JAAPA

An enlarging vulvar mass

Genetic testing for patients at risk of hereditary breast and ovarian cancer

ABSTRACT The field of cancer genetic testing has made great advances in correctly identifying patients at risk for hereditary cancer syndromes. These tests, used during a genetic consultation, promote earlier detection of cancer and potentially increase survival. Despite these advancements, a large number of persons at risk for BRCA1/2 mutations remain untested due to a shortage of genetic counselors and lack of clinician knowledge on how to properly screen, identify, and refer patients to genetic counseling. We suggest team-based practices that physician associates/assistants (PAs) and NPs can use in collaboration with genetic counselors. We also explore how PAs and NPs can alleviate the burden on genetic counselors by taking a comprehensive family history, providing elements of counseling, and ordering appropriate genetic tests. This approach maximizes the amount of time the patient spends receiving actual genetic counseling. By creating this collaborative relationship, PAs and NPs can help increase the number of qualifying patients who receive genetic testing and counseling for hereditary breast and ovarian cancer syndromes.

Hyperthermic intraperitoneal chemotherapy for treating ovarian cancer

ABSTRACT Hyperthermic intraperitoneal chemotherapy (HIPEC) has been used for decades as a treatment for disseminated abdominal malignancies, including pseudomyxoma peritonei and peritoneal mesothelioma. HIPEC had been used to treat recurrent ovarian cancer only when curative options were lacking, but new data indicate that it may be suitable as a primary treatment for patients with late-stage epithelial ovarian cancer, increasing the recurrence-free time interval and improving quality of life. However, treatment can be challenging because of patient trauma from surgery, combined with the toxicity and high temperature of the chemotherapeutic agents. This article reviews HIPEC and its targeted intraoperative and postoperative management.

A curious case of ovarian cysts

ABSTRACT Benign mature cystic teratomas are a form of ovarian germ cell tumor that originates from primordial germ cells in the ovaries. Of the three types of teratoma neoplasms, benign mature cystic teratomas (also called dermoid cysts) are the most common. Patients may present with intermittent abdominal or pelvic pain, abdominal enlargement, dysmenorrhea, dyspareunia, or may be asymptomatic. Clinicians should have a high suspicion for benign mature cystic teratomas, which account for more than 20% of all ovarian neoplasms. This article focuses on the clinical symptoms, ovarian growth characteristics, pathophysiology, potential complications, management options, and recurrence of benign mature cystic teratomas.

Cervical cancer screening guidelines

ABSTRACT Cervical cancer screening practices in the United States have been inefficient, with variable screening rates. Some women are screened too frequently, overmanaged, lost to follow-up, or are at risk and should be screened but are not. Timely screening, identification, and management of abnormal cervical cells is vital in order to prevent progression to cervical cancer. Educating, counseling, screening, and offering the human papillomavirus vaccine continue to be the primary methods of cervical cancer prevention practices. Guidelines and primary screening methods have been updated because of supporting evidence, and clinicians must stay up-to-date in order to provide effective patient care.

Barriers to cervical cancer screening among immigrants

ABSTRACT For women ages 21 to 65 years who have not had a hysterectomy, the US Preventive Services Task Force (USPSTF) recommends cervical cancer screening with cytology (Pap smear) every 3 years or a combination of cytology and human papillomavirus (HPV) testing every 5 years. However, foreign-born women were less likely to have received a Pap smear compared with US-born women. This article reviews barriers to cervical cancer screening for foreign-born women.

Cervical cancer

Using ultrasound to identify adnexal masses

ABSTRACT This article describes the use of ultrasound in the initial diagnosis of a patient with a pelvic mass. CT commonly is used to detect ovarian cancer, especially when the patient has nonspecific symptoms; ultrasound also can be used as a follow-up procedure after an abdominal ultrasound reveals suspicious findings.

Ovarian cancer

Abstract Ovarian cancer is the second most common gynecologic cancer in the United States and the deadliest gynecologic cancer worldwide, with a 5-year survival rate of less than 50%. Because of its vague symptoms, more than half of patients present with advanced disease and metastasis. This article reviews the epidemiology, pathogenesis, risk factors, screening, presentation, and diagnosis of ovarian cancer, in addition to providing an overview of the standard approach to treatment and novel targeted biologic therapies.

Endometrial cancer and obesity

ABSTRACT Endometrial cancer is the most common malignancy of the female reproductive system diagnosed in the United States. The most commonly cited cause is unopposed endogenous estrogen produced by excess adipose tissue. Endometrial cancer typically is diagnosed in postmenopausal women with a body mass index (BMI) of 25 kg/m2 or more. This article reviews how clinicians can use a systematic approach to fill the awkward silence when talking with patients about weight. Meaningful conversations about weight loss can be achieved using the 5 A's for obesity management with the goal of decreasing diagnosis and increasing survivorship from endometrial cancer.

Endometrial cancer