Cancer Flashcards
1
Q
Anatomy of cervix with regards to epithelium
A
The endocervix has columnar epithelium which produces mucin
Ectocervix has mature squamous epithelial cells
Separated by the squamocolumnar junction
2
Q
What is the transformation zone
A
In the squamocolmnar junction columnar epithelial cells transform into squamous cells in squamous metaplasia
3
Q
What process occurs at the transformation zone
A
Squamous metaplasia
4
Q
What causes cervical intraepithelial neoplasia
A
HPV infections cause dysplasia at the TZ
Over 100 HPVs but 16 and 18 most common
5
Q
Most common cause of CIN
A
HPV 16
6
Q
Where do CIN occur
A
Transformation zone
7
Q
How is CIN graded
A
CIN 1-3 on histology
CIN 1= dysplasia in lower 1/3 of epithelium
CIN 2= lower 2/3
CIN 3= full thickness but BM intact
8
Q
Rfx for CIN
A
Early age of first intercourse Multiple sexual partners Multiparity Smoking Immunosuppression
9
Q
What is CGIN
A
Cervical glandular intraepithelial neoplasia
10
Q
Difference between CIN and CGIN
A
CIN affects squamous cells
CGIN affects glandular cells
11
Q
How is CIN differentiated from CGIN
A
Cytology
12
Q
What is the treatment of CGIN
A
Excision of whole endocervix
13
Q
What is the problem with excision of whole endocervix
A
Compromises fertility
14
Q
How is CIN investigated
A
Colposcopy and biopsy
Can do cone biopsy
15
Q
Name of procedure for CIN excision
A
LLETZ where Heated thin wire removes abnormal cells
Large loop excision of the transformation zone
16
Q
What is risk of excisions for CIN
A
Preterm delivery
Midterm miscarriage
17
Q
What must be done after CIN removal
A
Test of cure 6 mo later
18
Q
What is most common type of cervical cancer
A
Squamous cell carcinoma
Adenocarcinoma and adenosquamous cell carcinomas less common
19
Q
Non-gynae involvement of cervical cancer
A
Can extend to bowel or bladder so get related symptoms
20
Q
Risks of radical hysterectomy
A
Bladder dysfunction- get urinary retention
Sexual dysfunction
Lymphoedema
21
Q
When does bladder dysfunction occur after hysterectomy
A
Immediate post operative
Manage with self catheterisation
22
Q
How is cervical IIB-IVA managed
A
Chemoradiation
- radiation can either be external beam or brachytherapy
- chemotherapy usual cisplatin
23
Q
What chemotherapy used in cervical cacner
A
Cisplatin
24
Q
What is brachytherapy
A
Internal radiation
25
How does bracytherapy work
Rods of radioactive selenium inserted into affected area- effects extend up to 5mm from rod
26
Side effects (short term) of radiation for cervical cancer
Tired
Bladder and bowel dysfunction
Erythema if external beam
27
Long term side effects of radiation for cervical cancer
Fibrosis
Vaginal stenosis
Cystitis symptoms
Malabsorption and mucous diarrorhoea
Radiotherapy induced menopause
28
Treatment of cervical cancer if pregnant
MDT approach
| Delivery after 35 weeks
29
What to do if recurrent cervical cancer
Surgery
Palliative chemo
Supportive care
30
Why get lymphoedema after hysterectomy
Pelvic lymph node removal
31
How to manage lymphoedema post hysterectomy
Leg elevation
Good skin care
Massage
32
How is CIN 1 managed
Repeat smear in 1 year
33
How are CIN 2 and CIN 3 managed
LLETZ or cone biopsy if very large
| Repeat smear in 6 months to check cure
34
Difference between operation for LLETZ and cone biopsy
LLETZ local anaesthetic
| Cone GA
35
What age do people get cervical cancer
2 peaks
| 30-39 and over 70
36
What are the 2 layers of endometrium
Functional layer innermost with glands and stroma
| Outer basal layer
37
What layer grows in preovulation phase
Functional layer from E2 growth
38
What happens to endometrium in post ovulation phase
Progesterone inhibits growth
