_2] strug: i got kicked off :(
02/6/05 19:11:52 [USMLE_Step_2] dua_frank: awww welcome back strug
02/6/05 19:11:54 [USMLE_Step_2] sanz: wb strug
02/6/05 19:12:05 [USMLE_Step_2] strug: its irritating
02/6/05 19:12:11 [USMLE_Step_2] sanz: ok, shall we do cervical can first?
02/6/05 19:12:14 [USMLE_Step_2] strug: yup
02/6/05 19:12:23 [USMLE_Step_2] megs: yup
02/6/05 19:12:33 [USMLE_Step_2] sanz: let's start with screening
02/6/05 19:12:49 [USMLE_Step_2] strug: at 18 years or when first intercourse
02/6/05 19:12:50 [USMLE_Step_2] megs: whats the age for screening???
02/6/05 19:12:58 [USMLE_Step_2] sanz: yup
02/6/05 19:13:00 [USMLE_Step_2] megs: yes strug
02/6/05 19:13:02 [USMLE_Step_2] lanny: which is firrst
02/6/05 19:13:16 [USMLE_Step_2] strug: every year till 3 negative
02/6/05 19:13:21 [USMLE_Step_2] dua_frank: whichever comes first lanny :P
02/6/05 19:13:32 [USMLE_Step_2] lanny: thats what i mean
02/6/05 19:13:34 [USMLE_Step_2] strug: then every 3 years if no high risk
02/6/05 19:13:40 [USMLE_Step_2] lanny: yep
02/6/05 19:13:48 [USMLE_Step_2] sanz: good
02/6/05 19:14:00 [USMLE_Step_2] sanz: so what is this screening test.. name me
02/6/05 19:14:06 [USMLE_Step_2] strug: Pap smear
02/6/05 19:14:08 [USMLE_Step_2] megs: what r high risk factors???
02/6/05 19:14:21 [USMLE_Step_2] lanny: xXx sex partners
02/6/05 19:14:23 [USMLE_Step_2] strug: multiple sexual, early age of intercouse
02/6/05 19:14:26 [USMLE_Step_2] sanz: what do you see on cytology of Pap?
02/6/05 19:14:28 [USMLE_Step_2] lanny: smoking
02/6/05 19:14:35 [USMLE_Step_2] dua_frank: dysplasia
02/6/05 19:14:37 [USMLE_Step_2] strug: cigg smoking and
02/6/05 19:14:39 [USMLE_Step_2] lanny: immunosupp
02/6/05 19:14:47 [USMLE_Step_2] strug: lanny u read my mind
02/6/05 19:14:48 [USMLE_Step_2] lanny: HPV inf
02/6/05 19:14:51 [USMLE_Step_2] megs: early age of intercourse,multiple sex partners...
02/6/05 19:15:06 [USMLE_Step_2] megs: hpv which type
02/6/05 19:15:07 [USMLE_Step_2] strug: also if clinical history of conyloma acuminate
02/6/05 19:15:11 [USMLE_Step_2] sanz: 16 18
02/6/05 19:15:18 [USMLE_Step_2] lanny: 31
02/6/05 19:15:19 [USMLE_Step_2] strug: 16,18,31,33,35
02/6/05 19:15:19 [USMLE_Step_2] megs: 16 18 and 31
02/6/05 19:15:37 [USMLE_Step_2] megs: 33 35 lower side of risk
02/6/05 19:15:55 [USMLE_Step_2] sanz: CIN systems... what are I II and III?
02/6/05 19:15:57 [USMLE_Step_2] lanny: thx didnt know that meg
02/6/05 19:15:59 [USMLE_Step_2] strug: sanz we see koilocytes? in cytoology of pap
02/6/05 19:16:21 [USMLE_Step_2] megs: koilocytes are suggestive of hpv infection
02/6/05 19:16:22 [USMLE_Step_2] sanz: yup.. koilocytes and dysplasia as dua said
02/6/05 19:16:34 [USMLE_Step_2] megs: how they look???
02/6/05 19:16:34 [USMLE_Step_2] strug: mild to mod., mod to sever, sever to carcinoma in situ for 1, 2, 3
02/6/05 19:16:35 [USMLE_Step_2] sanz: so also seen in vulvular ca
02/6/05 19:16:52 [USMLE_Step_2] strug: halo arund cell megs
02/6/05 19:16:53 [USMLE_Step_2] lanny: 1 is mild 2 is mod 3 is severe
02/6/05 19:16:59 [USMLE_Step_2] megs: yup strug
02/6/05 19:16:59 [USMLE_Step_2] sanz: but what classification is more commonlay used in USA?
02/6/05 19:17:02 [USMLE_Step_2] lanny: this is the CIN class
02/6/05 19:17:08 [USMLE_Step_2] lanny: bethesda
02/6/05 19:17:10 [USMLE_Step_2] strug: bethesda
02/6/05 19:17:10 [USMLE_Step_2] sanz: good
02/6/05 19:17:18 [USMLE_Step_2] sanz: tell me the categories
02/6/05 19:17:27 vladimir Logs in
02/6/05 19:17:29 [USMLE_Step_2] megs: now a days they r using bethesda classification
02/6/05 19:17:31 vladimir Joins Subroom USMLE_Step_2
02/6/05 19:17:41 [USMLE_Step_2] strug: normal. infl withoug atypia, infl with atypia, ascus, lgsil, hgsil
02/6/05 19:17:48 [USMLE_Step_2] sanz: i can never remember this...
02/6/05 19:17:48 [USMLE_Step_2] vladimir: hi everybody
02/6/05 19:17:49 [USMLE_Step_2] sanz: help?
02/6/05 19:17:53 [USMLE_Step_2] megs: ascus lg sil hg sil
02/6/05 19:17:56 [USMLE_Step_2] lanny: me too sanz
02/6/05 19:17:57 [USMLE_Step_2] sanz: hey vlad :)
02/6/05 19:18:05 [USMLE_Step_2] strug: hi vlad
02/6/05 19:18:07 [USMLE_Step_2] lanny: hi vlad
02/6/05 19:18:07 [USMLE_Step_2] sanz: cuz i'm used to CIN classification
02/6/05 19:18:22 [USMLE_Step_2] lanny: me too i trained on CIN class
02/6/05 19:18:39 [USMLE_Step_2] lanny: mild mod severe
02/6/05 19:18:40 [USMLE_Step_2] strug: the latest classification has changed i think.....shall i share with u guys
02/6/05 19:18:47 [USMLE_Step_2] lanny: sure
02/6/05 19:18:51 [USMLE_Step_2] sanz: yup strug
02/6/05 19:19:08 [USMLE_Step_2] strug: LGSIL corresponds to CIN 1 andHPV change
02/6/05 19:19:27 [USMLE_Step_2] strug: HGSIL corr to CIN 2 and 3
02/6/05 19:19:37 [USMLE_Step_2] megs: yup strug
02/6/05 19:19:43 [USMLE_Step_2] sanz: what abt ASCUS?
02/6/05 19:19:54 [USMLE_Step_2] strug: HPV change is ascus i guess
02/6/05 19:20:20 [USMLE_Step_2] megs: no strug
02/6/05 19:20:21 [USMLE_Step_2] sanz: So HPV changes are just mild dysplasia and koilocytes?
02/6/05 19:20:46 [USMLE_Step_2] megs: its cronic nonspecific inflammatory changes
02/6/05 19:21:04 [USMLE_Step_2] sanz: ok
02/6/05 19:21:14 [USMLE_Step_2] lanny: i think HPV changes is included in CIN1
02/6/05 19:21:18 [USMLE_Step_2] megs: thas ascus...atypical sq cells on undetermined significance
02/6/05 19:21:39 [USMLE_Step_2] strug: if abnormal Pap next step?
02/6/05 19:21:45 [USMLE_Step_2] lanny: HPV changes means dysplasia
02/6/05 19:21:59 [USMLE_Step_2] sanz: colposcopy
02/6/05 19:22:05 [USMLE_Step_2] megs: yp sanz
02/6/05 19:22:23 [USMLE_Step_2] lanny: what is the need for colposco
02/6/05 19:22:24 [USMLE_Step_2] sanz: and after that, everything is a blur for me!!!
02/6/05 19:22:26 [USMLE_Step_2] sanz: hehe
02/6/05 19:22:28 [USMLE_Step_2] strug: if female 26 yrs pap shows Cin 1 or LGSIL what next?
02/6/05 19:22:46 [USMLE_Step_2] sanz: colposcopy i guess
02/6/05 19:22:57 [USMLE_Step_2] megs: give treatment of trichomoniasis
02/6/05 19:23:05 [USMLE_Step_2] megs: and repeat papa
02/6/05 19:23:07 [USMLE_Step_2] megs: pap
02/6/05 19:23:08 [USMLE_Step_2] sanz: or do you reapt?
02/6/05 19:23:19 [USMLE_Step_2] sanz: repeat i mean
02/6/05 19:23:29 [USMLE_Step_2] lanny: reperat
02/6/05 19:23:45 [USMLE_Step_2] strug: acc ording to current recommendation u repeat pap every 6 m for 3 times
02/6/05 19:23:58 rx Logs in
02/6/05 19:24:05 [USMLE_Step_2] sanz: for CIN I?
02/6/05 19:24:05 rx Joins Subroom USMLE_Step_2
02/6/05 19:24:07 [USMLE_Step_2] strug: if negative then continue routine screeing
02/6/05 19:24:10 [USMLE_Step_2] strug: yup sanz
02/6/05 19:24:11 [USMLE_Step_2] megs: after taking treatment for cervical infection repeat the pap
02/6/05 19:24:25 [USMLE_Step_2] megs: good strug
02/6/05 19:24:25 [USMLE_Step_2] sanz: if CIN II or HGSIL?
02/6/05 19:24:32 [USMLE_Step_2] strug: colpsoc
02/6/05 19:24:46 [USMLE_Step_2] lanny: megs why give trt for tricho
02/6/05 19:25:05 [USMLE_Step_2] strug: megs is she has trichomonas infe it will show on th Pap
02/6/05 19:25:11 [USMLE_Step_2] sanz: megs, let me clarify... if someone is CIN I, you treat for cervical infection and then repeat in 6 mth?
02/6/05 19:25:12 [USMLE_Step_2] vladimir: colposcopy with endo-and ectocervical biopsy
02/6/05 19:25:27 [USMLE_Step_2] megs: cin 1 changes are may be due to infection...so wee give antibiotics
02/6/05 19:25:36 [USMLE_Step_2] strug: always?
02/6/05 19:25:38 [USMLE_Step_2] lanny: that is if the ques says she has trich inf
02/6/05 19:25:48 [USMLE_Step_2] strug: agree with lanny
02/6/05 19:25:51 [USMLE_Step_2] sanz: Ab against what org? Gnorr or chlam or tricho?
