Cancer Flashcards
classic symptom of endometrial cancer?
PMB (premenopausal = irregular bleed)
risk factors for endometrial cancer?
THINK OESTROGEN
- unopposed oestrogen (HRT)
- early menarche
- late menopause
- nulliparity
1) DB
2) PCOS
3) HNPCC (hereditary non-polyposis colorectal carcinoma)
4) tamoxifen
Investigating endometrial cancer?
- refer >55 to suspected cancer pathway
- 1st line = TVS (normal thickness <4mm)
- hysteroscopy + biopsy
Management of endometrial cancer?
1) total abdo hysterectomy + bilateral salpingo-oopherectomy
Add RT if high-risk
Progestogen therapy if unsuitable for surgery
2 protective factors against endometrial cancer?
COCP + smoking
iNCIDENCE/PROGNOSIS of ovarian cancer?
peak age of incidence is 60 years and it generally carries a poor prognosis due to late diagnosis (80% advanced on presentation)
Histology ovarian cancer?
90% epithelial -> 70-80% serous carcinomas (subtype)
Risk factors for ovarian cancer?
family history: mutations of the BRCA1 or the BRCA2 gene
many ovulations*: early menarche, late menopause, nulliparity
Sx ovarian cancer?
abdominal distension and bloating abdominal and pelvic pain urinary symptoms e.g. Urgency early satiety diarrhoea
Investigation of ovarian cancer?
IF SUSPECTED CA-125 IF RAISED (>135) US ABDO+PELVIS
diagnosis difficult (usually laparotomy)
What other conditions increase ca-125?
menstruation
endometriosis
benign ovarian cysts
Management?
Surgery + chemo (platinum)
Risk of malignancy index? (RMI)
Menopausal status
Ultrasound findings
CA125 level
If ovarian cancer suspected, under 40 years with complex ovarian mass?
Test for tumour markers of germ cell tumour:
- beta-HCG
- ALPHA-FETOPROTEIN
Staging of ovarian cancer?
FIGO:
Stage 1: Confined to the ovary
Stage 2: Spread past the ovary but inside the pelvis
Stage 3: Spread past the pelvis but inside the abdomen
Stage 4: Spread outside the abdomen (distant metastasis)
Histology of cervical cancer?
- 80% squamos cell carcinoma
- 20% adenocarcinoma
HPV types for cervical cancer?
HPV 16, 18, 33
16 + 18 produce E6 (inhibits p53) and E7 (inhibits RB)
cervical RF?
1) smoking
2) HIV
3) early first intercourse, many sexual partners
4) high parity
5) lower socioeconomic status (poor engagement with screening)
6) combined oral contraceptive pill* (>5 years)
7) Exposure to diethylstilbestrol (<1970s)
Cervical cancer: presentation?
- Abnormal vaginal bleeding (IMB, PCB or PMB)
- Vaginal discharge
- Pelvic pain / Dyspareunia
Cervical cancer: Initial investigations?
1) SPECULUM
2) URGENT CANCER REFERRAL FOR COLPROSCOPY if:
- inflammation
- ulceration
- bleeding
- visible tumour
Grading system for the level of dysplasia (premalignant change) in cells.
diagnosed on colposcopy:
CIN I: mild dysplasia, affecting 1/3 the thickness of the epithelial layer, likely to return to normal without treatment
CIN II: moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, likely to progress to cancer if untreated
CIN III: severe dysplasia, very likely to progress to cancer if untreated
Another name for CIN III?
Cervical carcinoma in situ
Cervical screening
Every three years aged 25 – 49
Every five years aged 50 – 64
- HIV = every year
- > 65 hasn’t one since 50
- pregnant women = wait 12 weeks postpartum
Management of smear results?
Inadequate sample – repeat the smear after at least three months
HPV negative – continue routine screening
HPV positive with normal cytology – repeat the HPV test after 12 months
HPV positive with abnormal cytology – refer for colposcopy