Progesterone encourages production of nutrients for implantation
39
Risk factors for endometrial hyperplasia
Related to high oestrogen and low progesterone
- obesity
- early menarche
- late menopause
- nulliparity
- DM
- HTN
- annovulatary amenorrhoea
- tamoxifen
- oestrogen replacement
40
Drugs which cause endometrial cancer
Tamoxifen
| Oestrogen replacement
41
What is metorrhagia
Bleeding between menstrual cycles
42
Symptoms of endometrial hyperplasia/cancer
Menorrhagia
| Metorrhagia
43
What is bleeding post menopause main concern
Endometrial cancer
44
What is most common cancer of gynae
Endometrial
45
Most important factor in progression of endometrial hyperplasia to endometrial cancer
Atypia
46
What does atypia mean
Larger nucleus and hyperchromatic
47
Management of endometrial hyperplasia without atypia
Address risk factors -eg stop HRT
Can either observe or treat with progesterone but higher rates of regression in treatment
Progestogen treatment
- Oral progesterone
- LNG-IUS
Biopsy every 6 months
If symptomatic then adivse progestogen treatment
48
How is endometrial hyperplasia diagnosed and surveyed
Hysteroscopy with biopsy of endometrium
49
How often should women with endometrial hyperplasia without atypia be surveyed
6 months
50
Indication for surgery in women with endometrial hyperplasia without atypia
Not wanting to preserve fertility and
- no regression after 12 months
- relapse
- persistent bleeding
- decline surveillance and medical management
51
What surgery is done in endometrial hyperplasia without atypia if indicated
Total hysterectomy and if post menopausal can offter bilateral salpingo oophorectomy
52
What determines the treatment of atypical endometrial hyperplasia
Whether the woman wants to preserve her fertility or is unsuitable for surgery
53
What is management principle of atypical endometrial hyperplasia
Should have hysterectomy due to risk of progression to malignancy- as high was 30% in 20 years
54
What is management of atypical endometrial hyperplasia if no need to preserve fertility
Total hysterectomy and bilateral salpingo-oophorectomy
Ablation of endometrium possible but not as successful so not recommended
55
Management of atypical endometrial hyperplasia if want to preserve fertility
Pretreatment investigations to rule out ovarian cancer
First line LNG-IUS
Can also give oral progestogens
Surveillance every 3 months
56
How often should women who have medical management of atypical hyperplasia be surveyed
3 months until 2 negative biopsies then every year
57
What method of hysterectomy is preferred
Laprasocopic
- Shorter hospital stay
- Less post op pain
- Quicker recovery
58
What are 2 types of endometrial cancer
Endometrioid T1
Non-endometrioid T2
59
What factors which protect against endometrial cancer
Breastfeeding
COCP
Later age of giving birth
60
What are types of non-endometrioid cancer
Serous
Papillary
Clear cell
61
What is difference in appearance between endometrioid and non-endometrioid cancers
Endometrioid resembles normal glands
62
What is differnece in cause of non endometrioid vs endometrioid cancer
Endometrioid caused by excess oestrogen
Non-endometrioid in very old people
63
Risk factors for non-endometrioid cancers
Low body weight
| Endometrial atrophy
64
What are the majority of endometrioid cancers
Adenocarcinomas
65
Symptoms of endometrial cancer
Abnormal vaginal bleeding
| Enlargement of uterus can lead to abdo pain and cramping
66
Difference in presentation between endometrial and cervical cancer
Vaginal pain in cervical
67
How can vulvar cancer present
Noticed a mass
White plaque
Vulval itching, pain
Bleeding from ulceration
68
What will see on examination of vulval cancer
Irregular mass
Fungating