02/6/05 19:25:53 [USMLE_Step_2] megs: yup sanz u can repeat after 3 monts
02/6/05 19:25:59 [USMLE_Step_2] megs: after treatment
02/6/05 19:26:13 [USMLE_Step_2] lanny: you dont autom atrt for trich if she dont have it
02/6/05 19:26:46 [USMLE_Step_2] strug: acc to me only if the q says she has...some infe, Pap is a very sensittive test for trichomans and it will show on pap
02/6/05 19:27:00 [USMLE_Step_2] dua_frank: it rules out infections lanny so giving a trial of Abs is not really harmful
02/6/05 19:27:08 [USMLE_Step_2] strug: if simply cin1 then repeat
02/6/05 19:27:20 [USMLE_Step_2] dua_frank: and neither does it go against the protocol of pap once in 3 months
02/6/05 19:28:03 [USMLE_Step_2] strug: dua but we follow certain recommendations set by the Preventive task force
02/6/05 19:28:20 [USMLE_Step_2] sanz: ok... so if CIN II then colposcopy with ECC
02/6/05 19:28:20 [USMLE_Step_2] dua_frank: i guess they are different for different countries strug
02/6/05 19:28:20 [USMLE_Step_2] lanny: agree with strug
02/6/05 19:28:32 [USMLE_Step_2] dua_frank: in india we follow in lines of what megs suggested
02/6/05 19:28:35 [USMLE_Step_2] strug: we talk about us in usmle
02/6/05 19:28:40 [USMLE_Step_2] sanz: we need to learn this country's giudelines now tho...
02/6/05 19:28:46 [USMLE_Step_2] dua_frank: yeah which i am not sure about
02/6/05 19:28:50 [USMLE_Step_2] dua_frank: i'll check and let you know
02/6/05 19:29:03 [USMLE_Step_2] megs: ok guys treatment of cin2???
02/6/05 19:29:21 [USMLE_Step_2] lanny: PAP is a cytological test looking for cellular atyo\pia not for bacteria
02/6/05 19:29:32 [USMLE_Step_2] megs: yeah lanny
02/6/05 19:29:43 [USMLE_Step_2] megs: u r 100% right
02/6/05 19:29:49 [USMLE_Step_2] vladimir: agree with lanny
02/6/05 19:29:52 [USMLE_Step_2] strug: megs did u mean next step in diagnoisi for cin2
02/6/05 19:30:16 [USMLE_Step_2] sanz: colposcopy
02/6/05 19:30:19 [USMLE_Step_2] strug: colposcopy and ECC[ non preg female] and ectocervical bipsy
02/6/05 19:30:20 [USMLE_Step_2] sanz: with ECC
02/6/05 19:30:39 [USMLE_Step_2] lanny: what if the fem is preg strug
02/6/05 19:30:46 [USMLE_Step_2] strug: no ecc
02/6/05 19:30:58 [USMLE_Step_2] vladimir: right strug bz endocervical may cause abortion
02/6/05 19:31:14 [USMLE_Step_2] sanz: but can do ectocervical Bx in pregnant women right?
02/6/05 19:31:16 [USMLE_Step_2] lanny: and incompet cervix
02/6/05 19:31:19 [USMLE_Step_2] strug: yes
02/6/05 19:31:30 [USMLE_Step_2] vladimir: yes
02/6/05 19:31:41 [USMLE_Step_2] sanz: ok
02/6/05 19:31:43 [USMLE_Step_2] lanny: yes ectocervix is ok
02/6/05 19:31:44 [USMLE_Step_2] strug: endocervix is highly vascular in pregn so cant do
02/6/05 19:32:33 [USMLE_Step_2] megs: yeah
02/6/05 19:32:33 [USMLE_Step_2] strug: when do we do cone bipsy?
02/6/05 19:32:34 [USMLE_Step_2] lanny: wow we started with a bomb im sweating already!!!!
02/6/05 19:32:50 [USMLE_Step_2] sanz: when pap smear and Bx histo is not matching
02/6/05 19:33:05 [USMLE_Step_2] lanny: if discrep bet pap and histol biopsy
02/6/05 19:33:12 [USMLE_Step_2] vladimir: when positive endocervical biopsy- do cone bx
02/6/05 19:33:25 [USMLE_Step_2] strug: also when ECC is abnormal, microinvasive Ca, if it involved endocervical canal,
02/6/05 19:33:26 [USMLE_Step_2] lanny: yes vlad
02/6/05 19:34:07 [USMLE_Step_2] sanz: define microinvasive ca
02/6/05 19:34:11 [USMLE_Step_2] lanny: incomp cervix can be caused by cone too
02/6/05 19:34:14 [USMLE_Step_2] vladimir: what stands for ECC strug
02/6/05 19:34:17 [USMLE_Step_2] strug: < 3mm sanz
02/6/05 19:34:18 [USMLE_Step_2] sanz: and frank invasion?
02/6/05 19:34:26 [USMLE_Step_2] strug: > 5 mm frank inv
02/6/05 19:34:29 [USMLE_Step_2] sanz: good
02/6/05 19:34:31 [USMLE_Step_2] lanny: endocervical curettage vlad
02/6/05 19:34:49 [USMLE_Step_2] vladimir: thanks lanny
02/6/05 19:34:53 [USMLE_Step_2] strug: Cx of conization of cervix
02/6/05 19:34:58 [USMLE_Step_2] lanny: what is the 3 mm
02/6/05 19:35:04 [USMLE_Step_2] strug: complication =Cx
02/6/05 19:35:11 [USMLE_Step_2] sanz: stenosis?
02/6/05 19:35:20 [USMLE_Step_2] strug: invol of basement memb lanny
02/6/05 19:35:21 [USMLE_Step_2] lanny: incomp cervix
02/6/05 19:35:26 [USMLE_Step_2] megs: cx stenosis..incompitance scarring
02/6/05 19:35:33 [USMLE_Step_2] sanz: lanny, if the invasion seen on Bx is <3mm, it's microinvasion
02/6/05 19:35:38 [USMLE_Step_2] dua_frank: yeah i got my source
02/6/05 19:35:39 [USMLE_Step_2] strug: right sanz and lanny incomp cervix and stenosis
02/6/05 19:35:44 [USMLE_Step_2] dua_frank: oxford pocket book
02/6/05 19:35:47 [USMLE_Step_2] sanz: >5mm is known as frank invasion
02/6/05 19:35:52 [USMLE_Step_2] sanz: this is impt cuz Rx is diff
02/6/05 19:35:53 [USMLE_Step_2] lanny: thanks sanz and strug
02/6/05 19:36:08 [USMLE_Step_2] dua_frank: says here you have to treat infections with first time dysplastic changes on pap and then repeat pap in 3-6 months
02/6/05 19:36:18 [USMLE_Step_2] sanz: thnx dua
02/6/05 19:36:22 [USMLE_Step_2] sanz: can i know the page?
02/6/05 19:36:28 [USMLE_Step_2] dua_frank: and if still present, repeat pap two more times and then go for colposcopy
02/6/05 19:36:40 [USMLE_Step_2] dua_frank: 35 sanz
02/6/05 19:36:48 [USMLE_Step_2] dua_frank: oxford book of clinical specialties
02/6/05 19:37:10 [USMLE_Step_2] strug: Rx of CIN?
02/6/05 19:37:13 [USMLE_Step_2] sanz: yup, i figured... thnx
02/6/05 19:37:16 [USMLE_Step_2] dua_frank: welcome
02/6/05 19:37:57 [USMLE_Step_2] sanz: microinvasion - just simple hysterectomy or modified radical hyst
02/6/05 19:37:58 [USMLE_Step_2] megs: how many yr it take to convert cin1 to cx cancer??
02/6/05 19:38:02 [USMLE_Step_2] strug: 10
02/6/05 19:38:10 [USMLE_Step_2] sanz: frank invasion - radial hyster
02/6/05 19:38:31 [USMLE_Step_2] strug: wait sanz we are still on CIn not invasive
02/6/05 19:38:40 [USMLE_Step_2] megs: its 7 to 10 strug
02/6/05 19:38:45 [USMLE_Step_2] strug: thanks megs
02/6/05 19:38:53 [USMLE_Step_2] megs: cin 2 in 4 yrs
02/6/05 19:39:05 [USMLE_Step_2] sanz: oh.. sorry strug
02/6/05 19:39:13 [USMLE_Step_2] strug: Rx of CIN?
02/6/05 19:39:26 [USMLE_Step_2] strug: is laser cryo,, Leep
02/6/05 19:39:43 [USMLE_Step_2] strug: follow up?
02/6/05 19:39:51 [USMLE_Step_2] megs: cin1 treat with antibiotics and repeat the pap...keep follow up
02/6/05 19:40:13 [USMLE_Step_2] megs: cin 2///cryo laser or leep
02/6/05 19:40:19 [USMLE_Step_2] lanny: strug that Rx deps on what CIN
02/6/05 19:40:20 [USMLE_Step_2] vladimir: follow up after procedures- pap 3mos for 3 yeras and latter pap every 6 mos for 3yeras
02/6/05 19:40:24 [USMLE_Step_2] strug: every 3 m for 2 years is follow up
02/6/05 19:40:45 [USMLE_Step_2] strug: vlad u r saying for invasive Ca i guess
02/6/05 19:40:47 [USMLE_Step_2] megs: YEAH VLAD
02/6/05 19:40:50 [USMLE_Step_2] sanz: ok... when do we do wide excision?
02/6/05 19:41:04 [USMLE_Step_2] vladimir: sorry - you right every 3 mos for first 2 years
02/6/05 19:41:23 [USMLE_Step_2] strug: for CIN sanz?
02/6/05 19:41:23 [USMLE_Step_2] megs: SANZ IS RIGHT
02/6/05 19:41:32 [USMLE_Step_2] sanz: yes strug...
02/6/05 19:41:37 [USMLE_Step_2] vladimir: no- i am talking about CIN
02/6/05 19:42:04 [USMLE_Step_2] strug: vlad u right i agree
02/6/05 19:42:09 [USMLE_Step_2] lanny: vlad thats for CIN2
02/6/05 19:42:34 [USMLE_Step_2] megs: TREATMENT OF CIN 2 AND 3 IS ALMOST SAME...
02/6/05 19:42:41 [USMLE_Step_2] lanny: yes
02/6/05 19:42:45 [USMLE_Step_2] strug: are we talking abut follow up for CIN? are there some controverises?
02/6/05 19:42:59 [USMLE_Step_2] vladimir: i mean as CIN 2 and 3 as precancer lesions
02/6/05 19:43:07 [USMLE_Step_2] lanny: we are talking trt for CIN 2
02/6/05 19:43:22 [USMLE_Step_2] strug: its laser, leep, cryo isnt it?
