View Full Version : Obgyn chat: Gynecological Neoplasia

03-16-2005, 08:38 PM
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[erum] n there wasnt enuf time
[erum] me too
[drsujitvasanth] did you do qbank t practice?
[drsujitvasanth] to pratice...
[erum] yep
[drsujitvasanth] timed?
[erum] q bank is way easier then those q
[erum] ye
[erum] always had
[drsujitvasanth] my exam was exactly like qbank
Now entering USMLE_Step_2 subroom.
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[drsujitvasanth] hi frank
[dua_frank] hey sujit
[dua_frank] sorry about the file
[drsujitvasanth] no problem...
[dua_frank] i'll try sending you again tonight
[drsujitvasanth] soent the day doing psych...
[drsujitvasanth] ok thank :o)
[drsujitvasanth] thanks
[dua_frank] welcome
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[drsujitvasanth] just telling erum to join us.,....
[drsujitvasanth] hi erum...
[erum] hi
[dua_frank] welcome erum
[dua_frank] i'll be right back
[drsujitvasanth] sam just arrived but left again...
[erum] tx dua
[drsujitvasanth] erum ...what saw your qbank score?
[drsujitvasanth] step 1 qbank...
[erum] around 78-80
[drsujitvasanth] wow!
[drsujitvasanth] youll do very well...
[drsujitvasanth] should get in the 90's
[erum] i felt like iwuz taking step 2
[drsujitvasanth] yeah...i know...
[erum] nooo way
[erum] im teling ya
[drsujitvasanth] its good for us postgrads...makes it easier than basic science...
[drsujitvasanth] really erum..i did the stats on peoples correltaions...
[drsujitvasanth] you'll do well for sure...
[erum] the q were getting harder
[drsujitvasanth] [email protected] found that too....
[drsujitvasanth] Im sure the first block was MUCH easier
[erum] is that progressive pattern
[drsujitvasanth] and then got harder...
[erum] exam/
[drsujitvasanth] nooo..?
[erum] ?
[drsujitvasanth] really?
[erum] yeh
[drsujitvasanth] i thaught the questions were random/
[drsujitvasanth] anyway..you WILL do well lol..im sure
[erum] if i got sum topics ..which i responded promptly got disappeared in upcoming blocks
[erum] n the tougher topics were coming back again n again
[erum] even with the answers ihad 2nd thoughts with majority of them
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[samantha] hi all
[drsujitvasanth] hi sam
[erum] hi
[dua_frank] hi sammy
[dua_frank] megs is not here today too, i hope shes okay
[samantha] hi sujit dua and erum
[an_bo_al] hey
[drsujitvasanth] hi an_
[erum] hi sam
[dua_frank] hey bo
[erum] hi an
[samantha] yes megs is not here miss her q's
[drsujitvasanth] yep...
[dua_frank] feros not here for the last two days too
[samantha] yea
[dua_frank] what can be used to assess if conservative management of a post menopausal adnexal cyst is working?
[drsujitvasanth] ?
[dua_frank] its obgyn today
[dua_frank] what test?
[dua_frank] hey megs :)
[megs] hi dua
[dua_frank] i'm so happy to see you :)
[megs] missed y day
[dua_frank] yeah, you can read the chat transcript on the forum megs, ive posted yesterdays
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[megs] i read dua
[dua_frank] obgyn today, Gynecological Neoplasia
[megs] ok
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[dua_frank] the test is USG to see the size of the mass which should ideally remain less than 5 cm, next best would be tumor marker CA 125
[drsujitvasanth] ah..
[drsujitvasanth] what would the conservative management be?
[dua_frank] removal
[dua_frank] surgical i mean
[dua_frank] first laproscopic evaluation and biopsy
[megs] what if cyst size is 5 cm in a pt of 34 yrs??
[dua_frank] then TAH with BSO
[megs] what will u do next??
[dua_frank] laproscopy
[megs] nope...
[dua_frank] cystectomy
[uniteus] hello everyone
[drsujitvasanth] hi uni...
[dua_frank] hi uni
[dua_frank] oh wait
[dua_frank] ocps?
[megs] chances in reproductive age ...of functional ovarian cyst
[megs] yup
[megs] ocps
[dua_frank] i tried almost everythng *)
[dua_frank] thats how bad i am at obgyn :(
[drsujitvasanth] whats an adenxal cyst anyways?
[drsujitvasanth] :?
[megs] adnexal mass is a term used for ...tubo.ovarian mass
[drsujitvasanth] ah...