Groin lymph node enlargement
Ulcers or sores
White plaquw
69
What is most common type of vulval cancer
Squamous epithelium
70
How is vulval cancer diagnosed
Examination
Biopsy at least 1mm deep
71
Management plan for vulvar cancer
If stromal invasion of over 1mm or diameter over 2cm then vulvectomy full inguinofemoral lymphadenectomy recommended ( do separately to avoid morbidity)
If less than 2cm diameter and 1mm depth of invasion do wide local excision
If is less than 4cm and no evidence of lymph node involvement can do sentinel node biopsy but if SNLB detects metastases then must do full
If patient unfit for surgery then radical radiotherapy used
Excise any other lichen sclerosus and VIN
72
What are the 2 groups of groin lymph nodes
Inguinal- superficial
Femoral deep
73
Complications of groin lymphadenectomy
Wound healing complications
Infection
VTE
Chronic lymphoedema
74
How does sentinel lymph node biopsy work in vulvar cancer
Dye or radioactive nucleotide injected into tumour to identify sentinel node- first one it drains to
75
What is main prognostic factor in vulvar cancer
Lymph node involvement
76
What can be used as adjuvant therapy prior to vulvar cancer excision
Radiotherapy
Only in cases where 2 or more present groin metastases or excision margins too close
77
What are 2 precursors to vulvar cancer
VIN
Pagets
78
What cancers to VIN develop into versus pagets
Squamous cell cancer from VIN
| Adenocarcinoma from pagets disease of the vulva
79
What causes VIN
HPV 16
80
What are the 2 types of VIN
Usual type
| Differentiated
81
What is difference in age group presentation of usual type VIN versus differentiated type
Usual- 35-55
| Differentiated- older women
82
What is difference in association of usual and differentiated VIN
Usual- warty/basaloid SCC
| Differentiated- keratinising SCC
83
What is often seen before differentiated VIN
Lichen sclerosus
84
What happens in at a cervical screening
Speculum exam done and sample of transformation zone taken
85
What do at cervical screening if are 2 cervixes
Take a sample from both
86
When do you refer a smear test for colposcoy
Cervical stenosis where consider cervical dilatation
Cervix cant be visualised
87
When do you delay cervical screening
Menstruating
Less than 12 weeks post partum or miscarriage/abortion
Infection or discharge
Pregnant- wait 12 weeks til is done
88
How does cervical screening work
Initially test for high risk HPV strains
If positive do cytology
If these are negative then can return to normal waiting time
UNLESS
- test of cure pathway
- CIN 1 pathway
- follow-up for CGIN removal, stratified mucin producing intraepithelial lesion of the cervix or cervical cancer removal
- follow-up of borderline endocervical changes
89
What comes under abnormal cytology in smear test
Abnormal squamous or endocervical changes
Low grade dyskaryosis
Moderately high grade dyskaryosis
Severely high grade dyskaryosis
Invasive cervical carcinoma
Glandular epithelium
90
What happens if hrHPV positive but cytology negative
Repeat in 1 year
If this negative then return to normal schedule
If this positive and cytology abnormal colposcopy
If this positive and cytology negative repeat in 1 year
91
What are the outcomes of HPV testing at 24 months following initial pos HPV but neg cytology
Positive here-> colposcopy
Negative-> return to normal scedule
Inadequate-> colposcopy
92
What can cause an inadequate cytology sample
Was taken but the cervix was not fully visualized.
Was taken in an inappropriate manner (for example, using a sampling device not approved by the NHS Cervical Screening Programme).
Contains insufficient cells.
Contains an obscuring element (for example, lubricant, inflammation, or blood).