02/6/05 19:43:24 [USMLE_Step_2] sanz: f/u for CIN II and III are the same - q 3 mht for 2 yr
02/6/05 19:43:35 [USMLE_Step_2] vladimir: agree
02/6/05 19:43:37 [USMLE_Step_2] strug: yup sanz i agree
02/6/05 19:43:49 [USMLE_Step_2] megs: THATS IT SANZ
02/6/05 19:43:55 [USMLE_Step_2] lanny: yes sanz basically CIN 2 and 3 follow the same in trt and F/U
02/6/05 19:44:00 [USMLE_Step_2] sanz: yup... what i'm nto sure is when do we do wide excision instead of laser, or cone bx or LEEP
02/6/05 19:44:24 [USMLE_Step_2] strug: when it involvee s endocervix too
02/6/05 19:44:37 [USMLE_Step_2] strug: or it involves endocerival canal
02/6/05 19:45:03 [USMLE_Step_2] megs: yeah strug is right
02/6/05 19:45:06 [USMLE_Step_2] dua_frank: endo
02/6/05 19:45:23 [USMLE_Step_2] sanz: so if its just ECTO, LEEP or cryo or lase would suffice
02/6/05 19:45:24 [USMLE_Step_2] dua_frank: cone biopsy only when endocx curettage is positive
02/6/05 19:45:59 [USMLE_Step_2] lanny: sanz i think its what is conv for pt and doctor to do
02/6/05 19:46:10 jnkhampton Logs in
02/6/05 19:46:11 jnkhampton Joins Subroom USMLE_Step_1
02/6/05 19:46:23 [USMLE_Step_2] sanz: can i be a pain and ask this... is wide excision the same as cone biopsy?
02/6/05 19:46:31 [USMLE_Step_2] megs: leep is opd procedure with less bld loss
02/6/05 19:46:33 [USMLE_Step_2] lanny: they are all used in pts with invasive cancer
02/6/05 19:46:45 [USMLE_Step_2] strug: invasive? lanny
02/6/05 19:46:50 [USMLE_Step_2] dua_frank: no no
02/6/05 19:46:52 [USMLE_Step_2] lanny: no sanz
02/6/05 19:47:04 [USMLE_Step_2] dua_frank: yuo're getting confused between cone biopsy and conization of the cx i think sanz
02/6/05 19:47:12 [USMLE_Step_2] lanny: no.. mean severe
02/6/05 19:47:27 [USMLE_Step_2] sanz: what is conization then?
02/6/05 19:47:28 [USMLE_Step_2] megs: wide local excision of cervix can be a cone biopsy sanz
02/6/05 19:47:36 [USMLE_Step_2] sanz: oh boy, i'm sooooo good in OG :)
02/6/05 19:47:49 [USMLE_Step_2] dua_frank: no megs
02/6/05 19:47:59 [USMLE_Step_2] strug: u r good in all :)
02/6/05 19:48:04 [USMLE_Step_2] dua_frank: cone biopsy is taken at the internal os
02/6/05 19:48:13 [USMLE_Step_2] sanz: strug, i meant it the EXACT opposite! hehe
02/6/05 19:48:20 [USMLE_Step_2] dua_frank: conization is when the cx from external os to internal os is removed
02/6/05 19:48:26 [USMLE_Step_2] lanny: you can do wide excision as part of a cone biopsy
02/6/05 19:48:34 huli72 Logs in
02/6/05 19:48:39 huli72 Joins Subroom USMLE_Step_2
02/6/05 19:48:57 [USMLE_Step_2] strug: i dont want to know in so much detail :(
02/6/05 19:49:05 [USMLE_Step_2] sanz: strug, neither do i...
02/6/05 19:49:14 [USMLE_Step_2] sanz: but i get confused with all these names...
02/6/05 19:49:32 [USMLE_Step_2] megs: acc to me cone biopsy conization is same dua
02/6/05 19:49:36 [USMLE_Step_2] dua_frank: leep is nothing but conization
02/6/05 19:49:41 [USMLE_Step_2] strug: yup agree megs
02/6/05 19:49:42 [USMLE_Step_2] dua_frank: no megs
02/6/05 19:49:53 [USMLE_Step_2] strug: leep is not conization????/
02/6/05 19:49:57 [USMLE_Step_2] dua_frank: it is?
02/6/05 19:50:03 [USMLE_Step_2] strug: in leep we put a wire
02/6/05 19:50:06 [USMLE_Step_2] megs: i think u r talking about wedge biopsy
02/6/05 19:50:09 [USMLE_Step_2] lanny: cone biopsy is an umbrella term guys
02/6/05 19:50:12 [USMLE_Step_2] dua_frank: loop electrocervical excision procedure
02/6/05 19:50:28 [USMLE_Step_2] dua_frank: conization of cx is performed by leep or by a cold knife
02/6/05 19:50:32 [USMLE_Step_2] megs: dua , i will check but i am pretty sure though i may be wrong
02/6/05 19:50:32 [USMLE_Step_2] vladimir: it seems me also different stuff- we just mixed up all together
02/6/05 19:50:42 [USMLE_Step_2] lanny: these procedures are choices ti do depending on involment of lesions
02/6/05 19:50:44 [USMLE_Step_2] sanz: ok, i just checked the dictionary
02/6/05 19:50:46 [USMLE_Step_2] strug: yup we mixed up
02/6/05 19:50:47 [USMLE_Step_2] dua_frank: ok
02/6/05 19:50:58 [USMLE_Step_2] dua_frank: any excised tissue can be sent for biopsy
02/6/05 19:51:02 [USMLE_Step_2] sanz: conization is excision of endocervix
02/6/05 19:51:07 [USMLE_Step_2] lanny: yes
02/6/05 19:51:15 [USMLE_Step_2] dua_frank: the difference in a biopsy alone procedure is the sample amount taken
02/6/05 19:51:16 [USMLE_Step_2] lanny: thats what im trying to say
02/6/05 19:51:17 [USMLE_Step_2] vladimir: right
02/6/05 19:51:33 [USMLE_Step_2] sanz: LEEP is a technique used to do conization
02/6/05 19:51:37 [USMLE_Step_2] dua_frank: yep sanz
02/6/05 19:51:39 [USMLE_Step_2] lanny: right
02/6/05 19:51:46 [USMLE_Step_2] lanny: finally were getting there
02/6/05 19:51:50 [USMLE_Step_2] strug: yup
02/6/05 19:51:58 [USMLE_Step_2] vladimir: what stands for LEEP
02/6/05 19:52:02 [USMLE_Step_2] strug: i am spinnning
02/6/05 19:52:13 [USMLE_Step_2] sanz: strug, join the club
02/6/05 19:52:19 [USMLE_Step_2] lanny: cone biposy is an umbrella term all these proced are included
02/6/05 19:52:22 [USMLE_Step_2] strug: loop electordiathermy excison procedure vlad
02/6/05 19:52:34 [USMLE_Step_2] strug: move ahead y guys move
02/6/05 19:52:52 [USMLE_Step_2] lanny: invasive ca diag
02/6/05 19:52:54 [USMLE_Step_2] strug: what if we get AScus on pap smear,,,,,,what next...?
02/6/05 19:53:11 [USMLE_Step_2] vladimir: thanks strug and it's done for conization
02/6/05 19:53:16 [USMLE_Step_2] sanz: dep in if the pt is reliable or not
02/6/05 19:53:18 [USMLE_Step_2] huli72: if the edge of atypical displasia is in question, LEEP is perfered.
02/6/05 19:53:18 [USMLE_Step_2] strug: there are three choices to proceed
02/6/05 19:53:35 [USMLE_Step_2] dua_frank: huli adds more confusion, thank you huli :P
02/6/05 19:53:41 [USMLE_Step_2] strug: one is......
02/6/05 19:53:45 [USMLE_Step_2] huli72: hi, dua
02/6/05 19:53:49 [USMLE_Step_2] dua_frank: hi, how are you?
02/6/05 19:53:53 [USMLE_Step_2] dua_frank: nice to see you
02/6/05 19:53:58 [USMLE_Step_2] strug: to follow up in 6 months
02/6/05 19:54:07 [USMLE_Step_2] strug: or do HPV DNA
02/6/05 19:54:15 [USMLE_Step_1] jnkhampton: All I can say is that I read that hepatitis C-related hepatocellular cancer is INCREASING in incidence
02/6/05 19:54:16 [USMLE_Step_2] strug: or do cone biopsy
02/6/05 19:54:21 [USMLE_Step_2] huli72: cone biopsy
02/6/05 19:54:29 [USMLE_Step_2] vladimir: DNA typing
02/6/05 19:54:30 [USMLE_Step_2] lanny: whats the ques guys?
02/6/05 19:54:36 jnkhampton Leaves Subroom
02/6/05 19:54:47 [USMLE_Step_2] strug: Ascus on pap what next? lanny
02/6/05 19:54:54 [USMLE_Step_2] vladimir: dna 6,11-screen as high risk cancer
02/6/05 19:54:55 jnkhampton Leaves Subroom
02/6/05 19:54:59 [USMLE_Step_2] lanny: solposcope
02/6/05 19:55:11 [USMLE_Step_2] strug: vlad not 6 11
02/6/05 19:55:15 [USMLE_Step_2] lanny: nad biopsy
02/6/05 19:55:16 [USMLE_Step_2] huli72: I think it is calposcope
02/6/05 19:55:17 [USMLE_Step_2] strug: its 16,18
02/6/05 19:55:25 jnkhampton Logs Out
02/6/05 19:55:25 [USMLE_Step_2] huli72: 16,18
02/6/05 19:55:30 [USMLE_Step_2] lanny: 31 35
02/6/05 19:55:37 jnkhampton Logs in
02/6/05 19:55:43 [USMLE_Step_2] vladimir: dna 16,18,31,33,35-proceed like hgsil and lsil management plan
02/6/05 19:55:50 jnkhampton Joins Subroom USMLE_Step_1
02/6/05 19:56:05 [USMLE_Step_2] strug: ok shall i tell what i knw and t hen u all can comment on it
02/6/05 19:56:14 [USMLE_Step_2] strug: on how to proced with ascus
02/6/05 19:56:26 [USMLE_Step_2] lanny: go ahead strug
02/6/05 19:56:38 [USMLE_Step_2] strug: there are 3 choices
02/6/05 19:56:57 [USMLE_Step_2] strug: u can do Hpv Dna and fin d out the strain of HPV
02/6/05 19:57:04 jnkhampton Logs Out
02/6/05 19:57:17 [USMLE_Step_2] strug: if 6, 11repeat pap in one year
02/6/05 19:57:32 [USMLE_Step_2] strug: if 16, 18 colposcopy and bipsy
02/6/05 19:57:53 [USMLE_Step_2] strug: second choic is repet pap in 6 months
02/6/05 19:58:03 [USMLE_Step_2] huli72: is HPV type routinely done?