[dua_frank] what could they mean?
[megs] it may be from tube, overy..or emb remnanets
[drsujitvasanth] ok so what would the first step in management?
[samantha] oral contra
[dua_frank] their existance may point toward ovarian abscess, dermoid cysts and sometimes malignancy
[samantha] ultra sound megs
[drsujitvasanth] ah ok..
[megs] yeas dua agree with u
[samantha] to see if simple or complex
[drsujitvasanth] so US, CEA and lap bx if over 5cm?
[dua_frank] over 7 mm in reproductive age
[megs] management of adnexal mass depend on age gr..
[drsujitvasanth] k..
[dua_frank] over 5cm in postmenopausal
[drsujitvasanth] 7 cm or mm?
[samantha] yes dua 7cm in repro age
[megs] postmenopausal ans prepubertal is ...always...considered harmful
[megs] yup dua
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[drsujitvasanth] thanks megs...
[drsujitvasanth] sory CA-125?
[drsujitvasanth] not CEA?
[dua_frank] yes
[drsujitvasanth] lol
[dua_frank] CEA is for colon? or pancreas?
[dua_frank] i always get confused
[drsujitvasanth] CEA non specific..
[dua_frank] oh
[dua_frank] great
[dua_frank] megs can you please tell us how to manage them according to age?
[drsujitvasanth] coloc and pancreas...i think...used to Follow up patuent not to diagnose...
[megs] both colon and p[ancreas dua
[dua_frank] hehe
[drsujitvasanth] CA125 ovaian...
[megs] ok
[samantha] but it says CA125 and CEA for epithelial ca
[megs] prepubertal...dd are germ cell tumours...so always explore surgically
[drsujitvasanth] i thinks thats epithelial ovarian Ca?
[samantha] yes sujit
[megs] iether do diagnostic laproscopic biopsy..followed by surgical exploration
[megs] ca 125 for epithelial ovarian ca
[megs] if benign cyst then cystectomy
[samantha] agree megs
[megs] and if germ cell t...then unilat salpingooophorectomy...try to conserve ovarian function if other overy is normal
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[drsujitvasanth] ah..
[megs] in reproductive age..cyst less than 7 cm ..observe and give ocps...generally fun cyst ressolves
[megs] if ovarian mass is complex...do oophorectomy
[drsujitvasanth] fun?
[uniteus] functional cyst
[drsujitvasanth] ah.. :)
[drsujitvasanth] got it..
[drsujitvasanth] thanks megs that was really good..
[dua_frank] how about in postmenopausal age megs?
[uniteus] thx megs
[megs] post menopausal..if overy is clinically palpable it is pathological
[megs] as in menopause ovaries undergo atrophy
[drsujitvasanth] ah..
[samantha] yes megs
[megs] so any ovarian mass above 5 cm...in menopausal age gr...think of malignancy first
[megs] and exploratary laprotomy will be the management
[megs] what is surgical laparotomy???
[drsujitvasanth] got it...
[dua_frank] TAH with BSO?
[megs] or surgical staging i mean??
[samantha] for what megs
[samantha] ovarian ca?
[drsujitvasanth] is that wen you cut it out and the paholoist tells you the margins are clear? (guess)
[megs] what is staging laprotomy...all q means same..for ovarian mass sammy??
[megs] no sujit
[uniteus] u look for the spread when u do the lap
[drsujitvasanth] oh well : :oops:
[megs] yup uni
[drsujitvasanth] ah...
[dua_frank] so you stage and then cut
[samantha] see if it benign or malign on histo
[dua_frank] right megs?
[megs] after opening abd u take samles from omentum paracolic guters ..ascitic fluid and send them for histopath to know extent of tumour
[samantha] oh...yes
[megs] so that u can know the spread of ovarian mass..in peritoneal cavity
[megs] what is debulking surgery???
[dua_frank] you remove all that is infected with cancer
[dua_frank] including omenta, intestine
[megs] yup dua
[dua_frank] plus TAH and BSP
[dua_frank] BSO
[megs] remove as much as u can...
[drsujitvasanth] ah..
[megs] it is also known as cytoreductive surgery
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[dua_frank] that was a nice explaination megs, thank you
[uniteus] yeah..thx megs
[drsujitvasanth] thanks:)
[megs] why u do debulking surgery???
[drsujitvasanth] palliation?
[megs] ju remove as much as tissue..so less tumour mass is remaining ...so the chemotherapy will be more effective
[drsujitvasanth] ah..