Was incorrectly labelled
93
What happens in inadequate sample or HPV testing unavailable
Repeat within 3 months
94
What happens if 2 inadequate or unavailable samples in a row
Refer to colposcopy
95
What is used to visualise cervix
Colposcope
96
Which stains are done during colposcopy
Acetic acid
Iodine
97
What happens to normal and abnormal tissue when apply acetic acid and iodine solution in colpsocopy
Acetic acid- CIN turns white
Iodine- normal tissue stains brown
98
How often are people screened with national cervical screening programme
25-49- every 3 years
50-65- every 5 years
99
What is BV
Where get an overgrowth of anaerobic bacteria and loss of lactobacilli leading to increase in vagina pH
100
Risk factors for BV
Copper IUD
Semen in vagina
Regular sex
Douches or vaginal implants
101
Management of BV not pregnant
Asymptomatic no treatment
If symptoms use oral metronidazole for 5-7 days. If adherance an issue can use one large dose
If contraindicated or prefers can use intravaginal metronidazole or clindamycin cream
102
What are uterine fibroids tumours of
Leiomyomas of smooth muscle cells and fibroblasts in myometrium
103
Risk factors for fibroids
Increasing age until the menopause
Early menarche
Older age at first pregnancy
Black
104
Complications of fibroids
IDA
Bladder and bowel compressive symptoms
Sub/infertility
Polycythaemia from autonomous EPO production
105
Symptoms of fibroids
Heavy menstrual bleeding
Pain/pressure in pelvis
Dyspareunia
Urinary and bowel symptoms
106
Examination finding of fibroids
Firm enlarged irregulary shaped uterus
107
Investigations for fibroids
Pelvic US abdo or transvaginal if needed to determine number. location and severity
Checking for IDA
108
When refer for fibroids
2WW if features of cancer clinically or on US
Arrange specialist consult if
- uncertain diagnosis
- severe bleeding or compressive sx
- confirmed fibroids over 3cm
- fertility issues
- post menopausal development of new sx
109
Management options in fibroids
Asymptomatic- no treatment needed just safety net about new symptoms
Treating the menorrhagia
- NSAIDS
- tranexamic acid
- levonorgestel intrauterine device
- the pill
Affecting fibroids themselves
- GNRH agonists
- uterine artery embolisation
- myomectomy
- hysterectomy
110
When consider fibroids for surgery
Rapidly growing
Large
Refractory to drugs
111
Side effects of GNRH agonists
Flushing
Vaginal drying
Loss of bone mineral density
112
Patient needs large fibroid removed however wants to maintain ability to conceive
Myomectomy
113
How is endometrial cancer investigated
Trans-vaginal US
Hysteroscopy with endometrial biopsy
114
Risk factors for ovarian cancer
BRCA1/2
Anyhting that increases number of ovulations
- nulliparity
- early pregnancy
- late menopause
115
When to suspect ovarian cancer and order tests
A woman in particular over 50 has one of these 12 times a month
- bloating
- early satiety
- pelvic/abdo pain
- urine urgency/frequency
116
How to manage suspected ovarian cancer
Abdo exam
- if mass or ascites 2WW
If clear measure CA125
- over 35 DO USS
- under consider other causes of raised CA125
117
Causes of raised CA125
Ovarian cancer
Fibroids
Pregnancy
PID
Endometriosis
118
What does meigs syndrome include
Ovarian mass
Pleural effusion
Ascites
119
Most common cause of Meigs syndrome
Fibroma
120
Management of meigs syndrome
Pleural effusion and ascites need drainage
Removal of ovarian tumour
121
When do you refer someone for 2WW with bleeding
Over 55
Over 45 on hormonal contraception
122
What is first investigation in PM bleeding 2WW
TVS looking for endometrial thickness over 5mm
123
What do if endometrial hyperplasia over 5mm
Hysteroscopy with biopsy
124
Risk factors for vulvar cancer
Lichen sclerosus
Immunosuppression
VIN
HPV
125
Long term complication of hysterectomy
Vaginal vault prolapse
Enterocele
126
How are ovarian cysts categorised
Physiological
Benign germ cell tumours
Benign epithelial tumours
Benign sex chord stroma tumours
