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  #1  
Old 11-20-2012
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ObGyn treatment of positive Pap smear

A 57-year-old G3P3 woman presents to her gynecologist with complaints of vaginal pruritus and increased vaginal discharge. The patient has no history of gynecologic surgery or sexually transmitted diseases; she is not currently sexually active. A bimanual examination and Pap smear are performed. The Pap smear is positive for malignant squamous cells. Followup colposcopy shows no cervical lesions, but a small lesion is noted on the lower vagina. Biopsy of this lesion confirms the diagnosis of vaginal squamous cell cancer, while cross sectional imaging excludes invasion of surrounding tissues. What is the most appropriate course of treatment in this patient?

(A) Chemotherapy
(B) Radiation therapy
(C) Surgical excision
(D) Surgical excision and chemotherapy
(E) Surgical excision and radiation therapy
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  #2  
Old 11-20-2012
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Option E. Surgery + Radiation

Stage I and II I think is Surg + Radiation.
III and IV is only Radiation +/- Chemo No surgery.
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(E) Surgical excision and radiation therapy
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(E) Surgical excision and radiation therapy
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The correct answer is B. Small squamous cell vaginal cancers in the upper portion of the vagina are often treated by surgical excision, which consists of radical hysterectomy, upper vaginectomy, and bilateral lymph node dissection. However, resection of malignancies in the lower portion of the vagina is difficult, and the primary treatment is radiation therapy. Early-stage cancers may be treated solely with brachytherapy, but more advanced cancers are treated with external beam radiation.
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Old 11-21-2012
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Quote:
Originally Posted by heartbeat View Post
The correct answer is B. Small squamous cell vaginal cancers in the upper portion of the vagina are often treated by surgical excision, which consists of radical hysterectomy, upper vaginectomy, and bilateral lymph node dissection. However, resection of malignancies in the lower portion of the vagina is difficult, and the primary treatment is radiation therapy. Early-stage cancers may be treated solely with brachytherapy, but more advanced cancers are treated with external beam radiation.
Could you provide a reference or what source are you using ?
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Old 11-21-2012
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Ans is B only Sx .

radiation given if stage 3 or 4

http://emedicine.medscape.com/articl...iew#aw2aab6c14
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Old 11-22-2012
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Quote:
Originally Posted by Nik7733 View Post
Could you provide a reference or what source are you using ?
1st -A i d ( Q&A) Step 2 CK 2008
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Old 11-22-2012
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Can you look to last paragraph under the head of Stage 1
Quote:
Stage I disease

In general, tumors of the upper posterior wall are more operable because the sigmoid reflects away from the posterior vaginal wall while the entire length of the anterior vaginal wall stays in close proximity to the bladder. A lower vaginal lesion can be treated with radical hemivulvectomy and lower vaginectomy with bilateral inguinal node dissection. Radiation therapy is commonly used as an alternative to surgery.
http://emedicine.medscape.com/articl...iew#aw2aab6c14
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