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Obstetrics and Gynaecology > Cancer > Flashcards

Cancer Flashcards

1
Q

Common types of cervical cancer

A
  1. 80% squamous cell carcinoma
  2. Adenocarcinoma
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2
Q

What is the most common cause of cervical cancer?

A

HPV

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3
Q

How do we screen for cervical cancer?

A

Smear tests

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4
Q

How is HPV transmitted?

A

Sexually transmitted

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5
Q

Important strains of HPV

A

16 and 18

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6
Q

How do you treat HPV?

A

There is no treatment for HPV infection and most cases resolve spontaneously within 2 years but some may persist.

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7
Q

How does HPV cause cervical cancer?

A

HPV produces E6 and E7 which suppress P53 and pRb (tumour suppressor genes) which as a result promotes the development of cancer.

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8
Q

Risk factors for cervical cancer

A

Early sexual activity
Increased number of sexual partners
Sexual partners who have had more partners
Not using condoms
Smoking
HIV
COCP use for more than five years
Increased number of full term pregnancies
Family history

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9
Q

Presentation of cervical cancer

A

Abnormal vaginal bleeding
Vaginal discharge
Pelvic pain
Dyspareunia

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10
Q

What should be done if a cervix appears abnormal on speculum examination?

A

Urgent cancer referral for colposcopy

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11
Q

What grading system is used for level of dysplasia?

A

CIN grading ( Cervical intraepithelial neoplasia)
CIN 1 - mild - affects 1/3 thickness of epithelial layer and likely to return to normal
CIN 2 - moderate - affects 2/3 of thickness of epithelial layer and likely to progress to cancer if untreated
CIN 3 - severe - very likely to progress to cancer if untreated

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12
Q

Cervical cancer screening process

A

Small brush collects cells from the cervix using a speculum and cells are deposited and looked at under a microscope for dyskaryosis. Sample is tested for high risk HPV before the cells are examined. If HPV negative then the cells are not examined - considered negative and returned to normal screening programme.

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13
Q

Cervical screening programme timeline

A

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

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14
Q

Exceptions to cervical screening programme timeline

A

Women with HIV screened annually
Immunocompromised women may have additional screening
Pregnancy women should wait 12 weeks (3 months) postpartum for cervical screening

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15
Q

Management of smear results:
1. Inadequate sample
2. HPV negative
3. HPV positive with normal cytology
4. HPV positive with abnormal cytology

A
  1. Inadequate sample - repeat smear after at least 3 months
  2. HPV negative - continue routine screening
  3. HPV positive with normal cytology - repeat HPV test after 12 months
  4. HPV positive with abnormal cytology - refer for colposcopy
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16
Q

What is colposcopy?

A

Involves inserting speculum and using a colposcope to magnify the cervix and examine abnormal areas of epithelial lining of cervix.

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17
Q

Types of biopsies during colposcopy

A

LLETZ or cone biopsy

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18
Q

Main risks of a cone biopsy

A

Pain
Bleeding
infection
Scar formation with stenosis of cervix
Increased risk of miscarriage and premature labour

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19
Q

Staging of cervical cancer

A

FIGO staging:
1. Confined to cervix
2. invades the uterus or upper 2/3 of vagina
3. invades pelvic wall or lower 1/3 of vagina
4. invades the bladder, rectum or beyond the pelvis

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20
Q

Management of cervical cancer

A

CIN I - LLETZ or cone biopsy
Stage 1b-2a - radical hysterectomy and removal of lymph nodes with chemo and radio
Stage 2b-4a - chemo and radio
stage 4b - combination of surgery, radio, chemo and palliative care

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21
Q

Current NHS vaccine for HPV

A

Gardasil

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22
Q

Most common type of endometrial cancer

A

Adenocarcinoma

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23
Q

Types of endometrial hyperplasia

A

Hyperplasia without atypic
Atypical hyperplasia

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24
Q

How may endometrial hyperplasia be treated?

A

Using progestogens : IUS or continuous oral progestogens

25
Q

Risk factors for endometrial cancer

A

Related to patient’s exposure to unopposed oestrogen so:

  • increased age
  • early onset of menstruation
  • late menopause
  • oestrogen only hormone replacement therapy
  • no or few pregnancies
  • obesity
  • PCOS
  • Tamoxifen
26
Q

How does PCOS lead to increased risk of endometrial cancer?

A

Increased exposure to unopposed oestrogen due to lack of ovulation. Women with PCOS are less likely to ovulate and for a corpus luteum and without the corpus luteum, progesterone is not produced -> unopposed oestrogen. For endometrial protection, women with PCOS should have either COCP, IUS, or cyclical progestogens.

27
Q

How does obesity lead to increased risk of endometrial cancer?

A

Adipose tissue contains aromatase which converts androgens such as testosterone to oestrogen. The extra oestrogen is unopposed in women who are not ovulating.

28
Q

How does tamoxifen lead to increased risk of endometrial cancer?

A

Tamoxifen is an anti-oestrogenic effect on breast tissue but an oestrogen effect on the endometrium -> increased risk of endometrial cancer.

29
Q

How does T2DM lead to increased risk of endometrial cancer?

A

Increased production of insulin may stimulate the endometrial cells and increase the risk of endometrial hyperplasia and cancer.