[megs] as chemotherapeutic agent has less cancer cells to act upon
[dua_frank] is there anything in particular you use for chemotherapy megs and for how long?
[megs] generally for ovarian..cisplatin +praclitaxel..are best drugs
[megs] u give 6 cycles of chemo
[dua_frank] cycles of how many months?
[megs] each cycle is 3 weekly
[megs] such 6 cycles
[dua_frank] so 6 months approx
[dua_frank] thanks megs
[drsujitvasanth] thanks megs...
[megs] yeah...gemnerally max pt respond to thhis
[dua_frank] can tamoxifen cause breast cancer?
[drsujitvasanth] ?
[drsujitvasanth] its a partial agonist....but id say no....
[drsujitvasanth] of estrogen
[dua_frank] right it doesnt
[drsujitvasanth] causes ebdometrial...
[drsujitvasanth] sometimes
[dua_frank] why can't you use this instead in ERT?
[megs] yes tamoxifene cause endometrial ca
[drsujitvasanth] ERT?
[dua_frank] estrogen replacement therapy
[megs] because its partial agonist...on some tissue it will act like estrogen like andometrium..
[dua_frank] oh
[megs] and on some tissue like antagonist...like breast..
[dua_frank] nice
[drsujitvasanth] ah..
[dua_frank] so another reason why it cannot be used
[drsujitvasanth] wow thanks mags :)
[drsujitvasanth] megs..
[dua_frank] apart from the fact that it cannot cure hot flashes and may cause DVT and risk of PE
[megs] ok i will ask tumour marker u tell me tumour
[megs] thanx dua
[megs] b hcg..???
[dua_frank] chorioca
[drsujitvasanth] mole preg?
[megs] yes
[megs] alfa fetoprt???
[drsujitvasanth] liver..seminoma...
[dua_frank] endodermal
[drsujitvasanth] and yolk sac..
[megs] tell gyn sujit
[dua_frank] and embryonal
[megs] yes
[megs] ldh???LDH
[dua_frank] dysgerminoma
[megs] YUP
[dua_frank] why are hypertensives and diabetics prone to endo cas?
[dua_frank] i don't know why...
[drsujitvasanth] obesity
[drsujitvasanth] inc estrogen?
[megs] yeu sujit correct
[dua_frank] no those are independent factors
[dua_frank] i want to know why HTN and DM
[drsujitvasanth] the link is probably pcos..
[drsujitvasanth] commonest cause inc bo is obesity
[megs] dm...associated with pcos
[dua_frank] oh
[dua_frank] polycystic ovarian syndrome?
[dua_frank] in DM and HTN?
[drsujitvasanth] pcos assoc dm....
[dua_frank] thanks, i didn't know this association
[megs] hypetension i am not sure but think..that is asssoocoated with obesity
[drsujitvasanth] htn assoc with obesity ...assoc inc oestrogen prduction in adipose
[megs] hypertension is not with PCOS DUA
[dua_frank] ok
[samantha] yes sujit
[drsujitvasanth] can someone summarise the mamography screening in the USA?
[drsujitvasanth] and then the cervical pap smear
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[dua_frank] what rx will you give to a patient with preinvasive ca of endo with atypical hyperplasia?
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[drsujitvasanth] D&C?
[megs] high dose progesterone can be given...but better to do hyterectomy
[dua_frank] hyterectomy
[drsujitvasanth] oh.. :)
[dua_frank] simple and complex hyperplasias, you can give progesterone
[lanny] hello guys
[drsujitvasanth] hi lanny!
[lanny] sorry late
[samantha] for pap smear is started at age 18 or when at the onset of sexual activity and after that for 3 consecutive years,if -ve then every 3 yrs
[lanny] good sammy
[drsujitvasanth] thanks sam :)
[dua_frank] hi lanny
[lanny] hi dua so OB right
[dua_frank] every 2 or 3 years sammy?
[megs] AGREE DUA
[dua_frank] yes lanny
[lanny] its 3 dua
[megs] 3
[dua_frank] thanks
[samantha] yes dua every 3 yrs
[drsujitvasanth] can someone do the same for mamography please....
[lanny] dua did you post the sched
[drsujitvasanth] [email protected] megs
[lanny] atrophy
[drsujitvasanth] agrre with lanny
[dua_frank] yes i did lanny
[lanny] thanks dua
[dua_frank] welcome
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[drsujitvasanth] mamography scedule?
[drsujitvasanth] hi malak....
[lanny] 50 yrs start annually
[drsujitvasanth] thanks lanny...
[lanny] 40 if fam hx. right dua?