02/6/05 19:58:18 [USMLE_Step_2] megs: dua i have sent a link to u have u recieved it
02/6/05 19:58:19 [USMLE_Step_2] strug: if again ascus on the 6 th month do colpos and bipsy
02/6/05 19:58:40 [USMLE_Step_2] strug: or directly go for colpos and bipsy if patient not relable
02/6/05 19:58:40 [USMLE_Step_2] sanz: megs, can you paste it here plz?
02/6/05 19:59:17 [USMLE_Step_2] huli72: what is your source, strug?
02/6/05 19:59:53 [USMLE_Step_2] strug: kaplan notes huli
02/6/05 20:00:04 [USMLE_Step_2] dua_frank: doesn't open megs :(
02/6/05 20:00:09 [USMLE_Step_2] lanny: ok thx strug how can you tell which PAP smear regular one or ASCUS
02/6/05 20:00:25 [USMLE_Step_2] strug: what are the S/S of invasive cercial ca?
02/6/05 20:00:34 [USMLE_Step_2] lanny: when do you choose to do reg PAP from ASCUS
02/6/05 20:00:48 [USMLE_Step_2] sanz: bleeding strug
02/6/05 20:00:59 [USMLE_Step_2] strug: lanny i didnt understan u r q
02/6/05 20:01:10 [USMLE_Step_2] lanny: is there something called ASCUS pap smear?
02/6/05 20:01:24 [USMLE_Step_2] strug: postcoital bleeding, irregular vaginal bellding, lower extremity pain and edema
02/6/05 20:01:30 [USMLE_Step_2] strug: no lanny
02/6/05 20:01:36 [USMLE_Step_2] vladimir: bleeding after coituse
02/6/05 20:01:47 [USMLE_Step_2] strug: i think it means ASCUS on pap smear
02/6/05 20:02:03 [USMLE_Step_2] strug: are u taling about thin prep lanny?
02/6/05 20:02:12 [USMLE_Step_2] lanny: yes there is i think after the first PAP is doubtful you then do ASCUS pap smear
02/6/05 20:02:46 [USMLE_Step_2] strug: the one in which we put the cell in a liquied vial lanny
02/6/05 20:02:47 [USMLE_Step_2] lanny: got it strug thats it !!
02/6/05 20:03:07 [USMLE_Step_2] strug: it has highrer sensitivity as close to 80%
02/6/05 20:03:14 [USMLE_Step_2] lanny: so when a pt comes in do you do this first or the regular PAP first
02/6/05 20:03:20 [USMLE_Step_2] strug: as compared to the normal which has 51%
02/6/05 20:03:30 [USMLE_Step_2] strug: regualr one lanny
02/6/05 20:03:59 [USMLE_Step_2] lanny: so if the reg one shows ASCUS when repeating we repeat with ASCUS pap?
02/6/05 20:04:00 [USMLE_Step_2] vladimir: they won't ask about ASCUS pap-smear
02/6/05 20:04:15 [USMLE_Step_2] strug: yeah lanny forgett it
02/6/05 20:04:23 [USMLE_Step_2] lanny: younever knwo vlad better clear it here
02/6/05 20:04:27 [USMLE_Step_2] dua_frank: this is too much detail, i'm not follwing anything *)
02/6/05 20:04:42 [USMLE_Step_2] strug: ooooh dua....
02/6/05 20:04:46 [USMLE_Step_2] lanny: ok guys lets continue
02/6/05 20:04:53 [USMLE_Step_2] vladimir: but we need to discuss only HY qs
02/6/05 20:05:13 [USMLE_Step_2] strug: how do u grade cervial ca , clinically or surgically?
02/6/05 20:05:22 [USMLE_Step_2] dua_frank: surgically
02/6/05 20:05:24 [USMLE_Step_2] megs: i was lost searching for a reference whats up here??
02/6/05 20:05:26 [USMLE_Step_2] huli72: clinically
02/6/05 20:05:34 [USMLE_Step_2] strug: yup huli clinically
02/6/05 20:05:48 [USMLE_Step_2] strug: the only cancer which is staged clinically
02/6/05 20:05:55 [USMLE_Step_2] lanny: invasive CA is only gynae cancer stagec d clinical
02/6/05 20:05:56 [USMLE_Step_2] huli72: yeah
02/6/05 20:06:16 [USMLE_Step_2] dua_frank: oh
02/6/05 20:06:22 [USMLE_Step_2] lanny: we dont need to know the stages though
02/6/05 20:06:23 [USMLE_Step_2] strug: first step in diagnoisi?
02/6/05 20:06:23 [USMLE_Step_2] dua_frank: what does that exactly mean?
02/6/05 20:06:30 [USMLE_Step_2] dua_frank: i mean staging it clinically
02/6/05 20:06:46 [USMLE_Step_2] dua_frank: you do have to stage it to know how far its spread to decide what surgery to perform right?
02/6/05 20:06:47 [USMLE_Step_2] strug: it means on peolvic exam
02/6/05 20:06:52 [USMLE_Step_2] dua_frank: oh
02/6/05 20:07:03 [USMLE_Step_2] huli72: yup
02/6/05 20:07:04 [USMLE_Step_2] lanny: i think on surgery
02/6/05 20:07:04 [USMLE_Step_2] strug: ok guys first step in dianoisis?
02/6/05 20:07:07 [USMLE_Step_2] dua_frank: thanks strug
02/6/05 20:07:15 [USMLE_Step_2] huli72: and we can do lymph node biopsy
02/6/05 20:07:24 [USMLE_Step_2] dua_frank: i understand now
02/6/05 20:07:35 [USMLE_Step_2] sanz: cervical Bx strug
02/6/05 20:07:40 [USMLE_Step_2] strug: cercial bipsy is first step yup sanz
02/6/05 20:07:48 [USMLE_Step_2] sanz: and then stage the dz clinically next
02/6/05 20:07:52 [USMLE_Step_2] strug: it shows SCC then what?
02/6/05 20:07:54 [USMLE_Step_2] vladimir: how about mictoinvasive Ca- you will alsodiagnose it clinically strug
02/6/05 20:07:59 [USMLE_Step_2] lanny: yes cause distant mets can be to the lymph node
02/6/05 20:09:04 [USMLE_Step_2] sanz: vlad, i think Dx is based upon the bx results...
02/6/05 20:09:18 [USMLE_Step_2] lanny: yes vlad micro inv ca can be diag clinical
02/6/05 20:09:22 [USMLE_Step_2] huli72: for microinvasive
02/6/05 20:09:29 jnkhampton Logs in
02/6/05 20:09:30 jnkhampton Joins Subroom USMLE_Step_1
02/6/05 20:09:33 [USMLE_Step_2] lanny: i think it is stage 1
02/6/05 20:09:42 [USMLE_Step_2] vladimir: how lanny
02/6/05 20:09:46 [USMLE_Step_2] lanny: not sure of the depth
02/6/05 20:09:53 jnkhampton Logs Out
02/6/05 20:09:53 [USMLE_Step_2] sanz: ok... let me explain
02/6/05 20:09:55 [USMLE_Step_2] strug: then do a metastatic workup whichi includes a pelvic exam, chest x ray, IVP, cystocopy and sigmoidoscopy
02/6/05 20:10:01 [USMLE_Step_2] sanz: if you have SCC, you do cervical bx
02/6/05 20:10:01 [USMLE_Step_2] strug: sanz go ahead
02/6/05 20:10:11 [USMLE_Step_2] megs: microsand also usg
02/6/05 20:10:20 [USMLE_Step_2] lanny: by pelvic exam or pyelograony vlad
02/6/05 20:10:22 [USMLE_Step_2] sanz: if on Bx, you see <3mm - then it's microinvasive ca
02/6/05 20:10:28 [USMLE_Step_2] sanz: if > 5 mm - frank invasion
02/6/05 20:10:42 [USMLE_Step_2] sanz: then now you'll have to stage the cervical ca clinically
02/6/05 20:10:49 [USMLE_Step_2] lanny: yea sanz got ir tight
02/6/05 20:10:52 [USMLE_Step_2] sanz: so you do pelvic exams
02/6/05 20:10:56 [USMLE_Step_2] sanz: then do CXR
02/6/05 20:10:58 [USMLE_Step_2] sanz: and IVP
02/6/05 20:10:59 [USMLE_Step_2] megs: yeah sanz
02/6/05 20:11:03 [USMLE_Step_2] sanz: and CT or MRI
02/6/05 20:11:18 [USMLE_Step_2] vladimir: agree with sanz, pyelography it's not clinical diagnosis- it's imaging technique
02/6/05 20:11:26 [USMLE_Step_2] sanz: now... after that you can manage the pt according to the stage
02/6/05 20:12:13 [USMLE_Step_2] strug: we do IVP for metastatis not for staging dear vlad
02/6/05 20:12:13 [USMLE_Step_2] lanny: vlad the procedure is imaging technique but it falls under clinical diagnosis
02/6/05 20:12:48 [USMLE_Step_2] sanz: no... IVP doesnt tell you the diagnosis - it's used for staging...
02/6/05 20:12:57 [USMLE_Step_2] vladimir: i think that in oncology we can't use only clinical staging- it's completely wrong unless you can see huge tumor with invasion to neighboring structure and packages of Lnodes amd remored mts
02/6/05 20:13:17 [USMLE_Step_2] strug: please read the page 105 in kaplan obgyn notes " staging is clinical based on pelvic exam and may include an IVP"
02/6/05 20:13:29 [USMLE_Step_2] lanny: thanks strug
02/6/05 20:13:38 [USMLE_Step_2] sanz: vlad, i know that is true... but in USMLE, cervical cancer is the ONLY ca that's staged clinically
02/6/05 20:13:52 [USMLE_Step_2] sanz: other cancers are staged surgically
02/6/05 20:14:05 [USMLE_Step_2] lanny: and IVP can be part of a clinical diag method
02/6/05 20:14:07 [USMLE_Step_2] megs: strug is absolutly right
02/6/05 20:14:21 [USMLE_Step_2] dua_frank: vlad you are right but see ca cx is grossly visible
02/6/05 20:14:23 [USMLE_Step_2] vladimir: sorry strug- but in kaplan is also a lot of mistakes (he is not gof fortunately for us)
02/6/05 20:14:29 [USMLE_Step_2] dua_frank: and you can measure it in size
02/6/05 20:14:36 [USMLE_Step_2] megs: ivp is the only imaging tecq that is included in staging
02/6/05 20:14:41 [USMLE_Step_2] sanz: but you can use imaging techniques to help you with cervical ca staging
02/6/05 20:14:44 [USMLE_Step_2] dua_frank: like a 4 mm size in width
02/6/05 20:14:47 [USMLE_Step_2] lanny: thanks megs
02/6/05 20:14:51 [USMLE_Step_2] dua_frank: thats what it means by clinical staging
02/6/05 20:14:52 [USMLE_Step_2] lanny: yes sanz
02/6/05 20:14:58 [USMLE_Step_2] strug: move move guys we have much more to discuss
02/6/05 20:14:58 [USMLE_Step_2] lanny: yes dua
02/6/05 20:15:13 [USMLE_Step_2] lanny: oh boy finally got it settled
02/6/05 20:15:26 [USMLE_Step_2] lanny: we need boxing gloves here lol
02/6/05 20:15:30 [USMLE_Step_2] strug: Rx?
