120 - Gynaecological cancers Flashcards
is vulval cancer common and what ages does it affect?
- rare
* peak incidence in 65 y/o
what type of cancer is it most likely to be and where does it affect?
- squamous cell carcinoma (>90%) (better prognosis than melanoma), melanoma (5%), basal cell carcinoma (1-2%)
- affects labia majora & menora & clitoris
what are the risk factors for vulval cancer?
- ages>65
- smoking
- HPV infection (only in younger women, not related in old)
- cervical/vaginal ca
- inflammatory dermatosis
how does vulval cancer present?
- lump/ulceration of vulva
- pruritis
- soreness/pain, discharge, bleeding
- lichen sclerosis in older
what investigations are required for vulval cancer?
biopsy necessary for diagnosis & radiological assessment to assess spread
what treatments are available for vulval cancer?
*surgery - wide local excision (1.5cm margin) or total vulvectomy +/- inguinal lymphadenectomy (ingunal-femoral LN spread high mortality as close to major vessels/nerves) & cross over of lymphatics (80% 5-yr survival if LN -ve 40% if +ve) +/- radio (before surgery to shrink ) with chemo (cisplatin)
how common is cervical cancer in the UK and the rest of the world and what is the cause of this? What age groups are at risk?
3rd most common in UK and most common in the rest of the world as ↓screening
2 peaks - 20-30 and 60s
what is the cause of cervical cancer?
dysplasia or neoplasia of the cervical transformation zone. at squamous cell (vagina)/columnar junction (cevical canal) pushed out of cervix at puberty. Columnar epithelium exposed to ↓pH of vagina & squamous metaplasia occurs
*75% squamous carcinoma 25% adenocarcinoma
what are the risk factors for cervical cancer?
- human papilloma virus (16&18) sexually transmitted- strong association HPV found in >90% of Ca & 16&18 >70%
- HIV/immunosuppression - inhibits HPV clearance
- smoking
- Oral contraceptive pill - whilst taking it
how does cervical cancer begin?
Cervical intraepithelial neoplasia in stages:
- 1 - mild dysplasia
- 2 moderate dysplasia
- 3 severe dysplasia/carcinoma in situ
what are the figo stages of cervical cancer, what are the treatment options and 5-year survival rates?
- 1 confined to cervix - local excision 70-90%
- 2 confined to uterus - TAH or radio/chemo 60%
- 3 involves pelvic wall/lower vagina 40%
- 4 beyond pelvis or bladder 15%
who does the cervical cancer screening test and what is the procedure?
*25-49 yr/olds every 3 years & 50-65 every 5 yrs
Aims to detect dysplasia (CIN) with a cervical swab which is examined for dyskariotic (abnormal nuclei) cells. Repear smear in 6months if mild and colposcopy if severe
how does cervical cancer present?
- via screening programme
- invasive tumors cause irregular bleeding (intermestrual, post coital, post menstrual) and vaginal discharge
- on examination cervical lesion appears red, friable
what treatment is available for CIN & cervical cancer?
- CIN - colposcopy (biopsy taken) & loop excision (abnormal tissue removed via diathermy large loop excision). Then follow up repeat smears
- surgery - stage 1A (mircroscopic lesion) radical trachelectomy (removes cervix), stage 1B-2A TAH +/- vaginal excision (radical hysterectomy) & lymphadenectomy
- stage 2-4 radiotherapy & chemo
what is endometrial (uterine) ca caused by?
malignant epithelial tumour in endometrium usually with with glandular differentiation (endometrioid adenocarcinoma). Can invade myometrium. Caused by ↑oestrogen (↑proliferation of endometrium) unopposed by progesterone (softens & maintains, withdrawal causes shedding) leading to uncontrolled proliferation of endometrium & ↑ ca mutation.
how common is uterine cancer?
most common gynae ca in UK
what are the risk factors for endometrial (uterine) ca?
- postmenopausal women
- nulliparity
- oestrogen only HRT
- longer fertile period
- obesity - ↑fat converted to oestrogen
- diabetes
- other ca especially breast ca
- genetic - HNPCC gene carriers
how does endometrial (uterine) ca normally present?
- post menopausal bleeding
- irregular bleeding in pre-menopausal women
- pelvic pain
- vaginal discharge
- metastasis to local area
what investigations should be carried out for suspected endometrial (uterine) ca?
- transvaginal USS - shows thickened endometrium
- endometrial biopsy - pepel
- radiological screening - CT or MRI
what are the figo stages for endometrial (uterine) ca?
- 1 confined to corpus
- 2 corpus & cervix
- 3 confined to pelvis
- 4 outside pelvis
what treatment can be given for endometrial (uterine) ca?
- hysterectomy with bilateral salpingoophrectomy + lymphadectomy.
- radio therapy / bracytherapy) in high grade ca as adjuvant & sometime chemo (carboplatin - cross links DNA) if advanced
how common is ovarian cancer in the uk and who does it normally affect?
2nd most common in UK but most common gynae cause of death. Affects ave age of 75
what are the risk factors for ovarian cancer?
- genetic - BRCA1 (breast & ovarian), BRCA2 (breast, pancreatic & ovarian), HNPCC (colorectal, endometrial, ovarian)
- oestrogen only HRT
- long period of fertility
- nulliparity
how do ovarian ca spread?
> 90% epithelial carcinoma. Spreads easily - intraperitoneal dissemination - into greater omentum (omental cake when completely taken over), abdo wall, uterus fallopian tubes, broad ligament, rectum, bladder, mesentary, bowel, liver , kidney, can spread to pleural cavity. Then metastatic via lymphatics & blood. All this causes ascites to form - break down of peritoneum to ECF, lymphatics blockage & ↓oncotic P (protein loss to ascites)
what are the figo stages of ovarian ca?
- 1 tumour in one or both ovaries
- 2 extension into pelvic region
- 3 spread to abdominal organs
- 4 distant metastasis - lung liver
how does ovarian ca present
*late presentation unless USS/CT for something else or torsion of enlarged ovary. signs & symptoms:
abdo/pelvic pain, bloating, feeling full quickly, frequent micturition, fatigue, weight loss, abdo distension, palpable abdo mass, pelvic mass, shifting dullness
what investigations can be done for ovarian ca?
- radiology - USS/CT (good for staging)/ MRI
* CA-125 marker - due to ascites but could be from any cause
what are the treatment options for ovarian ca?
- surgery - laparotomy - BSO +/- TAH, omentectomy
* complication - bowel resection, stoma