[dua_frank] mammo baseline at 35-40 yrs
[dua_frank] every 2 years between 40a nd 50
[dua_frank] annually after 50
[dua_frank] yes lanny annually after 40 with family history
[drsujitvasanth] thanks frank...
[drsujitvasanth] thanks lanny
[samantha] thanx dua
[dua_frank] welcome
[lanny] no probs sujit
[dua_frank] histo of endoca is?
[lanny] can we go thru pap smear screening systematically confusing
[megs] adenocarcinoma dua
[dua_frank] yes
[drsujitvasanth] adeno....agree
[dua_frank] when does endo ca become palpable?
[lanny] dont u stand q dua
[drsujitvasanth] with mets?
[drsujitvasanth] late?
[megs] stage 3 dua???
[dua_frank] yes when it spreads till the ligaments
[lanny] oh now i get it
[dua_frank] broad ligaments
[dua_frank] rx of endo ca?
[drsujitvasanth] lanny >> see sams post re. pap smear
[lanny] ok will do thanks
[lanny] surgery
[lanny] hyssterectomy
[dua_frank] stage 1 and 2 rx?
[lanny] chemo
[dua_frank] yes TAH with BSO, removal of LNs and radiation of adjuvant structures
[samantha] hysterectomy with BSO
[dua_frank] stage 3 and 4?
[lanny] radiation
[samantha] radiation and chemo
[dua_frank] radiation and chemo
[dua_frank] with hormones
[dua_frank] can anyone tell me why hormones like provera and tamoxifen?
[dua_frank] esp when these predispose to endocas
[dua_frank] provera is E or P?
[lanny] cause they have agonist and antagonist effects
[dua_frank] oh
[drsujitvasanth] provera i thaught was progesterone...
[dua_frank] premarin is E right?
[megs] yup
[dua_frank] maybe they give both together
[samantha] provera is medroxyprogesterone
[lanny] yes sam brand name
[samantha] yea lanny
[lanny] premarin is estrogen got from cows horses?
[dua_frank] horse urine
[drsujitvasanth] cool :o
[dua_frank] pregnant mare urine= premarin
[samantha] yuk
[dua_frank] yuck
[dua_frank] lol
[lanny] right horse
[dua_frank] which HPV causes genital warts?
[megs] 6 and 11
[lanny] 6 11 13
[dua_frank] right
[samantha] which causes ca cx?
[dua_frank] what therapy in males can prevent cervical cas in his female partners?
[dua_frank] HPV
[dua_frank] what procedure...
[lanny] cautery
[dua_frank] think lanny think
[drsujitvasanth] circumscision
[drsujitvasanth] @ dua
[dua_frank] very good sujit
[samantha] circium
[dua_frank] also prevents penile cancers
[lanny] dua you worded not correct?
[dua_frank] i guess
[drsujitvasanth] ep..male penile cancer assoc with smegma
[lanny] what pop is HPV common in?
[megs] its new for me...circumcision prevent ca cx???
[dua_frank] yes megs
[megs] is it really dua
[drsujitvasanth] AIDS, homosexual mean
[lanny] yes megs
[dua_frank] we know that cause of cervical cas is HPV
[megs] good to know
[dua_frank] its classified as an STD
[lanny] right sujit in ho mos
[dua_frank] so circumcision prevents penile and cervical cancers
[megs] i know its STD...
[lanny] yes penile i think
[megs] but related to circumcision...cant belive
[dua_frank] if partner never has STD with HPV she won't get it either
[lanny] HPV is thru contact with warts
[megs] dua can u tell how circum cision prevents ca cx???
[dua_frank] except for those 15% of adenocas
[dua_frank] male can never get warts with circumcision megs
[samantha] mulluscum contagiosum lanny
[drsujitvasanth] :o
[dua_frank] no warts in males, cannot transmit to female
[drsujitvasanth] thats not right dua...
[drsujitvasanth] y can t circumcised men get warts?
[dua_frank] no foreskin
[drsujitvasanth] shaft?
[lanny] sure
[megs] but warts are most common viral stds
[dua_frank] thats where warts due to HPV form
[lanny] why not circumcision and warts have no correlation
[drsujitvasanth] oh...
[dua_frank] why else will circumcision be a preventable procedure?
[dua_frank] it would be silly to do circumcision then
[drsujitvasanth] when I was a med sudent thaugh i saw warts on the shaft lol
[drsujitvasanth] in STD clinic..
[lanny] warts can be anywhere
[megs] agree lanny sujit...