02/6/05 20:15:35 [USMLE_Step_2] dua_frank: lanny lol
02/6/05 20:15:41 [USMLE_Step_2] huli72: radiation
02/6/05 20:15:43 [USMLE_Step_2] sanz: lanny we dont...
02/6/05 20:15:49 [USMLE_Step_2] huli72: or surgical
02/6/05 20:15:57 [USMLE_Step_2] lanny: ok thats good to know sanz
02/6/05 20:16:04 [USMLE_Step_2] strug: or chemo huli lol
02/6/05 20:16:13 [USMLE_Step_2] lanny: trt is by the stage guys
02/6/05 20:16:16 [USMLE_Step_2] strug: u treat a cc to stage guys
02/6/05 20:16:34 [USMLE_Step_2] dua_frank: no fighting here, we discuss and debate to find out the truth
02/6/05 20:16:36 [USMLE_Step_2] strug: for stage Ia?
02/6/05 20:16:38 [USMLE_Step_2] dua_frank: as in X files :P
02/6/05 20:16:52 [USMLE_Step_2] strug: simple hysterctomy
02/6/05 20:16:54 [USMLE_Step_2] dua_frank: "the truth is out there"
02/6/05 20:16:55 [USMLE_Step_2] lanny: hysterect for 1 radical for 2 rad for 3 or 4..
02/6/05 20:17:12 [USMLE_Step_2] lanny: can someone clarify the stages correctly
02/6/05 20:17:13 [USMLE_Step_2] strug: for Stage Ib radical hysterctomy
02/6/05 20:17:15 [USMLE_Step_2] huli72: that is nice , lanny
02/6/05 20:17:21 [USMLE_Step_2] megs: correct lanny
02/6/05 20:17:30 [USMLE_Step_2] huli72: no
02/6/05 20:17:32 [USMLE_Step_2] lanny: this is how i remember it simply
02/6/05 20:17:39 [USMLE_Step_2] huli72: surgery for Ia
02/6/05 20:17:51 [USMLE_Step_2] huli72: radia surgery for Ib
02/6/05 20:18:04 [USMLE_Step_2] huli72: no
02/6/05 20:18:12 [USMLE_Step_2] huli72: surgery for Ia1
02/6/05 20:18:25 [USMLE_Step_2] huli72: rad surgery for Ia2
02/6/05 20:18:25 [USMLE_Step_2] strug: for stage Ib or II a radical hyster with pelvic and paraoortic LN diss with peritoneal washing or Pelvc radiation
02/6/05 20:18:46 [USMLE_Step_2] huli72: yup, strug
02/6/05 20:19:00 [USMLE_Step_2] dua_frank: man different books give different protocols for treating ca cx
02/6/05 20:19:04 [USMLE_Step_2] strug: for III an IV radio and chemo
02/6/05 20:19:20 malak1993 Logs in
02/6/05 20:19:20 [USMLE_Step_2] lanny: yes thats why i remeber it simply like that
02/6/05 20:19:22 [USMLE_Step_2] dua_frank: oxford gives start chemo for I b even
02/6/05 20:19:25 [USMLE_Step_2] megs: ok lets move to andometrial cancer
02/6/05 20:19:37 [USMLE_Step_2] lanny: usu wharever there are controversies USMLE dont ask
02/6/05 20:19:38 [USMLE_Step_2] megs: what is corpus cancer syndrome???
02/6/05 20:19:41 [USMLE_Step_2] strug: wait how about preg and cervial ca
02/6/05 20:19:44 [USMLE_Step_2] dua_frank: and give radiorx for even I and II
02/6/05 20:19:51 [USMLE_Step_2] dua_frank: extensive radio for III and IV
02/6/05 20:20:07 malak1993: hepatitis B
02/6/05 20:20:08 [USMLE_Step_2] sanz: megs, dont know... never heard of it
02/6/05 20:20:13 [USMLE_Step_2] megs: DM ,HT AND ENDOMETRIAL CANCER
02/6/05 20:20:19 [USMLE_Step_2] strug: CIn and preg? what do do
02/6/05 20:20:29 [USMLE_Step_2] lanny: same exper here i have seen in like 3 major recent books diff trts for invasive cerv carcinoma
02/6/05 20:20:31 [USMLE_Step_2] sanz: HT is hypertension?
02/6/05 20:20:46 [USMLE_Step_2] megs: YEAH SANZ
02/6/05 20:21:09 [USMLE_Step_2] dua_frank: c/section
02/6/05 20:21:13 [USMLE_Step_2] huli72: no
02/6/05 20:21:16 [USMLE_Step_2] lanny: nice ques strug
02/6/05 20:21:34 [USMLE_Step_2] dua_frank: Radio
02/6/05 20:21:38 [USMLE_Step_2] lanny: think we do punch biopsy
02/6/05 20:21:42 malak1993 Logs Out
02/6/05 20:21:44 [USMLE_Step_2] huli72: > 24 wait for baby mature
02/6/05 20:21:49 [USMLE_Step_2] strug: CIn and preg do pap every 3 months and then 8 weeks postppartum again do colpo and pap
02/6/05 20:21:57 [USMLE_Step_2] lanny: to see if its micro or frank
02/6/05 20:22:00 [USMLE_Step_2] strug: huli its CIN
02/6/05 20:22:12 [USMLE_Step_2] lanny: then radical hyst
02/6/05 20:22:18 [USMLE_Step_2] megs: depends on stage again ..cin treat conservatively
02/6/05 20:22:21 [USMLE_Step_2] huli72: <24 and invasive ca, trt as if no preg
02/6/05 20:22:33 [USMLE_Step_2] megs: frank cancer classical c.s.
02/6/05 20:22:52 [USMLE_Step_2] strug: microinvasiev deliver vaginally
02/6/05 20:23:33 [USMLE_Step_2] strug: invasive and > 24 then wait for child to mature then do CS and definitive RX
02/6/05 20:23:58 [USMLE_Step_2] megs: agree strug
02/6/05 20:24:34 [USMLE_Step_2] vladimir: you mean 24 week
02/6/05 20:24:39 [USMLE_Step_2] strug: if u send for Pap smear and it comes as 'unsatisfactory' what do do next?
02/6/05 20:24:42 [USMLE_Step_2] lanny: def trt is rad hyster or rad strug
02/6/05 20:24:50 [USMLE_Step_2] strug: yes vald
02/6/05 20:24:50 [USMLE_Step_2] sanz: repeat
02/6/05 20:25:17 [USMLE_Step_2] strug: when to repeat imm or wait for....
02/6/05 20:25:21 malak1993 Logs in
02/6/05 20:25:28 [USMLE_Step_2] sanz: 3 mth?
02/6/05 20:25:36 [USMLE_Step_2] huli72: repeat imm
02/6/05 20:25:37 [USMLE_Step_2] lanny: whats imm
02/6/05 20:25:41 [USMLE_Step_2] strug: u repeat only after 6 weeks
02/6/05 20:25:50 [USMLE_Step_2] huli72: oh
02/6/05 20:26:11 [USMLE_Step_2] strug: otherwise u get false negative results
02/6/05 20:26:27 [USMLE_Step_2] strug: becauseo f the reparative chances in epithelium
02/6/05 20:26:31 malak1993 Logs Out
02/6/05 20:26:53 [USMLE_Step_2] sanz: oke.. presentation of endometrail ca
02/6/05 20:27:00 [USMLE_Step_2] lanny: whats imm guys
02/6/05 20:27:05 [USMLE_Step_2] strug: immediately
02/6/05 20:27:05 [USMLE_Step_2] sanz: imm = immediate lanny
02/6/05 20:27:07 [USMLE_Step_2] huli72: bleeding
02/6/05 20:27:11 [USMLE_Step_2] lanny: oh thx
02/6/05 20:27:16 [USMLE_Step_2] strug: postmenopausal bleedomg
02/6/05 20:27:24 [USMLE_Step_2] sanz: yup... what is the age group?
02/6/05 20:27:32 [USMLE_Step_2] strug: 52
02/6/05 20:27:34 [USMLE_Step_2] huli72: 55-65
02/6/05 20:27:38 [USMLE_Step_2] sanz: postmenopausal
02/6/05 20:27:39 [USMLE_Step_2] vladimir: more than 50
02/6/05 20:27:45 [USMLE_Step_2] sanz: risk factors?
02/6/05 20:27:58 [USMLE_Step_2] strug: obesity , Ht
02/6/05 20:28:03 [USMLE_Step_2] strug: nullliparity
02/6/05 20:28:08 [USMLE_Step_2] huli72: HRT, obesy
02/6/05 20:28:09 [USMLE_Step_2] strug: dm
02/6/05 20:28:14 [USMLE_Step_2] huli72: HT
02/6/05 20:28:18 [USMLE_Step_2] strug: late maenopause
02/6/05 20:28:22 [USMLE_Step_2] sanz: which is the biggest risk factor?
02/6/05 20:28:27 [USMLE_Step_2] strug: chronic anovulation
02/6/05 20:28:29 [USMLE_Step_2] megs: nulliparity,late menopause unopposed estr exposure
02/6/05 20:28:40 [USMLE_Step_2] lanny: agree megs
02/6/05 20:28:40 [USMLE_Step_2] vladimir: chronic anovulation/PCOD
02/6/05 20:28:42 [USMLE_Step_2] dua_frank: DM
02/6/05 20:28:50 [USMLE_Step_2] dua_frank: HTN
02/6/05 20:28:58 [USMLE_Step_2] sanz: which is the biggest risk factor? (i have different ans fr various sources.. so i dont know the ans)
02/6/05 20:28:59 [USMLE_Step_2] strug: biggest is obesity?
02/6/05 20:29:02 [USMLE_Step_2] vladimir: granulosa teca ovarian tumors
02/6/05 20:29:04 [USMLE_Step_2] dua_frank: infertile
02/6/05 20:29:09 [USMLE_Step_2] megs: biggest is obesity
02/6/05 20:29:13 [USMLE_Step_2] lanny: i think biggest is age
02/6/05 20:29:17 [USMLE_Step_2] dua_frank: drugs- tamoxifen
02/6/05 20:29:19 [USMLE_Step_2] sanz: age is for breast ca
02/6/05 20:29:19 [USMLE_Step_2] huli72: it is age
02/6/05 20:29:20 [USMLE_Step_2] lanny: postmenopause
02/6/05 20:29:25 [USMLE_Step_2] dua_frank: post meno
02/6/05 20:29:26 [USMLE_Step_2] vladimir: exogenous unopposed estrogen
02/6/05 20:29:33 [USMLE_Step_2] megs: if 50 lb overwt
02/6/05 20:29:53 [USMLE_Step_2] vladimir: biggest- obesity
02/6/05 20:29:53 [USMLE_Step_2] sanz: strug, some say obesity some say unopposed esg...
