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Womens health > Cancer > Flashcards

Cancer Flashcards

1
Q

classic symptom of endometrial cancer?

A

PMB (premenopausal = irregular bleed)

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2
Q

risk factors for endometrial cancer?

A

THINK OESTROGEN

  • unopposed oestrogen (HRT)
  • early menarche
  • late menopause
  • nulliparity
    1) DB
    2) PCOS
    3) HNPCC (hereditary non-polyposis colorectal carcinoma)
    4) tamoxifen
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3
Q

Investigating endometrial cancer?

A
  • refer >55 to suspected cancer pathway
  • 1st line = TVS (normal thickness <4mm)
  • hysteroscopy + biopsy
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4
Q

Management of endometrial cancer?

A

1) total abdo hysterectomy + bilateral salpingo-oopherectomy

Add RT if high-risk
Progestogen therapy if unsuitable for surgery

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5
Q

2 protective factors against endometrial cancer?

A

COCP + smoking

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6
Q

iNCIDENCE/PROGNOSIS of ovarian cancer?

A

peak age of incidence is 60 years and it generally carries a poor prognosis due to late diagnosis (80% advanced on presentation)

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7
Q

Histology ovarian cancer?

A

90% epithelial -> 70-80% serous carcinomas (subtype)

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8
Q

Risk factors for ovarian cancer?

A

family history: mutations of the BRCA1 or the BRCA2 gene

many ovulations*: early menarche, late menopause, nulliparity

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9
Q

Sx ovarian cancer?

A 
abdominal distension and bloating
abdominal and pelvic pain
urinary symptoms e.g. Urgency
early satiety
diarrhoea
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10
Q

Investigation of ovarian cancer?

A 
IF SUSPECTED CA-125 
IF RAISED (>135) US ABDO+PELVIS

diagnosis difficult (usually laparotomy)

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11
Q

What other conditions increase ca-125?

A

menstruation
endometriosis
benign ovarian cysts

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12
Q

Management?

A

Surgery + chemo (platinum)

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13
Q

Risk of malignancy index? (RMI)

A

Menopausal status
Ultrasound findings
CA125 level

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14
Q

If ovarian cancer suspected, under 40 years with complex ovarian mass?

A

Test for tumour markers of germ cell tumour:

  • beta-HCG
  • ALPHA-FETOPROTEIN
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15
Q

Staging of ovarian cancer?

A

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)

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16
Q

Histology of cervical cancer?

A
  • 80% squamos cell carcinoma

- 20% adenocarcinoma

17
Q

HPV types for cervical cancer?

A

HPV 16, 18, 33

16 + 18 produce E6 (inhibits p53) and E7 (inhibits RB)

18
Q

cervical RF?

A

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)

19
Q

Cervical cancer: presentation?

A
  • Abnormal vaginal bleeding (IMB, PCB or PMB)
  • Vaginal discharge
  • Pelvic pain / Dyspareunia
20
Q

Cervical cancer: Initial investigations?

A

1) SPECULUM
2) URGENT CANCER REFERRAL FOR COLPROSCOPY if:

  • inflammation
  • ulceration
  • bleeding
  • visible tumour
21
Q

Grading system for the level of dysplasia (premalignant change) in cells.

A

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

22
Q

Another name for CIN III?

A

Cervical carcinoma in situ

23
Q

Cervical screening

A

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
24
Q

Management of smear results?

A

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

25
Q

Procedure to take a biopsy? Risk?

A

Colposcopy with LLETZ (large loop excision of the transformation zone)

Risks - preterm labour, infection (tampons, sex)

26
Q

Procedure to manage CIN + very early stage cancer?

A

CONE BIOPSY

Risks - stenosis of cervix, miscarriage/premature labour, infection/bleeding/pain

27
Q

Staging cervical cancer?

A

Stage 1: Confined to the cervix
Stage 2: Invades the uterus or upper 2/3 of the vagina
Stage 3: Invades the pelvic wall or lower 1/3 of the vagina
Stage 4: Invades the bladder, rectum or beyond the pelvis

28
Q

HPV vaccine?

A

Garsadil - against 6, 11, 16, 18
genital warts = 6, 11
cervical cancer = 16, 18

Womens health (8 decks)

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