[lanny] warts can be anywhere
[dua_frank] then whats the point in doing circumcion?
[drsujitvasanth] its done for religous reasons lol
[lanny] religious dua
[dua_frank] and studies have proven that it prevents cas in both partners
[drsujitvasanth] yep
[dua_frank] no lanny, studies have proved it
[megs] and...HSV6 AND 11 HAS NOTHING TO DO WTH CA CX...
[lanny] yes thats the point studies have shown
[dua_frank] that it prevents both cas
[lanny] i agree dua
[drsujitvasanth] agree
[megs] OK DUA
[lanny] but circumcision is not done to prevent cancer per se
[drsujitvasanth] K lets move on to new subject...
[megs] NOW AGREE
[lanny] ok good
[dua_frank] well its a choice
[dua_frank] it also prevents phimosis and other infections
[dua_frank] anyway lets move too
[drsujitvasanth] k..i got this q on qbank....
[lanny] today is female subject
[dua_frank] lol
[lanny] leave the shaft alone lol lol
[drsujitvasanth] preinvasive cervical lesion in a pregnanct woman? Management...?
[lanny] same as in non preg?
[drsujitvasanth] i dont know the answer vy the way...its for discussion..
[dua_frank] podophyllin?
[drsujitvasanth] was hoping megs might know..
[uniteus] colonoscopy --> cone biopsy --> cryotherapy
[lanny] right uni same as in noon preg
[uniteus] ok lanny
[drsujitvasanth] any danger to baby?
[drsujitvasanth] of Rx...
[uniteus] not dat i know off
[drsujitvasanth] thanks megs...
[dua_frank] mc histology of cx ca?
[lanny] no baby is tucked inside the uterus
[megs] sq cell ca
[dua_frank] right
[lanny] transitional
[dua_frank] and mc form?
[uniteus] atypical?
[dua_frank] fungating
[dua_frank] whats the cause of death?
[megs] if lady is dignosed to have ca cx at 22 wk of gestation what will be management???
[megs] uremia dua
[dua_frank] yes megs
[uniteus] uremia
[dua_frank] plan c section?
[samantha] proceed till 33 weeks megs
[uniteus] managed the pregnancy expectantly
[drsujitvasanth] good plan sam...
[megs] npe
[samantha] for lung maturity and c sec
[dua_frank] depends on stage?
[lanny] proceed as in non preg
[megs] stage 1 b???how will u treat in pregnancy dua???
[megs] at 22 WEEK
[dua_frank] like normal pregnancy
[lanny] radical hyster
[megs] radical hysterctomy..
[megs] yup lanny
[uniteus] wait so u gettin the fetus too?
[dua_frank] oh b
[lanny] i said it before megs trt as in non preg
[uniteus] i mean aborting the preg?
[megs] or radiation
[drsujitvasanth] !
[megs] ok lanny might be i missed that
[megs] after 24 weeks u conserve ..till 32..33 weeks and then do cs...
[lanny] uni even in stg 1 as long as its invasive cancer you have to trt simple hyster means you have to abort
[samantha] rt lanny
[uniteus] ok..thanks...lanny n megs
[lanny] right at third trim you can wait and do cs
[dua_frank] what will you do if you detect dysplasia and carcinoma in pap smear?
[uniteus] cone biopsy
[megs] colposcopy
[lanny] agree megs
[dua_frank] colposcopic biopsy and ACC
[dua_frank] ECC
[uniteus] oops...thought she had colposcopy before :) sleeping again
[dua_frank] if it is atypia alone colposcopic biosy suffices
[dua_frank] lol uni
[lanny] cone biopsy is done to confirm mismatch bet cytology from the pap wmear
[uniteus] agree lanny...dat is wat i thought the q was
[megs] yes lany
[lanny] so its step wise
[dua_frank] i already said dysplasia and ca
[megs] what are the complications of cone biopsy??/
[drsujitvasanth] thanks...that cleared up a difficult topic
[uniteus] stenosis of cer os
[megs] cervical stenosis..incompitent cervix
[megs] yup uni
[lanny] dont get you dua
[megs] what is the treatment of microinvasive ca in non pregnant???
[uniteus] cone biopsy
[lanny] LEEP
[megs] yeah
[uniteus] cryo
[uniteus] lanny plz remind me LEEP please
[megs] is pap done in a lady with history of hystercomy???
[lanny] loop electroderm excison procedure
[uniteus] thx
[lanny] yes
[dua_frank] yes
[drsujitvasanth] megs..i think so...