02/6/05 20:29:57 [USMLE_Step_2] sanz: so i dont know...
02/6/05 20:30:06 [USMLE_Step_2] strug: acc to me obesity
02/6/05 20:30:13 [USMLE_Step_2] dua_frank: its unopposed estrogen sanz
02/6/05 20:30:19 [USMLE_Step_2] megs: why obesity is at risk???
02/6/05 20:30:32 [USMLE_Step_2] dua_frank: see after menopause, the progestrogens which are protective against estrogens harmful effects decrease
02/6/05 20:30:42 [USMLE_Step_2] strug: becasue inc conversion od estoggen in adipsoe tissue
02/6/05 20:30:47 [USMLE_Step_2] sanz: unoppsoed esg covers a wide range - nulliparity, late menopause, PCOS, OCP
02/6/05 20:30:49 [USMLE_Step_2] lanny: yes strug
02/6/05 20:30:53 [USMLE_Step_2] dua_frank: and estrogens attack the endometrium and it proliferates
02/6/05 20:31:03 [USMLE_Step_2] dua_frank: and all those cause endo ca
02/6/05 20:31:08 [USMLE_Step_2] huli72: it is obesity 3 time for RR
02/6/05 20:31:20 [USMLE_Step_2] vladimir: women who are more than 50lbs over their weight have 9-fold increased risk
02/6/05 20:31:25 [USMLE_Step_2] huli72: late menopause 2.4 times for RR
02/6/05 20:31:29 [USMLE_Step_2] dua_frank: and as strug said adipose tissue coverts to estrogen too
02/6/05 20:31:34 [USMLE_Step_2] huli72: DM 2.8 for RR
02/6/05 20:31:38 [USMLE_Step_2] sanz: so obesity is the ans then?
02/6/05 20:31:40 [USMLE_Step_2] megs: why obesity will cause endometrial cancer? what mech???
02/6/05 20:31:41 [USMLE_Step_2] huli72: so, it is obesity
02/6/05 20:31:46 [USMLE_Step_2] sanz: thnx huli
02/6/05 20:31:50 [USMLE_Step_2] dua_frank: i mean increased estrogen in fat cells, sorry
02/6/05 20:31:58 [USMLE_Step_2] dua_frank: fat cells megs
02/6/05 20:32:02 [USMLE_Step_2] strug: what is the first step in diagtnosi?
02/6/05 20:32:05 [USMLE_Step_2] megs: good dua
02/6/05 20:32:19 [USMLE_Step_2] megs: endometrial biopsy
02/6/05 20:32:22 [USMLE_Step_2] huli72: and if over 50 pounds overweight, the RR is 10 times
02/6/05 20:32:28 [USMLE_Step_2] dua_frank: DNC?
02/6/05 20:32:28 [USMLE_Step_2] strug: right megs
02/6/05 20:32:43 [USMLE_Step_2] lanny: so whaats the ans for biggest risk fac ?
02/6/05 20:32:52 [USMLE_Step_2] sanz: lanny obesity
02/6/05 20:32:53 [USMLE_Step_2] dua_frank: obesity
02/6/05 20:33:02 [USMLE_Step_2] vladimir: obesity for sure
02/6/05 20:33:03 [USMLE_Step_2] strug: whats the most common cause of Postmenaupaula bleeding>?
02/6/05 20:33:03 [USMLE_Step_2] dua_frank: because of it's prevalence as a risk factor
02/6/05 20:33:13 [USMLE_Step_2] dua_frank: more than 50% of the population is overweight
02/6/05 20:33:17 [USMLE_Step_2] sanz: endometrial ca strug
02/6/05 20:33:17 [USMLE_Step_2] lanny: thanks all
02/6/05 20:33:19 [USMLE_Step_2] huli72: endometrual ca
02/6/05 20:33:22 [USMLE_Step_2] strug: nope
02/6/05 20:33:26 [USMLE_Step_2] lanny: yep
02/6/05 20:33:31 [USMLE_Step_2] vladimir: leyomiomata
02/6/05 20:33:33 [USMLE_Step_2] sanz: atrophic?
02/6/05 20:33:37 [USMLE_Step_2] megs: most common cause is endometrial polyp
02/6/05 20:33:47 [USMLE_Step_2] strug: vaginal and endometial atrophyis the most cmn coz
02/6/05 20:33:57 [USMLE_Step_2] dua_frank: don't polyps decrease in incidence after menop?
02/6/05 20:34:03 [USMLE_Step_2] strug: but enodmetrial ca is the most imp dianoisi to rule out
02/6/05 20:34:08 [USMLE_Step_2] dua_frank: yeah
02/6/05 20:34:16 [USMLE_Step_2] lanny: its atrophy guys as most common
02/6/05 20:34:22 [USMLE_Step_2] dua_frank: i agree
02/6/05 20:34:27 [USMLE_Step_2] lanny: post men bleed
02/6/05 20:34:40 [USMLE_Step_2] lanny: right strug
02/6/05 20:35:38 [USMLE_Step_2] huli72: tamoxifen incr or decr endometrial ca?
02/6/05 20:35:41 [USMLE_Step_2] sanz: Prognosis depe on grade or stage?
02/6/05 20:35:43 [USMLE_Step_2] dua_frank: inc
02/6/05 20:35:44 [USMLE_Step_2] sanz: incr
02/6/05 20:35:52 [USMLE_Step_2] huli72: yup
02/6/05 20:35:57 [USMLE_Step_2] dua_frank: stage
02/6/05 20:36:03 [USMLE_Step_2] huli72: stage
02/6/05 20:36:07 [USMLE_Step_2] strug: grade sanz
02/6/05 20:36:13 [USMLE_Step_2] sanz: grade is the ans
02/6/05 20:36:19 [USMLE_Step_2] sanz: what are the diff grades?
02/6/05 20:36:26 jnkhampton Logs in
02/6/05 20:36:27 jnkhampton Joins Subroom USMLE_Step_2
02/6/05 20:36:36 [USMLE_Step_2] strug: Ln metas, sanz/
02/6/05 20:36:44 [USMLE_Step_2] lanny: uli tamox increases risk
02/6/05 20:36:50 [USMLE_Step_2] lanny: huli i mean
02/6/05 20:36:56 [USMLE_Step_2] sanz: all i know is grade 1 has 5% solid growth
02/6/05 20:37:02 [USMLE_Step_2] vladimir: grade, but if in Q stem there is no grade, next should be stage
02/6/05 20:37:04 [USMLE_Step_2] sanz: grade 2 <50% solid growth
02/6/05 20:37:07 [USMLE_Step_2] megs: post menopausal bleeding due to lower genital cause is atropy
02/6/05 20:37:12 [USMLE_Step_2] sanz: grade 3 >50% solid growth
02/6/05 20:37:23 [USMLE_Step_2] lanny: why is raloxifen used instead of tamox?
02/6/05 20:37:42 [USMLE_Step_2] strug: less side effect selective estrogen receptor modularotr
02/6/05 20:37:47 [USMLE_Step_2] megs: but upper genital bleeding...then endometrial polyp is the commonest cause
02/6/05 20:37:51 [USMLE_Step_2] vladimir: prevention osteoporosis
02/6/05 20:37:55 jnkhampton Joins Subroom USMLE_Step_1
02/6/05 20:37:58 [USMLE_Step_2] sanz: lanny ralo is endome antag
02/6/05 20:38:02 [USMLE_Step_2] megs: raloxifene do not cause ca breat
02/6/05 20:38:09 [USMLE_Step_2] huli72: raloxifen don't incr risk of endometrial ca?
02/6/05 20:38:18 jnkhampton Joins Subroom Clinical_Skills
02/6/05 20:38:21 [USMLE_Step_2] megs: sorry
02/6/05 20:38:22 [USMLE_Step_2] sanz: huli, no
02/6/05 20:38:24 [USMLE_Step_2] lanny: also ralox has no inc risk of endo cancer
02/6/05 20:38:24 jnkhampton Joins Subroom USMLE_Step_2
02/6/05 20:38:31 [USMLE_Step_2] sanz: cuz ralox is endom antag
02/6/05 20:38:38 [USMLE_Step_2] lanny: yes sanz
02/6/05 20:38:38 [USMLE_Step_2] megs: hi mean to say as huli said
02/6/05 20:38:55 [USMLE_Step_2] lanny: tamox is mixed agon and antag
02/6/05 20:38:56 [USMLE_Step_2] sanz: tamox is endom agonist
02/6/05 20:39:04 [USMLE_Step_2] sanz: but breast antag
02/6/05 20:39:13 [USMLE_Step_2] sanz: so used in breast ca
02/6/05 20:39:20 jnkhampton Logs Out
02/6/05 20:39:20 [USMLE_Step_2] lanny: yes
02/6/05 20:39:23 [USMLE_Step_2] huli72: tamox incr risk of endometrial ca.
02/6/05 20:39:36 [USMLE_Step_2] lanny: agonist on bone too thats why it prvt osteo
02/6/05 20:39:38 [USMLE_Step_2] huli72: you are right,sanz
02/6/05 20:39:53 [USMLE_Step_2] megs: lanny huli corrct
02/6/05 20:40:05 [USMLE_Step_2] lanny: tam agonist on endo bone antag on breast
02/6/05 20:40:14 [USMLE_Step_2] sanz: vlad, i agree abt staging next if the q doesnt mention grade
02/6/05 20:40:29 [USMLE_Step_2] sanz: what is the most common stage at presentation in endom ca?
02/6/05 20:40:29 [USMLE_Step_2] vladimir: thanks
02/6/05 20:40:35 [USMLE_Step_2] huli72: you get it now, lanny
02/6/05 20:40:49 [USMLE_Step_2] lanny: i agree with you all along huli
02/6/05 20:40:59 [USMLE_Step_2] huli72: I
02/6/05 20:41:06 [USMLE_Step_2] sanz: good which is...?
02/6/05 20:41:10 [USMLE_Step_2] megs: stage 1
02/6/05 20:41:10 [USMLE_Step_2] strug: ok pt with PMP bleeding negative endometial bipsoy..what next?
02/6/05 20:41:32 [USMLE_Step_2] huli72: us?
02/6/05 20:41:34 [USMLE_Step_2] vladimir: what is PMP strug
02/6/05 20:41:39 BabaORiley Logs in
02/6/05 20:41:39 [USMLE_Step_2] strug: post menopausal
02/6/05 20:41:40 [USMLE_Step_2] sanz: confined to uterus...
