Cancer Flashcards
cervical cancer epidemiology
younger women
peaks in reproductive years
cervical cancer pathology
squamous cell carcinoma (80%)
adenocarcinoma
cervical cancer aetiology
HPV (type 16 &18)
cervical cancer risk factors
increased risk of catching HPV
- early sexual activity
- increased number of sexual partners
- not using condoms
non-engagement with cervical screening smoking HIV COCP for >5 years Increased number of full-term pregnancies family history
cervical cancer presentation
may be asymptomatic abnormal vaginal bleeding vaginal discharge pelvic pain dyspareunia
abnormal appearance of cervix: ulceration, inflammation, bleeding, visible tumour
cervical intraepithelial neoplasia
grading system for level of dysphasia
CIN I: mild dysplasia, affecting ⅓ thickness of epithelial layer
CIN II: moderate dysplasia, affecting ⅔ thickness
CIN III: severe dysplasia (sometimes called cervical carcinoma in situ)
Cervical Screening
Look for precancerous changes (dysskaryosis)
every 3 years aged 25-49
every 5 years aged 50-64
cervical cancer investigation
Colposcopy
- Stains to differentiate abnormal areas (acetic acid, Schiller’s iodine test)
- Tissue sample (obtain through LLETZ or cone biopsy)
Staging of cervical cancer
1: confined to cervix
2: invades to uterus or upper ⅔ of vagina
3: invades pelvic wall or lower ⅓ of vagina
4: invades bladder, rectum or beyond pelvis
management of cervical cancer
CIN & Early-Stage 1: LLETZ or cone biopsy
Stage 1b-2A: radical hysterectomy & removal of local lymph nodes with chemo& radiotherapy
Stage 2B-4A: chemotherapy & radiotherapy
stage 4B: combination of surgery, radiotherapy, chemotherapy & palliative care
Benvacizumab (Avastin)
- monoclonal antibody can be used in combo with other chemo
- reduces development go new blood vessels
endometrial cancer
cancer of the endometrium: lining of uterus
endometrial cancer pathology
adenocarcinoma
oestrogen-dependent
endometrial hyperplasia
precancerous condition involving thickening of endometrium
types
- hyperplasia without atypic
- Atypical hyperplasia
Treatment
- intrauterine system (Mirena coil)
- Continuous oral progestogens
endometrial cancer risk factors
relate to patients exposure to unopposed oestrogen Increase age early onset of menstruation late menopause oestrogen only HRT no/fewer pregnancies Obesity PCOS Tamoxifen
Additional (not related to oestrogen)
T2DM
HNPCC or Lynch syndrome
Endometrial cancer protective factors
COCP
Mirena coil
increased pregnancies
smoking
presentation of endometrial cancer
postmenopausal bleeding.
Postcoital bleeding intermenstrual bleeding unusually heavy menstrual bleeding abnormal vaginal discharge haemaaturia Anaemia Raised platelet count
endometrial cancer referral criteria
2-week-wait urgent cancer referral
- postmenopausal bleeding
Referral for Transvaginal US women >55years
- unexplained vaginal discharge
- visible haematuria + raised platelets, anaemia or elevated glucose levels
endometrial cancer investigations
Transvaginal US
- endometrial thickness (normal <4cm post menopause)
Pipelle biopsy
hysteroscopy with endometrial biopsy
Stages of endometrial cancer
Stage 1: confined to uterus
Stage 2: invades cervix
Stage 3; invades ovaries, Fallopian tubes, vagina or lymph nodes
Stage 4: invades, bladder, rectum or beyond pelvis
Management of endometrial cancer
Stage 1& 2: total abdo hysterectomy with bilateral sapling-oophorectomy
ovarian cancer types
epithelial cell tumours
dermoid cysts/germ cell tumours
sex cord-stomal tumours
metastasis
krukenberg tumour
metastasis in the ovary, usually from GI cancer, particularly stomach
Characteristic ‘signet-ring’ cells on histology
Risk factors of ovarian cancer
Age (peaks 60) BRCA1 and BRCA2) Increased number of ovulations obesity Smoking Current use of Clomifene
ovarian cancer protective factors
COCP
breastfeeding
pregnancy
Ovarian cancer presentation
often non-specific
abdo bloating early satiety loss of appetite pelvic pain urinary symptoms weight loss abdo or pelvic mass ascites
Ovarian mass may press on obturator nerve-> referred hip/groin pain
Ovarian cancer referral criteria
2-week-wait referral if exam reveals
- ascites
- pelvic mass
- abdo mass
ovarian cancer investigations
Initial
- CA125
- Pelvic US
Risk of malignancy index
- menopausal status
- US findings
- CA125 levels
CT scan
Histology: CT guided biopsy, laparoscopy or laparotomy
Paracentesis
Women <40 with complex ovarian mass
-Tumour markers
tumour markers needed for women <40 with complex ovarian mass
Possible germ cell tumour
- alpha-fetoprotein
- HCG
Causes of raised CA125
Epithelial cell ovarian cancer Endometriosis FIbroids Adenomyosis Pelvic infection Liver disease Pregnancy
Staging. of ovarian cancer
1: confined to ovary
2: spread past ovary but inside pelvis
3: past pelvis but inside abdo
4: outside abdo (metastasis
management of ovarian cancer
Requires MDT
Usually combo of surgery and chemotherapy
vulval cancer pathology
Squamous cell carcinoma (90%)
Malignant melanomas
vulval cancer risk factors
advanced age
immunosuppression
HPV infection
Lichen sclerosus
vulval intraepithelial neoplasia
premalignant condition affecting squamous epithelium of the skin
High grade squamous VIN
- associated with HPV infection
- typically age 35-50
Differentiate VIN
- Associated with lichen sclerosis
- typically 50-60
Biopsy required for diagnosis
vulval cancer presentation
vulval lump ulceration bleeding pain itching lymphadenopathy in groin
frequently affects labia majora -rregular mass -fungating lesion ulceration bleeding
investigation of vulval cancer
Establishing diagnosis and stage
- biopsy
- sentinel node biopsy for lymph node spread
- further imaging. (CT abdo and pelvis) for staging
management of vulval cancer
wide local excision to remove cancer
groin lymph node dissection
chemotherapy
radiotherapy