127
What are the physiological cysts
Follicular
Corpus luteum cyst
128
What are the benign germ cell tumours
Dermoid cyst
129
What are the benign epithelial tumours
Serous cystadenoma
Mucinous cystadenoma
130
What are follicular cysts
They form from failure of degeneration of non-dominant or dominant follicles
131
What are most common benign ovarian cysts
Follicular
132
Progression of follicular cysts
Will degrade naturally over multiple cycles
133
What are corpus luteal cysts
Occurs when corpus luteum does not degenerate and fills with fluid or blood
134
Which of the physiological ovarian cysts is more dangerous
Corpus luteal as increased risk of intraperitoneal bleeding
135
What is most common ovarian cyst in under 30
Dermoid cyst
136
Which ovarian cyst most likely to present with torsion
Dermoid
137
Which is most common epithelial benign tumour
Serous cystadenoma
138
Which ovarian cyst often becomes massive
Mucinous cystadenoma
139
Risk of mucinous cystadenoma
If ruptures get pseudomyxoma peritonei
140
What is pseudomyxoma peritonei
Mucinous adenocarcinoma cells producing mucin and ascites into peritoneum
141
Presentation of ovarian cysts
Normally asymptomatic and will come and go
Dull pain unilaterally in abdomen that may only occur during sex
If very large can cause compressive sx on bowel and bladder/urinary symptoms
Fullness or bloating
142
Risk factors for ovarian cyst
Letrozole or drugs causing to ovulate
Pregnancy
PID
Endometriosis
143
How are ovarian cysts assessed
Using IOTA criteria. Looking for B (benign) or M (malignant) signs
M
- irregular and solid
- ascites
- mutliloculated (has septum)
- strong blood flow
- diameter over 100mm
IF HAS ANY OF THESE THEN BIOPSY
144
After USS what is management of cysts based on size
If has any M features then biopsy
If cyst between 50mm-70mm then can do yearly USS
Less than 50mm can reassure will disappear
145
What is most likely diagnosis when no PCB but is PMB
Endometrial hyperplasia/cancer
146
If are no plans for a fmaily in future, what surgical options for fibroids
Hysteroscopic ablation
Hysteroscopy
147
Pathophysiology of endometriosis
When endometrial tissue migrates to places other than the endometrium most commonly in the ovaries, fallopian tubes or uterine ligaments. The endometrial cells produce lots of oestrogen and pro-inflammatory markers which can lead to adhesions and bleeding especially during menstruation
148
Risk factors for endometriosis
Fhx
Nulliparity
Early menarche
Late menopause
149
Risks of endometriosis
Ovarian cancer
Rupture of chocolate cysts
Infertility
150
What can be seen on examination of endometriosis
Reduced pelvic organ mobility
Visible vaginal endometriomas
151
What are chocolate cysts
Endometriomas which contain old blood from menstruation of the endometrial tissue
152
Presentation of endometriosis
Deep dyspareunia
Secondary dysmenorrhoea
Subfertility
Compressive symptoms- painful bowel movements, dysuria, urgency especially around times of period
Chronic pelvic pain
153
When to refer for endometriosis
To gynae for USS
- if severe and persistent signs of endometriosis
- pelvic signs of endometriosis
To endometriosis centre
- bladder and bowel involvement
If under 17 then to paed gynae service
Hormonal management unsucessful
Fertility a priority
154
Management of endometriosis in primary care
Paracetamol or NSAID for pain for 3 months
Second line- hormonal treatment including COCP, progestogen or LNG-IUS
Follow-up in 3 months
155
Investigations for endometriosis
Can do TVUSS in secondary care or abdominal if CI or not tolerated
Laparoscopy gold standard and still indicated even if TVUSS NAD
156
Secondary care management of endometriosis
When have diagnostic laparoscopy remove peritoneal endometriosis and ovarian endometriomas
Can give GnRH agonists for 3 months as adjunct
Give COCP afterwards
If fertility not a priority and having uncontrolled bleeding/ symptoms can consider hysterectomy with or without oophorectomy.