02/6/05 20:41:43 [USMLE_Step_2] lanny: postmenopausal
02/6/05 20:41:45 [USMLE_Step_2] huli72: post menopausla
02/6/05 20:42:01 [USMLE_Step_2] strug: stage 1 is most common stage at dianois
02/6/05 20:42:02 [USMLE_Step_2] lanny: sono
02/6/05 20:42:04 BabaORiley Joins Subroom Clinical_Skills
02/6/05 20:42:10 BabaORiley Joins Subroom USMLE_Step_1
02/6/05 20:42:14 BabaORiley Joins Subroom USMLE_Step_2
02/6/05 20:42:24 [USMLE_Step_2] huli72: correct? strug
02/6/05 20:42:46 [USMLE_Step_2] megs: usg for ovarian malignancy
02/6/05 20:42:55 [USMLE_Step_2] lanny: sonogram measures the endo lining
02/6/05 20:43:01 [USMLE_Step_2] megs: or ectopic hormone production by ovary
02/6/05 20:43:08 [USMLE_Step_2] sanz: then pt has atrophic bleeding strug
02/6/05 20:43:17 [USMLE_Step_2] huli72: usg to see what's inside the uterus.
02/6/05 20:43:20 [USMLE_Step_2] strug: yup sanz u gotacha
02/6/05 20:43:30 [USMLE_Step_2] megs: atropy will be seen on histopath sanz
02/6/05 20:43:45 [USMLE_Step_2] huli72: you may be right, strug
02/6/05 20:43:56 [USMLE_Step_2] strug: i think my q was incomplete i should have said endomatrial samplling shows atrophy what next?
02/6/05 20:44:00 [USMLE_Step_2] sanz: pt doesnt have endom ca... no need to do more inestigation
02/6/05 20:44:36 [USMLE_Step_2] sanz: ?
02/6/05 20:44:41 [USMLE_Step_2] strug: how do u treat atrophic bleeeign?
02/6/05 20:44:51 [USMLE_Step_2] dua_frank: progesterone?
02/6/05 20:44:52 [USMLE_Step_2] sanz: estrogen cream?
02/6/05 20:44:57 [USMLE_Step_2] huli72: young or old pt have a better prognosis of endometrial ca?
02/6/05 20:45:05 [USMLE_Step_2] sanz: old huli?
02/6/05 20:45:05 [USMLE_Step_2] lanny: if atrophy then give HRT?
02/6/05 20:45:09 [USMLE_Step_2] huli72: estrogen
02/6/05 20:45:16 [USMLE_Step_2] huli72: no, sanz
02/6/05 20:45:19 [USMLE_Step_2] strug: HRT with eso and prog both....estro alone inc the chanced of endo carcinoma guys
02/6/05 20:45:24 [USMLE_Step_2] lanny: cause you know its not bleed from cancer
02/6/05 20:45:40 [USMLE_Step_2] huli72: oh
02/6/05 20:45:54 [USMLE_Step_2] huli72: young pt has a better prog
02/6/05 20:45:55 [USMLE_Step_2] lanny: give both estr and prog
02/6/05 20:45:58 [USMLE_Step_2] sanz: huli, i was guessing... i thought it would be very unusual for young ppl to have endom ca... so if they have it, would be very aggressive and so bad Px...
02/6/05 20:46:49 [USMLE_Step_2] huli72: but the ans is young pt has better ...
02/6/05 20:46:56 [USMLE_Step_2] sanz: ok
02/6/05 20:47:03 [USMLE_Step_2] strug: bipsy shows endometrial carcnoma..... what next?
02/6/05 20:47:12 [USMLE_Step_2] sanz: stage
02/6/05 20:47:23 [USMLE_Step_2] huli72: CT pelvis?
02/6/05 20:47:29 [USMLE_Step_2] lanny: hysterectomy
02/6/05 20:47:29 [USMLE_Step_2] strug: do a metastatic worksup and Rx acc to stage.....
02/6/05 20:47:59 [USMLE_Step_2] strug: remember in all cancer after diagnois...is staging and metastatic workup
02/6/05 20:48:11 [USMLE_Step_2] strug: then RX
02/6/05 20:48:22 [USMLE_Step_2] lanny: what is inovlved in metast work up
02/6/05 20:48:23 [USMLE_Step_2] vladimir: let's go to ovarian -HY topic
02/6/05 20:48:29 [USMLE_Step_2] strug: to which patients u give radiotherapy?
02/6/05 20:49:00 [USMLE_Step_2] lanny: there is something about poor and good prognosis strug
02/6/05 20:49:09 [USMLE_Step_2] strug: yup
02/6/05 20:49:17 [USMLE_Step_2] lanny: poor prog give rad
02/6/05 20:49:27 [USMLE_Step_2] strug: who have poor prog lanny
02/6/05 20:49:27 [USMLE_Step_2] lanny: this is those with mets
02/6/05 20:49:29 [USMLE_Step_2] sanz: ok.. ovarain ca... presentation?
02/6/05 20:49:41 [USMLE_Step_2] strug: ascites
02/6/05 20:49:44 BabaORiley Logs Out
02/6/05 20:49:45 [USMLE_Step_2] vladimir: mass in pelvis
02/6/05 20:49:53 [USMLE_Step_2] huli72: and ovarian mass
02/6/05 20:50:03 [USMLE_Step_2] dua_frank: baba o riley lol
02/6/05 20:50:23 [USMLE_Step_2] sanz: dua
02/6/05 20:50:25 [USMLE_Step_2] lanny: who is he oer she
02/6/05 20:50:29 [USMLE_Step_2] vladimir: whaqt that men dua
02/6/05 20:50:34 [USMLE_Step_2] lanny: ok lets focus
02/6/05 20:50:38 [USMLE_Step_2] dua_frank: somebody by that name left the chat
02/6/05 20:50:40 [USMLE_Step_2] dua_frank: sorry guys
02/6/05 20:50:50 [USMLE_Step_2] lanny: kick him out dua
02/6/05 20:50:59 [USMLE_Step_2] dua_frank: he kicked himself out
02/6/05 20:51:14 [USMLE_Step_2] sanz: yes... abdo mass and ascites
02/6/05 20:51:19 [USMLE_Step_2] vladimir: what's MC ovarian Ca
02/6/05 20:51:20 [USMLE_Step_2] sanz: Dx?
02/6/05 20:51:22 [USMLE_Step_2] dua_frank: i have a question
02/6/05 20:51:34 [USMLE_Step_2] sanz: shoot
02/6/05 20:51:41 [USMLE_Step_2] dua_frank: how do provera and tomoxifen help in stage III and IV endo ca?
02/6/05 20:51:42 [USMLE_Step_2] sanz: vlad, serous?
02/6/05 20:52:00 [USMLE_Step_2] vladimir: yes- up to 30-50%
02/6/05 20:52:09 [USMLE_Step_2] strug: serous
02/6/05 20:52:27 [USMLE_Step_2] huli72: leading cause of death from gyn ca?
02/6/05 20:52:33 [USMLE_Step_2] vladimir: what's arrhenobalstoma
02/6/05 20:52:36 [USMLE_Step_2] strug: ovdariaon
02/6/05 20:52:39 [USMLE_Step_2] dua_frank: ov ca
02/6/05 20:52:40 [USMLE_Step_2] megs: ca ovary
02/6/05 20:52:46 [USMLE_Step_2] huli72: yup
02/6/05 20:52:56 [USMLE_Step_2] sanz: arrhenoblastoma is ovarian ca?
02/6/05 20:53:00 [USMLE_Step_2] huli72: what is that? vlad
02/6/05 20:53:09 [USMLE_Step_2] vladimir: i am asking what's kind
02/6/05 20:53:12 [USMLE_Step_2] dua_frank: genital ca huli
02/6/05 20:53:17 [USMLE_Step_2] sanz: i cant even pronouce that vlad! hehe
02/6/05 20:53:19 [USMLE_Step_2] dua_frank: gyn ca would be breast ca
02/6/05 20:53:20 [USMLE_Step_2] huli72: thanks, dua
02/6/05 20:53:36 [USMLE_Step_2] sanz: dua, dunno
02/6/05 20:53:43 [USMLE_Step_2] megs: arrenoblastoma is androgen secreting tumor
02/6/05 20:53:48 [USMLE_Step_2] dua_frank: no i mean MC genital ca is ov ca
02/6/05 20:53:53 [USMLE_Step_2] dua_frank: and overall gyn ca, breast ca
02/6/05 20:53:59 [USMLE_Step_2] lanny: i think so dua
02/6/05 20:54:00 [USMLE_Step_2] vladimir: it's Sertoli_leidig tumor adrogen secreting Ca
02/6/05 20:54:08 [USMLE_Step_2] dua_frank: welcome huli
02/6/05 20:54:22 [USMLE_Step_2] lanny: is ovary considered a genital
02/6/05 20:54:32 [USMLE_Step_2] dua_frank: yeah
02/6/05 20:54:42 [USMLE_Step_2] lanny: or you mean gynecological
02/6/05 20:54:56 [USMLE_Step_2] dua_frank: genital system comprises of ovary too
02/6/05 20:55:06 [USMLE_Step_2] dua_frank: it's a different way to say reproductive
02/6/05 20:55:21 [USMLE_Step_2] dua_frank: some books say that way
02/6/05 20:55:24 [USMLE_Step_2] vladimir: what's MC germ cell Ca
02/6/05 20:55:28 [USMLE_Step_2] lanny: yes but your previous question was not answered correctly
02/6/05 20:55:44 [USMLE_Step_2] sanz: dysgermino vlad
02/6/05 20:55:47 [USMLE_Step_2] dua_frank: i didn't ask a question, i was merely correcting huli's question
02/6/05 20:55:55 [USMLE_Step_2] megs: when ovarian mass is considered to be followed up for malignancy imean wwhat siza???
02/6/05 20:55:56 [USMLE_Step_2] vladimir: yes sanz
02/6/05 20:55:59 [USMLE_Step_2] dua_frank: most common gyn ca would be breast ca not ov ca
02/6/05 20:56:01 [USMLE_Step_2] sanz: dua, you asked a q abt provera
02/6/05 20:56:08 [USMLE_Step_2] sanz: what's the ans?
02/6/05 20:56:11 [USMLE_Step_2] dua_frank: oh yeah sanz but nobody answered
02/6/05 20:56:13 [USMLE_Step_2] dua_frank: i don't know either
02/6/05 20:56:19 [USMLE_Step_2] sanz: lol
02/6/05 20:56:20 [USMLE_Step_2] lanny: ok now i got you dua
02/6/05 20:56:22 [USMLE_Step_2] huli72: oh, no, dua, I asked most common cause of death from Gyn ca.
