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development > Gynaecological Cancers > Flashcards

Gynaecological Cancers Flashcards

1
Q

what is the most common cancer in female non-smokers

A

breast cancer

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2
Q

which factors are associated with an increased risk of developing breast cancer

A

older age
oestrogen exposure for long uninterrupted periods (the pill?/HRT)
large gap between menarche and the menopause
nulliparity
late first pregnancy
obesity
FHx

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3
Q

what is the typical presentation of breast cancer

A

painless breast mass +/-:

  • discharge
  • nipple changes
  • skin tethering
  • ulceration (late)
  • oedema/erythema
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4
Q

at which point is a carcinoma (cancer of the epithelium) considered invasive?

A

once it penetrates the basement membrane

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5
Q

how might a breast cancer spread

A

via lymph
via blood (lungs, bones, brain)
locally

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6
Q

which genes are associated with breast cancer in first degree relatives

A

BRCA1 - 80% lifetime risk of breast Ca; autosomal dominant; also increased risk of bowel Ca, ovarian and prostate Ca
BRCA2 - men with BRCA2 have a 6% risk of developing breast Ca
HER2- overexpressed in breast ca tissue; targeted by monoclonal ab trastuzumab

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7
Q

how many women need to be screened (50-70 every 3 yrs) to save one person

A

500

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8
Q

what are the poor prognostic features of a breast cancer

A 
young age/premenopausal
large primary tumour size
high grade tumour
oestrogen and progesterone receptor negative
positive lymph nodes
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9
Q

why can aromatase inhibitors only be given post menopausally

A

premenopausal women synthesize oestrogen in the ovary, where as post menopausally it is produced in the adrenal glands and in adipose tissue - aromatase inhibitors work on the adrenal gland and hence only work on post-menopausal women

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10
Q

what are the aims of screening

A

1) to make early diagnoses
2) to catch people in a PRECLINICAL condition

the aim of this is to detect the maximum number of people with cancer/pre cancer therefore a 2 stage test may be advisable. The first test being of a high sensitivity and the second with a high specificity

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11
Q

Wilson and Jungner classic screening criteria (from WHO website)

A
  1. The condition sought should be an important health problem.
  2. There should be an accepted treatment for patients with recognized disease.
  3. Facilities for diagnosis and treatment should be available.
  4. There should be a recognizable latent or early symptomatic stage.
  5. There should be a suitable test or examination.
  6. The test should be acceptable to the population.
  7. The natural history of the condition, including development from latent to declared disease, should be adequately understood.
  8. There should be an agreed policy on whom to treat as patients.
  9. The cost of case-finding (including diagnosis and treatment of patients diagnosed) should be economically balanced in relation to possible expenditure on medical care as a whole.
  10. Case-finding should be a continuing process and not a “once and for all” project.
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12
Q

what is the most common gynae cancer in the UK

A 
uterine cancer (E2 therapies and weight)
followed by : ovarian then cervical
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13
Q

what is the most common gynae cancer worldwide

A

cervical cancer

incidence is less in the UK owing to screening and the HPV vaccination programme

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14
Q

what is assessed in TNM staging

A

size and local invasion
lymph node involvement
distant mets

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15
Q

which gynae cancer does not follow FIGO staging

A

cervical cancer as it behaves differently with lymph node invasion

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16
Q

why is staging used in cancer

A

provides a objective representation tool for communicating about disease

17
Q

what does grading measure

A

the behaviour of the cells

ie how well differentiated they are

18
Q

MRI is used in the local staging of which gynae cancers

A

cervical
uterine
not ovarian as less sensitive to abdominal contents as can move

19
Q

is surgery the primary curative treatment for all gynae cancers

A

YES - if caught early enough

20
Q

for which gynae cancers might radiotherapy be used as the primary curative treatment

A

cervical

endometrial

21
Q

why is concomittant chemotherapy and radiotherapy more effective than monotherapy in the treatment of advanced cervical Ca

A

both cisplatin and radiotherapy target the DNA- it is attacked on two fronts!

22
Q

how does bevacizumab work? for which gynae cancers is it licensed?

A

it is a VEGF inhibitor
prevents angiogensis which is increased in tumours as they have a high metabolic demand.
it is NICE approved for ovarian cancer
it is FDA approved for cervical Ca

23
Q

what is the difference between adjuvant and neo-adjuvant chemotherapy?

A

adjuvant is chemo after surgery

neo-adjuvant is chemo before surgery

24
Q

which is the only surgical proceedure for gynae cancers which preserves fertility

A

radical tacelectomy

only used for stage Ia of disease (endometrial cancer)

25
Q

What investigation should all menopausal bleeding under go

A

pipelle biopsy

26
Q

how does endometrial cancer most commonly present

A

its present early with post menopausal bleeding

27
Q

which genes are associated with ovarian cancer

A

BRCA1/2 and HNPCC

28
Q

how does ovarian cancer most commonly present

A

it presents late with non-specific symptoms such as bloating, change in bowel habit and abdominal distention

29
Q

what is the most common type of vagina cancer

A

80% SCC

15% Adenocarcinoma

30
Q

how does vagina cancer present

A

discharge pain and bleeding

31
Q

how does cervical cancer present

A

through screening or irregular bleeding

32
Q

which HPV viruses are most associated with cervical cancer and CIN

A

16 and 18

33
Q

what are the risk factors for cervical cancer

A

sexual behaviour
smoking
immunosuppresion
genetics (link with vulval ca and GI/resp on paternal side)

34
Q

what are the risk factors for endometrial cancer

A 
unopposed oestrogen therapy
nuliparity
late menopause
PCOS
obesity
DM
FHx (HNPCC)
35
Q

which cell type is the most common endometrial cancer

A

adenocarcinoma

36
Q

what are the treatment options for endometrial cancer

A

surgery - TAH + BSO
radiotherapy
Brachytherapy
Chemo - carboplatin or doxorubicin + carboplatin/cisplatin
Hormone treatments - high dose progesterones

37
Q

which skin conditions are associated wtih vulval cancer

A

lichen planus
lichen sclerosis
paget’s disease

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