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Obs and Gynae Y4 > 23. Gynaecology Oncology > Flashcards

23. Gynaecology Oncology Flashcards

1
Q

Ovarian cancer presentation:

A

80% occur in postmenopausal women, peaks in 70s

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2
Q

Ovarian cancer signs and symptoms

A

o Abdominal distension
o Bloating and ascites
o Pelvic/abdominal pain and mass
o Urinary urgency/Frequency

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3
Q

Investigations in ovarian cancer

A
  • Cancer markers: (CA125 >30U/L, germ call markers AFP/HCG, LDH)
  • Ascitic tap (cytology)
  • USS – ascites, tumours, blood flow on doppler
  • Image guided biopsy, laparoscopy or laparotomy
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4
Q

Ovarian cancer management:

A
  • Combination of treatment and 6 cycles of chemotherapy
  • Surgery
  • +- Adjuvant treatment
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5
Q

Combination surgery and chemotherapy for ovarian cancer:

A
  • PDS Primary Debulking Surgery, followed by 6 cycles of chemotherapy OR
  • 3 cycles of NACT neo-adjuvant chemotherapy, IDS Interval Debulking Surgery, 3 further cycles of chemotherapy OR
  • 6 cycles of NACT, DDS Delayed Debulking Surgery, 2 further cycles of chemotherapy
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6
Q

Combination surgery and chemotherapy for ovarian cancer (Shortcut):

A
  • PDS, 6CT
  • 3NACT, IDS, 3CT
  • 6NACT, DDS, 2CT
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7
Q

TAH BSO

A

Total abdominal hysterectomy and bilateral salpingo-oophorectomy

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8
Q

Surgery for ovarian cancer:

A
  • TAH BSO
  • Omentectomy
  • Bowel resection
  • Removal of masses and nodes
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9
Q

Adjuvant treatment for ovarian cancer:

A
  • Adjuvant chemotherapy
  • Chemotherapy (carboplatin and paclitaxel 3 weekly)
  • Vascular endothelial growth factor inhibitor (Bevacizumab)
  • PARP inhibitors (BRCA- Olaparib, Non-BRCA-Niraparib)
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10
Q

Radiotherapy in ovarian cancer treatment:

A

NO role

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11
Q

Adjuvant chemotherapy – disease grades:

A

For all I-IVb aside from:

  • Low grade serous 1A
  • Grade 1 and 2 endometroid 1A
  • Grade 1 and 2 mucinous 1A
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12
Q

Chemotherapy variants in ovarian cancer:

A
  • Single agent: carboplatin

- Neutropenia, thrombocytopenia, neuropathy, alopecia – paclitaxel

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13
Q

Classification of ovarian cancer:

A

Primary (Epithelial, Stromal, Germ cell)

Secondary/Metastatic

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14
Q

Epithelial ovarian cancer examples:

A
  • High grade serous carcinoma
  • Low grade serous carcinoma
  • Endometrioid
  • Mucinous
  • Clear cell
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15
Q

Aetiology of ovarian cancer:

A

Factors reducing a number of ovulations reduces risk of ovarian cancer

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16
Q

Ovarian cancer risk reduction:

A
  • Pregnancy
  • COCP
  • Sterilisation
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17
Q

Ovarian cancer risk increase:

A
  • HRT
  • Age>50
  • Endometriosis
  • Subfertility
  • Familial cancer (BRCA1, BRCA2, RAD51C/D, BRIP1)
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18
Q

Patterns of spread of ovarian cancer:

A

1) Transcoelomic

2) Lymphatic to pelvic and paraaortic lymph nodes

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19
Q

Follow up tests for ovarian cancer:

A
  • CA 125

- CT

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20
Q

Staging of ovarian cancer:

A 
Stage I (ovaries only)
Stage II (spread to pelvis)
Stage III (spread to peritoneal cavity and retroperitoneal lymph nodes)
Stage IV (spread to liver, or distant metastasis)
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21
Q

Ovarian germ cell tumours examples:

A
  • Mature cystic teratoma

- Struma ovarii (thyroid tissue in ovarian mass)

22
Q

Ovarian germ cell tumour:

A
  • Young women or children
  • AFP, hCG, LDH (all raised)
  • Conservative surgical management
23
Q

Endometrial cancer presentation:

A
  • Average onset 63yo

- Most are postmenopausal

24
Q

Symptoms of endometrial cancer:

A
  • Postmenopausal bleeding or menstrual abnormality
25
Q

Investigations for endometrial cancer:

A
  • USS (thickened endometrium >5cm)
  • Endometrial biopsy (sampling, hysteroscopy)
  • MRI (myometrium and pelvic nodes)
  • CT chest/abdomen/pelvis
26
Q

Primary treatment for stage 1-2 endometrial cancer:

A
  • Hysterectomy and BSO
  • Lymphadenopathy and Sentinel lymph node biopsy
  • Surgery
27
Q

Primary treatment for stage 3-4 endometrial cancer:

A
  • Hysterectomy
  • Lymphadenectomy
  • Removal of all visible disease
28
Q

Hormonal treatment for endometrial cancer:

A
  • High oral dose progesterone and progesterone IUD
  • Fertility sparing (grade 1 tumour)
  • Unfit for surgical management
29
Q

Endometrial cancer pathology/type:

A
  • Adenocarcinoma (endometrioid)

- Sarcoma (leiomyosarcoma, endometrial stromal sarcoma, undifferentiated sarcoma)

30
Q

Molecular stratification of endometrial cancer:

A
  • MMR abnormal (mismatch repair gene immunohistochemistry)
  • POLE mutant (DNA polymerase epsilon)
  • P53 wild type (protein product of TP53)
  • P53 mutant (aggressive, adjuvant therapy)
31
Q

Endometrial cancer FIGO staging:

A 
Stage I (body of uterus) IA (<0.5 myometrium invaded) or IB (more than >0.5)
Stage II (cervical stroma)
Stage III (extends outside of the uterus) IIIA (serosa of uterus and adnexa) IIIB (+vaginal involvement) IIIB (+nodal involvement
Stage IV (involvement of bladder and rectum)
32
Q

Adjuvant treatment for endometrial cancer:

A

Radiotherapy (improves local control but not survival)
Hormonal therapy (stage III/IV disease, uncertain benefit)
Chemotherapy (Advanced disease)

33
Q

How does recurrence of endometrial cancer present?

A

Vaginal bleeding and pain (majority within 3 years)

34
Q

Cervical cancer demographics:

A

Peaks at 30-35 and 80-85 yo.

35
Q

Symptoms of cervical cancer:

A
  • Abnormal vaginal bleeding and discharge

- Advanced cases: lower limb oedema, haematuria, pelvic pain,

36
Q

3 examples of abnormal vaginal bleeding:

A
  • Postcoital
  • Intermenstrual
  • Postmenopausal
37
Q

Diagnosis of cervical cancer:

A
  • Colposcopy and cervical biopsy
  • Examination Under Anaesthesia
  • MRI pelvis, CT chest/abdomen/pelvis
38
Q

Cervical cancer staging:

A

Stage I: confined to cervix
Stage II: beyond uterus
Stage III: pelvic side wall, lower 1/3 vagina or hydronephrosis, pelvic nodes
Stage IV: outside true pelvis or involving bladder/rectum

39
Q

Surgical treatment of cervical cancer:

A
  • Cone biopsy or simple hysterectomy
  • Radical hysterectomy complications
  • Primarily Stage I
40
Q

Chemoradiotherapy treatment of cervical cancer:

A
  • Stage IB-IV
  • Radiotherapy
  • Brachytherapy to central tumour
  • External beam radiotherapy
  • Platinum-based chemotherapy
41
Q

Radiotherapy chronic complications:

A
  • Proctosigmoiditis, cystitis
  • Fistulas (rectovaginal, vesicovaginal)
  • Small bowel obstruction or fistula
42
Q

Adjuvant treatment for cervical cancer:

A

Chemoradiotherapy – post-op for high risk factors

  • Lymph node involvement
  • Positive surgical margins
  • Invasion of paracervical tissue
  • Lymphovascular invasion
43
Q

Recurrence of cervical cancer – treatment:

A
  • Previous surgery -> radiotherapy
  • Previous radiotherapy -> removal of pelvic organs
  • Chemotherapy is palliative
44
Q

Preinvasive states for cervical cancer:

A
  • CIN (cervical intraepithelial neoplasia)

- AIS/CGIN (adenocarcinoma in situ/ cervical glandular intraepithelial neoplasia

45
Q

Aetiology of cervical cancer:

A
  • HPV infection, strains 16, 18 – invasive disease

- These 2 produce E6 and E7 proteins that inhibit the function of tumour suppressor genes (p53 and RB)

46
Q

Risk factors for cervical cancer:

A
  • Early age 1st intercourse
  • Multiple sexual partners
  • Smoking
  • HIV
  • High grade cervical intraepithelial neoplasia
47
Q

Vulval cancer presentation:

A
  • Pruritis
  • Pigmentary changes
  • Vulval bleeding, discharge, dysuria
  • Vulval lump or mass
48
Q

Vulval cancer staging:

A

Stage I: confined to vulva
Stage II: extended to adjacent perineal structures and negative nodes
Stage III: extended to adjacent perineal structure and positive inguino-femoral nodes
Stage IV: invasion of other regional structures (anus, rectum, upper vagina)

49
Q

Treatment for cancer staging:

A
  • Primary lesion (radical local excision or vulvectomy)
  • Regional lymph nodes dissection (inguinal node)
  • Adjuvant radiotherapy (irradiation of pelvic and groin with >2 nodes involvement
50
Q

Complement for Lupus

A

Complement: C3 and C4, both decreased

51
Q

HELLP

A

H - haemolysis (elevated LDH)
EL – elevated liver enzymes (AST, ALT)
LP – low platelets (thrombocytopenia)

52
Q

Red cell casts diagnosis:

A

Glomerulonephritis

Obs and Gynae Y4 (22 decks)

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