[uniteus] yes if she has cx
[megs] yeah its recommended...
[lanny] tell us why
[lanny] megs
[megs] even without cx too
[megs] they do it
[megs] as by pan smear we see for exfoliated cells
[drsujitvasanth] thanks megs...we are learning a LOT today!
[megs] which may be from vaginal walls too
[megs] or from remnanet of cervical tissue
[dua_frank] so we're basically looking to see if it has extended
[dua_frank] right megs?
[dua_frank] to the vagina
[dua_frank] or from vagina
[megs] yup dua...
[dua_frank] thanks
[lanny] thanks for bringing it up again remember last chat so much controversy!!!!
[megs] which imaging is included in staging of ca cx???
[lanny] CT MRI
[megs] they are not included lanny
[lanny] also clinical staging
[dua_frank] laproscopic?
[megs] IVP
[lanny] oh yes right
[dua_frank] :O
[dua_frank] nice
[dua_frank] why IVP?
[lanny] staging done at surgery
[megs] its high yield guys
[drsujitvasanth] good q megs...
[dua_frank] also cystoscopy and proctoscopy
[lanny] spread to organs
[drsujitvasanth] how does cervical ca cause uraemia?
[dua_frank] and CXR
[lanny] adjacent to cervix
[dua_frank] presses on ureters
[drsujitvasanth] huh?
[lanny] right dua
[megs] invasion of ureters ..obstructive uropathy...and uremia
[drsujitvasanth] oh ok...
[megs] agree dua
[drsujitvasanth] thus IVP...makes sense....
[drsujitvasanth] thanks megs..dua
[lanny] invasion meaning spreading and pressing as diua said
[drsujitvasanth] thanks lanny..
[drsujitvasanth] <- my anatomy is not good :o
[lanny] welcom sujit
[lanny] mine is rusty
[lanny] needs polishinglol
[megs] in microinvasive ca cx...what will be mode of delivery???
[drsujitvasanth] you can frget it now lol
[megs] vaginal or cs??
[lanny] vaginal
[megs] yup
[uniteus] vaginal
[dua_frank] megs can we go through the stage diagnostics wise?
[dua_frank] i want to get it clear
[lanny] me too dua
[megs] ok dua..u proceed
[dua_frank] first you do pap smear
[megs] yes
[dua_frank] if you find inflammation you treat
[dua_frank] pap again aftetr 3-6 months
[dua_frank] if negative it was just an infection
[megs] agree
[dua_frank] if positive colposcopic biopsy
[dua_frank] positive meaning atypia
[megs] dua want to add
[dua_frank] if you find dysplasia or carcinoma you do CB plus ECC
[dua_frank] you confirm by ECC then do cone biopsy
[dua_frank] please do megs
[megs] if cin 2 and 3
[megs] u can do hpv dna
[dua_frank] thanks megs, important point
[megs] if 16 18 31...hpv u do calposcopic biopy
[megs] but its an additional...
[dua_frank] you do schillers before cone biopsy, outlines margins better
[dua_frank] yes
[megs] rest u told is a perfect routine
[megs] we follow that
[lanny] megs for CIN 1 do we do HPV dna?
[dua_frank] what do you do with moderate dysplasias megs?
[megs] no lanny
[lanny] why not
[lanny] CIN 1 is mild mod dysp
[megs] MODERATE DYSPLASIA.. cin...2 we trat as cin 3...or severe like
[lanny] is it that HPV will cause severe dyspl
[dua_frank] with conization?
[megs] treatment of CIN 2 AND 3 IS SAME
[dua_frank] thanks
[uniteus] which one prefer megs cryo, con or leep?
[lanny] no megs i mwan for HPV diag why dont we do it for CIN1?
[megs] now a days leep uni
[lanny] agree LEEP is done more
[uniteus] ok..thx
[lanny] but contra in preg/
[megs] because cin 1 in most cases is due to infection lanny
[megs] and reversible...
[dua_frank] yeah
[lanny] oh ok
[megs] if cin preogress to cin 2 then we do hpv
[dua_frank] it does include HPV lanny
[dua_frank] but we wait till it becomes moderate dysplasia to get it
[dua_frank] the changes can be easily confused with any other infection like megs said
[lanny] oh i see thanks guys
[megs] how many yeras it takes to cin1 ..in to..invasive ca cx???
[lanny] about 2 yrs
[samantha] 8-9 yrs
[megs] 7 to 10 yup sammy
[dua_frank] how will you treat stage 1 cx ca?