If fertility a priority excision or ablation with adhesiolysis of endometriosis not involving bowel/bladder. Also remove cyst wall of ovarian endometriomas
157
Surgical mangement of endometriosis if fertility a priority
Always remove peritoneal endometriosis and ovarian endometriomas but include the wall
Ablation or partial excision of endometriosis with adhesiolysis for non-peritoneal endometriosis ie fallopian tubes and ovaries
158
Surgical mangement of endometriosis if fertility not a priority
Consider hysterectomy with or without oophorectomy if having uncontrolled symptoms or adenomysosi and remove any other endometriosis
Use COCP afterwards
159
Surgical management of deep endometriosis
Adjunct of GNRH agonist for 3 months
Excision laparascopically
COCP afterwards
160
What is given after endometriosis surgery
COCP unless fertility a priority
161
What is adenomyosis
Where endometrium grows within the myometrium
162
Who does adenomyosis occur in
Multiparous women aproaching menopause
163
What is best imaging for adenomyosis
MRI
164
How does adenomyosis present
Menorrhagia
Dysmenorrhoea
Bulky uterus on examination
165
What is boggy uterus seen in
Adenomyosis
166
If suspect adenomyosis what is first line investigation
TVUSS
If not appropriate or tolerated do MRI
167
Management of menorrhagia in adenomyosis
LNG-IUS
2nd line- tranexamic acid or oral hormones
168
How manage fibroids under 3cm
LNG-IUS or tranexamic acid depending on contraception desires
Consider surgery options if unsuccessful
169
How manage fibroids over 3cm
Multifactorial but consider tranexamic acid, LNG-IUS
Or surgical namely myomectomy, hysterectomy or uterine artery embolisation
170
What is management of adenomyosis
Treat menorrhagia
Surgical options include uterine artery embolisation and hysterectomy which is definitive
171
What are the different types of fibroid
Submucosal- project into uterine cavity
Intramural- grow within wall
Subserosal- project out of uterus
172
Management of submucosal fibroids
Consider hysteroscopic removal
173
What is purpose of GNRH agonists pre surgery for fibroids and endometriosis
Pseudomenopause where little stimulation of masses
174
What is an example of a GNRH agonist
Triptorelin
175
What can happen to fibroids in pregnancy
Undergo carneous degeneration- as oestogen sensitive can grow which exceeds capacity of blood vascular supply therefore can have haemorrhagic infarction
176
How does carneous degeneration of fibroids present in pregnancy
Abdo pain
Vomiting
Slight fever
177
Management of endometrial cancer
Mainstay for localised treatment is hysterectomy
If frail have progestogen therapy
178
Risk factors for cervical cancer
Early age of first pregnancy
Multiple partners
Lack of barrier protection
Immunosuppression
Smoking
COCP
179
If you have HIV how often should you get cervical smears
Annually
180
Which ovarian cancer is endometrial hyperplasia associated with
Granulosa cell tumours as produce oestrogen
181
What are powder burn spots seen in
Endometriosis
These are brown spots on the pelvic peritoneum
182
What is rotikansky protuberance seen in
Dermoid cyst
When tooth projects towards middle of cyst
183
What are types of vulvar cancer
Mainly SCC
Basaloid- from HPV
Keratinising - lichen sclerosus
Can get adenocarcinoma from pagets disease of the vulva
184
What lines the endometrium
Columnar epithelium as adenocarcinoma most common cancer
185
Presentation of adenomyosis
Menorrhagia
Dymenorrhoea
Dyspareunia
186
Where do the pelvic cancers metastasise to (lymph nodes)
Ovarian- para-aortic
Vulvar- inguinal
Cervical- pelvic lymph nodes along iliac arteries
187
What is pathophysiology of ovarian stromal hyperthecosis
You get clusters of thecal cells in the ovarian stroma which respond to LH by producing excess testosterone
188
Presentation of ovarian stromal hyperthecosis
Signs of hyperandrogenism
Older women
Bilaterally enlarged solid ovaries
189
Management of lichen sclerosus
1st line- high potency steroids like clobetasol propionate
2nd line- calcineurin inhibitor like tacrolimus
190
First line for prolactinoma
