220 - Gynae Cancer Flashcards by Lucy Knox

Commonest cancer in the Female in the UK.

a) Lungs
b) Breast
c) Colorectal
d) Ovary
e) Uterus

Breast - 30% of female cancers

Lung second

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Commonest Gynaecological cancer in the UK.

a) Cervix
b) Uterus
c) Ovary
d) Vulva
e) Vagina

Uterine - endometrial

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Commonest Gynaecological cancer in the world.

a) Cervix
b) Uterus
c) Ovary
d) Vulva
e) Vagina

Cervix

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TNM staging for solid cancer includes following parameters

a) Lymph node metastasis
b) Distant metastasis
c) LVSI (Lympho-vascular space invasion)
d) Tumour size/ local extension
e) Cytology

Lymph nodes
Distent Mets
Tumour size

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Which one parameter of TNM is not included for staging of cervical cancer?

Doesn’t include nodes

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Clinically proven effective screening is available for

a) Ovarian cancer
b) Uterine cancer
c) Cervical Cancer
d) Vulvar cancer
e) Vaginal Cancer

Cervical

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Why do you do screening programs?

To catch pre-clinical changes

To catch the disease early

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A blood test for CA125 is indicated for suspected

a) Uterine cancer
b) Vaginal cancer
c) Ovarian cancer
d) Cervical cancer
e) Vulvar cancer

Ovarian Cancer
(indicated uterine too but less clear)

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MRI scan is indicated in local staging for

a) Ovarian cancer
b) Cervical cancer
c) Uterine cancer
d) Vulvar cancer
e) Vaginal cancer

Uterine
Cervical
?Vuval

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Surgery may be the primary curative treatment for

a) Endometrial cancer
b) Ovarian cancer
c) Cervical cancer
d) Vulvar cancer
e) Vaginal cancer

All if early enough!

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Radiotherapy may be the primary curative treatment for

a) Endometrial cancer
b) Ovarian cancer
c) Cervical cancer
d) Vulvar cancer
e) Vaginal cancer

Cervical
Endometrial

But surgery usually prefered

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Recently NICE has approved molecular therapy (Bevacizumab) for

a) Endometrial cancer
b) Ovarian cancer
c) Cervical cancer

Ovarian

+ FDA approved for cervical

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When are you worried about malignancy in ovarian cancer?

Older women - post menopausal 30% malignant

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What increases your risk of ovarian ca?

Low parity

Increased number of ovulations

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What are the main tumour types seen in ovarian cancer?

70% surface epithelium - adenocarcinomas
20% germ cell
10% sex cord

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90% of ovarian malignancies come from which cell type?

Surface epithelium

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What does a borderline ovarian ca mean?

It has the pathological features of malignacy, but doesn’t show invasion - better prognosis

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Of the epithlial ovarian tumoours, which subtype are the most aggressive?

Serous - make up 80%

- spreads widely, obstructs bowel, resistant to chemo

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What staging method is used in many gynae cancers?

FIGO + TNM

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What are the symptoms of ovarian Ca?

Abdo/pelvic pain
Distension/bloating
Loss of appetite
Weight loss
Back pain
Dyspareunia
Ascites

What cancer marker is high in ovarian ca?

CA125

What treatment can be offered in ovarian ca?

Debulking surgery - laparotomy, BSO, TAH, omentectomy

Chemo - adjuvent or neo adjuvent

Radiotherapy - not often used

Targeted therapy - try block blood supply

What type of test is used in cervical screening?

Cytology test

moving on to HPV testing

What do they look for in a smear test?

High grade dyskaryosis - if found -> colposcopy

What is the pre-cancerous appearance you may see in colposcopy?

CIN - Carcinoma in situ - hasn't yet left the epithelial layer

What treatment do they do for CIN at colposcopy?

LLETZ - Large loop excision of transformational zone Diathermy Cryotherapy Cone biopsy

How common is cervical cancer?

Worldwide- most common female ca | in UK - 3rd

What are the risk factors asoc with cervical ca?

HPV Risky sexual behaviour Smoking immunosupression

What histology are more cervical cencers?

75% SCCs | 25% adeno

Which lymph nodes do cervical ca spread to?

Paracervical

What are the treatment options for cervical ca?

All get surgery - Radical tracelectomy (remove cervix - if still want kids) - TAH - Radical Hysterectomy - removes parametrium too Radiotherapy - most get it too

What are the symptoms of cervical ca?

``` often asymptomatic Abnormal vaginal bleeding Vaginal discomfort Malodorous discharge Dysuria ```

What are the peaks in age of cervical ca?

high in 25-30s | high in 80+s

What symptom do 90% of people with uterine cancer experience?

Post menopausal bleeding

What are the risk factors for uterine cancer?

``` High oestrogen (low parity, late menopause, Oestrogen only HRT) Obestiy ```

What histological types of uterine cancer are seen?

``` Mostly adenocarcinoma (80% endometrial) Rarely endometrial stroma ```

What is endometrial hyperplasia?

Like CIN - pre-malignant - due to persistant oestrogen stimulation - if detected, get TAH

What age group is uterine cancer most common in?

Over 60s

What are the management options for Endometrial ca?

Surgery - TAH + BSO + Lymph node dissection Radiotherapy Chemo - rarely used

What age group are most vulval cancers seen in?

Over 65s

What risk factors are there for vulval ca?

Smoking | HPV

What histological cell type are 90% of vulval cancers?

SSC

What are the symptoms of vulval cancer?

``` Itching Irritation Pain Lump Discharge ```

What is vulval cancer associated with?

Lichen Sclerosis

What is the crucial factor when deciding on treatment of vulval cancers?

The depth - if over 1mm need much more radical surgery

What is VIN?

Vulval intraepithelial neoplasia - neoplasia just in epithelium - can occur at any age - HPV related

What are the management options for vulval ca?

``` If under 1mm depth - wide local excision If more: - Radical vulvectomy + groin lymph node disection + radiotherapy (alone as palliative or with) ``` If advanced - Chemoradiation

What is the prognosis of vulval ca? If it has gone to lymph nodes?

80% 5 yrs survival if LN -ve | 40% 5 yr survival if LN +ve

What is a sentinel lymph node approach?

Inject ca mass with a radioactive blue dye In surgery, use a gyger counter to see if the radioactivity has spread to the lymph nodes - tells you if you can just resect one lymph node (the sentinel one) or all or none.