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3- Reproduction > Cancer > Flashcards

Cancer Flashcards

1
Q

cervical cancer epidemiology

A

younger women

peaks in reproductive years

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2
Q

cervical cancer pathology

A

squamous cell carcinoma (80%)

adenocarcinoma

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3
Q

cervical cancer aetiology

A

HPV (type 16 &18)

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4
Q

cervical cancer risk factors

A

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
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5
Q

cervical cancer presentation

A 
may be asymptomatic 
abnormal vaginal bleeding 
vaginal discharge
pelvic pain 
dyspareunia

abnormal appearance of cervix: ulceration, inflammation, bleeding, visible tumour

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6
Q

cervical intraepithelial neoplasia

A

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)

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7
Q

Cervical Screening

A

Look for precancerous changes (dysskaryosis)

every 3 years aged 25-49
every 5 years aged 50-64

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8
Q

cervical cancer investigation

A

Colposcopy

  • Stains to differentiate abnormal areas (acetic acid, Schiller’s iodine test)
  • Tissue sample (obtain through LLETZ or cone biopsy)
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9
Q

Staging of cervical cancer

A

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

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10
Q

management of cervical cancer

A

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
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11
Q

endometrial cancer

A

cancer of the endometrium: lining of uterus

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12
Q

endometrial cancer pathology

A

adenocarcinoma

oestrogen-dependent

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13
Q

endometrial hyperplasia

A

precancerous condition involving thickening of endometrium

types

  • hyperplasia without atypic
  • Atypical hyperplasia

Treatment

  • intrauterine system (Mirena coil)
  • Continuous oral progestogens
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14
Q

endometrial cancer risk factors

A 
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

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15
Q

Endometrial cancer protective factors

A

COCP
Mirena coil
increased pregnancies
smoking

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16
Q

presentation of endometrial cancer

A

postmenopausal bleeding.

Postcoital bleeding 
intermenstrual bleeding 
unusually heavy menstrual bleeding 
abnormal vaginal discharge
haemaaturia
Anaemia
Raised platelet count
17
Q

endometrial cancer referral criteria

A

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
18
Q

endometrial cancer investigations

A

Transvaginal US
- endometrial thickness (normal <4cm post menopause)

Pipelle biopsy

hysteroscopy with endometrial biopsy

19
Q

Stages of endometrial cancer

A

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

20
Q

Management of endometrial cancer

A

Stage 1& 2: total abdo hysterectomy with bilateral sapling-oophorectomy

21
Q

ovarian cancer types

A

epithelial cell tumours
dermoid cysts/germ cell tumours
sex cord-stomal tumours
metastasis

22
Q

krukenberg tumour

A

metastasis in the ovary, usually from GI cancer, particularly stomach

Characteristic ‘signet-ring’ cells on histology

23
Q

Risk factors of ovarian cancer

A 
Age (peaks 60)
BRCA1 and BRCA2) 
Increased number of ovulations 
obesity 
Smoking 
Current use of Clomifene
24
Q

ovarian cancer protective factors

A

COCP
breastfeeding
pregnancy

25
Q

Ovarian cancer presentation

A

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

26
Q

Ovarian cancer referral criteria

A

2-week-wait referral if exam reveals

  • ascites
  • pelvic mass
  • abdo mass
27
Q

ovarian cancer investigations

A

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

28
Q

tumour markers needed for women <40 with complex ovarian mass

A

Possible germ cell tumour

  • alpha-fetoprotein
  • HCG
29
Q

Causes of raised CA125

A 
Epithelial cell ovarian cancer
Endometriosis
FIbroids
Adenomyosis
Pelvic infection
Liver disease
Pregnancy
30
Q

Staging. of ovarian cancer

A

1: confined to ovary
2: spread past ovary but inside pelvis
3: past pelvis but inside abdo
4: outside abdo (metastasis

31
Q

management of ovarian cancer

A

Requires MDT

Usually combo of surgery and chemotherapy

32
Q

vulval cancer pathology

A

Squamous cell carcinoma (90%)

Malignant melanomas

33
Q

vulval cancer risk factors

A

advanced age
immunosuppression
HPV infection
Lichen sclerosus

34
Q

vulval intraepithelial neoplasia

A

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

35
Q

vulval cancer presentation

A 
vulval lump 
ulceration 
bleeding 
pain 
itching 
lymphadenopathy in groin 
frequently affects labia majora
-rregular mass
-fungating lesion 
ulceration
bleeding
36
Q

investigation of vulval cancer

A

Establishing diagnosis and stage

  • biopsy
  • sentinel node biopsy for lymph node spread
  • further imaging. (CT abdo and pelvis) for staging
37
Q

management of vulval cancer

A

wide local excision to remove cancer
groin lymph node dissection
chemotherapy
radiotherapy

3- Reproduction (15 decks)

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