Cabergoline- dopamine agonist
191
Why does tamoxifen cause endometrial cancer
Although it is anti-oestrogenic in breast it is pro in the uterus
192
Can obesity itself cause menorrhagia
Yes
193
If in TVUSS of menstrual woman endometrial thickness is 12cm but about to menstruate what do
Repeat post menses
194
What is pipelle
Tool used to take biopsy from endometrium
195
What does cervix easily bleeding suggest
Cervical cancer
196
What drug can be used to cure endometriosis
Triptorelin
197
What is a wertheimers hysterectomy
Removes upper third of vagina with uterus
USED FOR CERVICAL CANCER
198
What is a subtotal hysterectomy
Where leave cervix
199
What would be management of someone admitted to hospital with severe vaginal bleeding from sex who is in shock
Resus
Examination under GA
200
If go into shock post operatively what is assumed cause and how manage
Bleeding
Resus and go to theatre
201
Why is abdomen illuminated prior to surgery
To allow visulisation of vessels so can avoid them- superficial epigastric artery
202
What causes umbilical distension and abdo pain after laparoscopy
Umbilical portal site bleed
203
Management of umbilical port bleed
Resus
Go back to surgery
204
How are low risk cysts under 5cm managed
Conservatively with follow up in 3 months
205
Pedunculated red growths which protrude through the external OS
Cervical polyp
206
Can you consider a hysterectomy for CIN
Yes if severe menorrhagia as well as finished family
207
How is RMI calculated
Ca125 x menstrual status x USS
208
How does menstrual scoring work for RMI
Premenopausal= 1
Post menopausal= 3
209
How does USS scoring work for RMI
No features= 0
1 feature = 1
2 or more = 3
210
What are USS points for in RMI
Multiloculated
Ascited
Bilateral
Solid area
Metastases
211
What is RMI cutoff for an MDT
250
212
What does iodine bind to in cells
Glycogen
213
Lady with vaginal itching and white streaks in mouth
Lichen planus
214
How does lichen planus appear on vagina
Red with excoriation marks
215
What is the urgency of colposcopy after cytological analysis showed abnormalities
Non-urgent
216
If see white plaque on vulvar what need to do
Take a biopsy as this is not necessarily lichen sclerosus, cancer can also present like this
217
How can lichen sclerosus present
Dyspareunia
Itching
Skin splitting
Bleeding
Thickended skin
Adhesions leading to narrowed vaginal introitus
218
2WW requirements for vulval lesions
Unexplained vulval bleeding, lump or ulceration
219
How should submucosal fibroids be removed when wanting to preserve fertility
Transcervical resection of the fibroid
220
What would prompt to skip Ca125 and go stragiht to 2WW
Mass or ascites on examination
221
Which cyst most associated with bleeding
Corpus luteal
222
What would prompt to do hysteroscopy instead of pipelle
Cervical stenosis
Sample inadequate
Pipelle not tolerated
223
What colour does abnormal tissue stain after iodine application
Yellow
224
How does uterine artery embolisation work
Using a catheter embolic agents are inserted into arteries supplying fibroids to cause infarction and subsequent degeneration
225
Woman wants to avoid surgery for fibroids but maintain fertility
Uterine artery embolisation
226
Management if have BRCA1 gene
Can choose between monitoring and surgery
- monitoring involves regular USS and Ca125
- surgical can involve having a bilateral salpingoophorectomy
227
What are amber filled lumps seen around the cervix
Nabothian cysts
228
What are nabothian cysts
Where cervical squamous cells can cover the columnar epithelium of the ectocervix. When columnar cells release mucous these become trapped under the squamous cells
229
Once USS has been done for ovarian cancer alongside Ca125, what is next investigation
CT scan to determine extent
230
In secondary care ovarian cancer investigations, what is measured in women under 40
AFP
bHCG
231
What is preferred method of collecting cytology in ovarian cancer
Laparotomy
232
Most common site of vulva cancer
Labia majora
233
What is management if cervical ectropion symptoms are bothersome
Can refer to colposcopy non-urgently to have it cauterised