[lanny] simple hysterect
[dua_frank] with lymph node dissection
[dua_frank] yes surgery with LND
[dua_frank] how about other stages?
[dua_frank] 2 3 and 4
[lanny] radiation chemoo
[dua_frank] yes
[lanny] what drug is used for chemo
[dua_frank] did we miss anything in cx ca?
[lanny] dua plz post todays thankyou dear
[lanny] also is the sched in this site dua?
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[dua_frank] will do
[dua_frank] yes
[lanny] are we staying for more
[lanny] what time did you start?
[dua_frank] what two things prevents ovarian cancers?
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[drsujitvasanth] 00.30....
[dua_frank] i could stay more, how about the others?
[lanny] i can
[drsujitvasanth] can..#
[drsujitvasanth] pregnancy
[drsujitvasanth] ocp
[lanny] loose weight
[drsujitvasanth] (by decreasing total ovulation cycles)
[dua_frank] right sujit
[uniteus] early preg
[dua_frank] MC ovarian cancer type?
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[samantha] gtg too
[dua_frank] bye megs and sammy
[drsujitvasanth] vy sam
[uniteus] me too
[lanny] bye megs sam
[uniteus] bye all
[dua_frank] bye uni
[uniteus] thx
[dua_frank] epithelial
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[dua_frank] BCPs reduce the risk of what cancers?
[drsujitvasanth] BCP?
[dua_frank] OCPs
[lanny] endometrial
[drsujitvasanth] ovarian
[dua_frank] yes
[dua_frank] estrogen excess associated with what cancers?
[lanny] breast
[drsujitvasanth] breast, endometrial
[lanny] endometrial
[dua_frank] or unopposed
[dua_frank] right also ovarian
[drsujitvasanth] frank...not ovarian?
[dua_frank] sujit ovarian too
[drsujitvasanth] oh...
[dua_frank] the reason why women do not get ovarian cancers is due to protective progesterones
[drsujitvasanth] ok
[dua_frank] reason why PCO causes ovarian cans
[dua_frank] excess estrogens
[dua_frank] ovulation also reduces estrogen levels every month
[dua_frank] so protection is by ovulation and progesterone
[drsujitvasanth] oh ok....
[dua_frank] against excess estrogens
[dua_frank] but trauma to ovarian epithelium remains the mc cause of ovarian cas
[drsujitvasanth] Very productive session today.....
[dua_frank] which is why pregnancy and ocps help
[drsujitvasanth] got it....
[dua_frank] mc is serous
[dua_frank] epithelian tumor
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[dua_frank] whats pseudomyxoma peritonei?
[drsujitvasanth] i heard of it..but dont know...
[lanny] seeding of ovarian tumor cells in peritoneum
[lanny] ???
[dua_frank] its by mucinous tumor
[dua_frank] progressive accumulation of mucin within the cavity
[drsujitvasanth] ah..
[lanny] mucin coming from the tumor cells right
[dua_frank] this occurs with mucinous tumors or with mucocele of the appendix
[dua_frank] so we perform appendicetomy in all cases
[dua_frank] yes lanny
[lanny] mucinous cystadenocarc
[dua_frank] what drugs can cause ovarian cas?
[drsujitvasanth] hm..
[drsujitvasanth] ocp
[drsujitvasanth] :)
[dua_frank] nope
[dua_frank] has protective progesterone
[dua_frank] estrogen alone yes
[drsujitvasanth] oh...
[drsujitvasanth] k..
[dua_frank] clomiphene and pergonal
[dua_frank] ovulatory drugs
[drsujitvasanth] ah yes!
[drsujitvasanth] increase ovultaion...
[lanny] yes dua thanks
[drsujitvasanth] good q
[dua_frank] how abotu tamoxifen?
[dua_frank] can it cause?
[lanny] no
[drsujitvasanth] no
[lanny] can cause endom ca
[dua_frank] if it can cause endo ca can't it also cause ovarian ca/
[dua_frank] ?
[drsujitvasanth] what does the book say?
[dua_frank] no book
[dua_frank] my doubt
[drsujitvasanth] im not sure about what you said about ovarian ca and estrogen....
[drsujitvasanth] ovarian ca risk is ovulation
[drsujitvasanth] not sure if oestrogen itself is a risk
[drsujitvasanth] (i have only been through first few gynae lectures)
[dua_frank] i am sorry
[dua_frank] i meant that for endocas
[dua_frank] not ovarian
[drsujitvasanth] no problem...