02/6/05 20:56:35 [USMLE_Step_2] vladimir: what's said about Schiller-Duval body
02/6/05 20:56:41 malak1993 Logs in
02/6/05 20:56:41 [USMLE_Step_2] dua_frank: yes huli which is still breast ca
02/6/05 20:56:45 [USMLE_Step_2] dua_frank: before ov ca
02/6/05 20:56:48 [USMLE_Step_2] huli72: most common ca is breast ca
02/6/05 20:57:00 [USMLE_Step_2] dua_frank: ca breast, lung, large intestine then ov ca
02/6/05 20:57:06 [USMLE_Step_2] dua_frank: death order that is
02/6/05 20:57:07 [USMLE_Step_2] lanny: agree huli
02/6/05 20:57:09 [USMLE_Step_2] huli72: but cause of death is ovarian ca
02/6/05 20:57:16 [USMLE_Step_2] sanz: vlad, dont know...
02/6/05 20:57:29 [USMLE_Step_2] dua_frank: my book says this way huli, might be wrong
02/6/05 20:57:34 [USMLE_Step_2] megs: provera is projesterone ..that protects endometrium from estrogen
02/6/05 20:57:35 [USMLE_Step_2] vladimir: endodermal sinus tumor
02/6/05 20:58:00 [USMLE_Step_2] vladimir: very HY Q- what's associated with struma ovarii
02/6/05 20:58:21 [USMLE_Step_2] sanz: so it's a germ cell tumour then... yolk sac basically
02/6/05 20:58:26 [USMLE_Step_2] megs: hyperthyroidism vlad
02/6/05 20:58:47 [USMLE_Step_2] dua_frank: megs why tamoxifen?
02/6/05 20:58:53 [USMLE_Step_2] huli72: granulosa cell tumor, vlad
02/6/05 20:58:54 [USMLE_Step_2] dua_frank: i understand provera but why tamoxifen?
02/6/05 20:59:08 [USMLE_Step_2] vladimir: yes megs but which kind of ovfarian tumor is associate with
02/6/05 20:59:15 [USMLE_Step_2] dua_frank: esp when it causes endo ca itself
02/6/05 20:59:24 [USMLE_Step_2] megs: teratoma.dermoid cyst
02/6/05 20:59:37 [USMLE_Step_2] sanz: vlad, has hydrothorax...
02/6/05 20:59:57 [USMLE_Step_2] huli72: that is fibroma, sanz
02/6/05 21:00:09 [USMLE_Step_2] lanny: megs is right
02/6/05 21:00:11 [USMLE_Step_2] sanz: what is the one with ascites?
02/6/05 21:00:17 [USMLE_Step_2] vladimir: exactly- it's benign cystic teratome (Kaplan simulated CD, block 2)
02/6/05 21:00:48 [USMLE_Step_2] huli72: epithelial ovarian tumor, sanz?
02/6/05 21:00:54 [USMLE_Step_2] lanny: fibroma has acites
02/6/05 21:00:58 [USMLE_Step_2] sanz: huli dont know
02/6/05 21:01:13 [USMLE_Step_2] huli72: I mean, do I ans correct?
02/6/05 21:01:16 [USMLE_Step_2] sanz: vlad, can you summarise what stuma ovarii is and what it is asso with?
02/6/05 21:01:25 [USMLE_Step_2] vladimir: serous cystadenocarcinoma, mucinous, endometriod
02/6/05 21:01:35 [USMLE_Step_2] sanz: huli, i asked cuz i dont know... i'm quite confused... hehe
02/6/05 21:01:45 [USMLE_Step_2] huli72: oh, sanz
02/6/05 21:01:58 [USMLE_Step_2] dua_frank: meigs?
02/6/05 21:02:04 [USMLE_Step_2] dua_frank: i mean metastatic ca
02/6/05 21:02:04 [USMLE_Step_2] sanz: yes! that;s it
02/6/05 21:02:05 [USMLE_Step_2] huli72: you are right, lanny
02/6/05 21:02:32 [USMLE_Step_2] sanz: Meig's syndr has ascites
02/6/05 21:02:37 [USMLE_Step_2] lanny: also fibrioma has calcifi
02/6/05 21:02:38 [USMLE_Step_2] sanz: thnx dua
02/6/05 21:02:43 [USMLE_Step_2] dua_frank: welcome
02/6/05 21:02:51 [USMLE_Step_2] lanny: meigs sd is bilat fibroma
02/6/05 21:02:58 [USMLE_Step_2] megs: what is krukenbergs tumor??
02/6/05 21:03:08 [USMLE_Step_2] lanny: mets to stooamch
02/6/05 21:03:11 [USMLE_Step_2] sanz: gastric ca mets to ovary
02/6/05 21:03:15 [USMLE_Step_2] huli72: stomach ca meta to ovrary
02/6/05 21:03:20 [USMLE_Step_2] megs: sanz is rt
02/6/05 21:03:31 [USMLE_Step_2] lanny: yes other way round
02/6/05 21:03:32 [USMLE_Step_2] sanz: what is struma ovarii?
02/6/05 21:03:52 [USMLE_Step_2] lanny: ovary contain thyroid tissue
02/6/05 21:04:05 [USMLE_Step_2] huli72: benign cystic terotoma with a lot of thyroid tissue that cause hyperthyroidism
02/6/05 21:04:15 [USMLE_Step_2] sanz: thnx guys... sorry abt my confusion
02/6/05 21:04:39 [USMLE_Step_2] lanny: is struma ovarii also cystic teratoma
02/6/05 21:04:45 [USMLE_Step_2] dua_frank: peudomyxoma peritonei?
02/6/05 21:05:23 [USMLE_Step_2] huli72: only one kind of, lanny
02/6/05 21:05:41 [USMLE_Step_2] lanny: oh thanks
02/6/05 21:05:44 [USMLE_Step_2] sanz: dua, that's mucinous adeno
02/6/05 21:05:49 [USMLE_Step_2] dua_frank: yes
02/6/05 21:05:53 [USMLE_Step_2] sanz: really?
02/6/05 21:06:05 [USMLE_Step_2] dua_frank: yes
02/6/05 21:06:20 [USMLE_Step_2] sanz: ok... it was a guess
02/6/05 21:06:28 [USMLE_Step_2] dua_frank: good guess :P
02/6/05 21:06:38 [USMLE_Step_2] dua_frank: which are more malignant, epithelial or germ cell tums?
02/6/05 21:06:47 [USMLE_Step_2] huli72: epit\
02/6/05 21:06:50 [USMLE_Step_2] dua_frank: yep
02/6/05 21:07:03 [USMLE_Step_2] sanz: epith
02/6/05 21:07:16 [USMLE_Step_2] lanny: which assoc with turners
02/6/05 21:07:21 [USMLE_Step_2] vladimir: i found it in Kaplan Cd -block 2, q.48-49. q.48- 14 y.o.lady with excessive eating, weight loss and tremer
02/6/05 21:07:36 [USMLE_Step_2] dua_frank: inc HCG in?
02/6/05 21:07:39 [USMLE_Step_2] huli72: at which stage are most ovarian tumor found?
02/6/05 21:07:52 [USMLE_Step_2] sanz: huli, late atsges with mets
02/6/05 21:07:52 [USMLE_Step_2] huli72: no, T4
02/6/05 21:08:01 [USMLE_Step_2] megs: 50 yrs
02/6/05 21:08:01 [USMLE_Step_2] sanz: stages even
02/6/05 21:08:10 [USMLE_Step_2] huli72: you are right, stage 3 or 4
02/6/05 21:08:30 [USMLE_Step_2] lanny: think is more 4
02/6/05 21:08:47 [USMLE_Step_2] megs: ovarian ca screening?? do what???
02/6/05 21:08:48 [USMLE_Step_2] dua_frank: dysgerminoma and chorioca
02/6/05 21:09:05 [USMLE_Step_2] dua_frank: alpha fetoprotein marker for which kind of ov ca?
02/6/05 21:09:06 [USMLE_Step_2] huli72: pelvic exam?
02/6/05 21:09:17 [USMLE_Step_2] megs: usg and tumor marker ca125 too huli
02/6/05 21:09:41 [USMLE_Step_2] huli72: but I heard they are not effective
02/6/05 21:09:44 [USMLE_Step_2] lanny: tell us dua
02/6/05 21:10:00 [USMLE_Step_2] dua_frank: endofermal sinus tumor
02/6/05 21:10:24 [USMLE_Step_2] dua_frank: isn't ca 125 a marker for only epith tums?
02/6/05 21:10:27 [USMLE_Step_2] lanny: megs tell us about screening plz
02/6/05 21:10:42 [USMLE_Step_2] huli72: I think you r right, dua
02/6/05 21:10:55 [USMLE_Step_2] megs: pelvic exam main stay for screening
02/6/05 21:11:12 [USMLE_Step_2] lanny: who should screen
02/6/05 21:11:25 [USMLE_Step_2] megs: then usg..mass more than 8 cm is high risk
02/6/05 21:11:38 [USMLE_Step_2] megs: and tomor markers
02/6/05 21:11:38 [USMLE_Step_2] huli72: ovarian tumor pt also be monitor for what other ca?
02/6/05 21:11:50 [USMLE_Step_2] megs: ca125 for epithelial
02/6/05 21:11:56 [USMLE_Step_2] lanny: yes megs
02/6/05 21:11:59 [USMLE_Step_2] megs: ldh for dysgerminoma
02/6/05 21:12:04 [USMLE_Step_2] lanny: epithelial is right
02/6/05 21:12:16 [USMLE_Step_2] lanny: whats idh
02/6/05 21:12:21 [USMLE_Step_2] megs: alfa feto for endidernal sinus\
02/6/05 21:12:34 [USMLE_Step_2] megs: and hcg for chorioca
02/6/05 21:13:13 [USMLE_Step_2] megs: these r some specifec tumor markers for each
02/6/05 21:13:30 [USMLE_Step_2] lanny: thanks megs, whats idh
02/6/05 21:13:35 [USMLE_Step_2] dua_frank: LDh lanny
02/6/05 21:13:41 [USMLE_Step_2] megs: LDH SORRY
02/6/05 21:13:49 [USMLE_Step_2] lanny: thx
02/6/05 21:13:49 [USMLE_Step_2] megs: typing mistake
02/6/05 21:13:57 [USMLE_Step_2] lanny: ok got you
02/6/05 21:14:22 [USMLE_Step_2] dua_frank: sanz, all ov cas can cause ascitis but when ascitis is associated with hydrothorax thinking of due to ovarian fibroma and thats meigs syndrome
02/6/05 21:14:38 [USMLE_Step_2] sanz: oke... thnx dua
02/6/05 21:14:39 [USMLE_Step_2] megs: dua is right
02/6/05 21:14:41 [USMLE_Step_2] dua_frank: "right sided hydrothorax"
02/6/05 21:14:45 [USMLE_Step_2] megs: yup
02/6/05 21:14:49 [USMLE_Step_2] lann







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