30
Q

Protective factors against endometrial cancer examples.

A

COCP
Mirena coil
Increased pregnancies
Cigarette smoking

31
Q

How is smoking protective against endometrial cancer?

A

Smoking in post menstrual women is protective by being anti-oestrogenic, for example:

Oestrogen is thought to be metabolised differently in smokers.
Smokers tend to be leaner - so less adipose tissue and less aromatase
Smoking destroys oocytes resulting in earlier menopause

32
Q

How does endometrial cancer present?

A

Main symptom is post-menstrual bleeding.

  • unusually heavy menstrual bleeding
  • postcoital bleeding
  • intermittent bleeding
  • haematuria
  • anaemia
  • raised platelet count
33
Q

What should you do if you suspect endometrial cancer?

A

2-week wait referral for post menstrual bleeding (more than 12 months after last menstrual period)

34
Q

For whom does NICE recommend a transvaginal USS?

A

Women over 55 with:

Unexplained vaginal discharge
Visible haematuria plus raised platelets, anaemia or elevated glucose levels

35
Q

Endometrial cancer investigations

A

Transvaginal USS,
Pipelle biopsy (highly sensitive for endometrial cancer)
Hysteroscopy with endometrial biopsy

36
Q

Staging of endometrial cancer

A

FIGO

Stage 1: confined to uterus
Stage 2: invades the cervix
Stage 3: invades the ovaries, Fallopian tubes, vagina or lymph nodes
Stage 4: invades bladder, rectum or beyond the pelvis

37
Q

Endometrial cancer management

A

Usual treatment for stage 1 and 2 endometrial cancer is a total abdominal hysterectomy with bilateral sapling-ooophorectomy

Other treatment options:
- Radio
- Chemo
- Progesterone can be used as hormonal treatment to slow the progression of the cancer
- radical hysterectomy with lymph node, surrounding tissue and top of vagina removal

38
Q

Ovarian cancer presentation

A

Often presents late due to non-specific symptoms and usually has a bad prognosis

39
Q

Types of ovarian cancer

A

Epithelial cell tumours (most common)
Dermoid cysts/ Germ cell tumours
Sex cord-stomal tumours
Metastasis

40
Q

Dermoid cysts/ Germ cell tumours

A

Benign ovarian tumours. They are teratomas meaning they come from the germ cells. They contain various tissue types such as skin, teeth, hair and bone. They are particularly associated with ovarian torsions. This protuberance is referred to as the Rokitansky protuberance. Germ cell tumours may cause raised alpha-fetoprotein and hCG.

41
Q

Sex cord-stomal tumours

A

Rare tumours that can be benign or malignant. They arise from the storm or sex cords. Either from sertoli-leydig cell tumours and granulose cell tumours

42
Q

Krukenberg tumour

A

metastasis in the ovary from a gastrointestinal tract cancer - most commonly the stomach.

43
Q

Risk factors for ovarian cancer

A

Age >60
BRCA 1 and BRCA 2 genes
Increased number of ovulations
Obesity
Smoking
Recurrent use of clomifene

44
Q

Protective factors of ovarian cancer

A

COCP
Breastfeeding
Pregnancy

45
Q

Ovarian cancer presentation

A

Abdominal bloating
Loss of appetite
Pelvic pain
Weight loss
Abdominal or pelvic mass
Ascites

46
Q

Referral criteria for ovarian cancer

A

Refer directly for 2 week wait referral if physical examination reveals:

Ascites
Pelvic mass
Abdominal mass

47
Q

Ovarian cancer investigations

A

CA125 blood test >35
Pelvic USS

48
Q

What is RMI?

A

Risk of malignancy index which is based on:

Menopausal status
USS findings
CA125 level

49
Q

Causes of raised CA125

A

Endometriosis
Fibroids
Adenomyosis
Pelvic inflammation
Liver disease
Pregnancy

50
Q

Staging of ovarian cancer

A

FIGO

Stage 1: confined to ovary
Stage 2: spreads past the ovary but inside the pelvis
Stage 3: past the pelvis but inside the abdomen
Stage 4: spread outside the abdomen

51
Q

Management of ovarian cancer

A

Managed by specialist with combination of surgery and chemo

52
Q

Vulval cancer types

A

Squamous cell carcinomas most common

53
Q

Risk factors for vulval cancer

A

Advanced age >75
Immunosuppression
HPV
Lichen Sclerosis

54
Q

What is vulval intraepithelial neoplasia?

A

Premalignant condition affecting the squamous epithelium that can precede vulval cancer.

55
Q

Types of vulval intraepithelial neoplasia

A

High grade VIN - VIN with HPV infection and occurs in younger women
Differentiated VIN - VIN with lichen sclerosis and occurs in older women

56
Q

How to diagnose and manage VIN?

A

Diagnose via biopsy and management includes:

  • Watch and wait
  • Wide local excision
  • Imiquimod cream
  • Laser ablation
57
Q

Presentation of vulval cancer

A

Vulval lump
Ulceration
Bleeding
Pain
Itching
Lymphadenopathy in groin

58
Q

Management of vulval cancer

A

Wide local excision
Groin lymph node dissection
Chemotherapy
Radiotherapy

Obstetrics and Gynaecology (9 decks)

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