[dua_frank] you're right the only way to cause ovarian ca is by ovulation
[dua_frank] not estrogen excess
[drsujitvasanth] <-- rarely right :congrats:
[dua_frank] shiller duval bodies in?
[drsujitvasanth] dont know...
[dua_frank] endodermal sinus tumor
[dua_frank] what is it's tumor marker?
[lanny] teratoma
[drsujitvasanth] ah..ok
[dua_frank] alpha feto protein
[drsujitvasanth] AFP
[dua_frank] whats struma ovarii?
[lanny] thyroid tissue in ovsry
[drsujitvasanth] heard of it...but dont know...
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[dua_frank] yes its a type of teratoma
[dua_frank] causing hyperthyroidism
[drsujitvasanth] ah... :)
[lanny] right
[dua_frank] call exner bodies in?
[lanny] gran theca
[lanny] cell tumors
[dua_frank] yes
[dua_frank] high testos in?
[lanny] sertoli leydig
[dua_frank] yes
[dua_frank] whats meigs syndrome?
[drsujitvasanth] ovarianca with chylous plearal effusion..?
[lanny] right sujit
[dua_frank] fibroma with ascitis and right sided hydrothorax
[lanny] something else
[dua_frank] what does a patient with ovarian ca die of usually?
[drsujitvasanth] ah...thats more like it @ dua....
[lanny] good dua
[drsujitvasanth] hmm...die from/
[drsujitvasanth] ?
[lanny] assoc with turners/
[dua_frank] bowel obstruction
[drsujitvasanth] good q dua :)
[lanny] what was the q dua?
[drsujitvasanth] ovarian ca in turner's @ lanny?
[lanny] yes
[dua_frank] why don't you give RT in ovarian cas?
[drsujitvasanth] ah thanks...good correlation..
[lanny] what type sujit
[drsujitvasanth] dont know lanny?
[dua_frank] we only do surgery or chemotherapy but no radio, why?
[lanny] rad therapy dua?
[drsujitvasanth] dont know dua?
[lanny] spread?
[dua_frank] kidneys and liver can't take it
[dua_frank] you have to irradiate the abdoment
[lanny] take what dua
[drsujitvasanth] ah...
[dua_frank] not safe
[drsujitvasanth] good q's!
[dua_frank] thanks
[dua_frank] common symptom of vulvar ca?
[lanny] can you explain a bit dua
[lanny] pruritus
[drsujitvasanth] agree lanny
[dua_frank] yes lanny
[dua_frank] lanny ovarian cancers are radiosensitive
[dua_frank] esp dysgerminomas
[dua_frank] like cervical and other cas
[dua_frank] but we give RT in other cas not in ovarian
[dua_frank] reason why is that ovarian cas get big inside abdomen
[dua_frank] if you irradiated the abdomen you can damage the liver and kidneys too
[dua_frank] so you manage by surgery and chemo alone
[lanny] oh i see wow never thought of that so its the size of the tumor large com to cervical or endom..
[dua_frank] vulvar lesion, red with white crust, dx?
[lanny] pagets
[dua_frank] also approach lanny
[dua_frank] yes
[drsujitvasanth] good lanny!
[dua_frank] you approach transcervical for RT
[dua_frank] route i mean
[lanny] yes dua
[dua_frank] so the abdominal structures are protected
[dua_frank] unlike in ovaries where you have to approach from the abdomen
[lanny] and you cant go trans cervix for the ovaries
[dua_frank] right
[lanny] gotcha!
[drsujitvasanth] It was very good chat today! thanks all. learned a lot.
[lanny] thanks a lot will never forget!!!!
[dua_frank] shall we call it a day?
[dua_frank] it was a good day
[lanny] welcome sujit
[lanny] it was!
[dua_frank] take care guys
[dua_frank] bye and see you tomorrow
[drsujitvasanth] uda
[drsujitvasanth] dua
[dua_frank] yes sujit
[lanny] ok dua thanks a lot agian really stim to be with you all
[drsujitvasanth] dont forget....
[drsujitvasanth] lol...
[dua_frank] same here
[dua_frank] i remember sujit, i'll send it tonight :)
[lanny] dua plz post todays
[dua_frank] i will lanny
[drsujitvasanth] k see you all tomorrow!
[drsujitvasanth] bye
[dua_frank] bye
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[lanny] is the sched in this site like last one dua
[dua_frank] yes lanny

03-21-2005, 04:18 PM
bad ovarian mass---coma--lied on med records..now what can be done?

05-09-2005, 12:16 AM
how bad i am wiith molluscum contigiosum i need help

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