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obs and gynae > Cancer > Flashcards

Cancer Flashcards

1
Q

Ctype of epithelium in cervical cancer

A

s.c.c (most common)
adeno

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2
Q

associations of cervical cancer

A

Human papilloma virus

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3
Q

when vaccinated against HPV

A

12-13 yrs

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4
Q

if HPV +ve increased risk of what other cancers

A

anal
vulval
vaginal
penis
mouth and throat

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5
Q

2 important strains of HPV

A

type 16 and 18

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6
Q

what tell pt with HPV +VE

A

no treatment for infection with HPV. Most cases resolve spontaneously within two years, while some will persist.

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7
Q

pathophysiology of HPV causing cervical cancer

A

P53 and pRb are tumour suppressor genes. They have a role in suppressing cancers from developing. HPV produces two proteins (E6 and E7) that inhibit these tumour suppressor genes. The E6 protein inhibits p53, and the E7 protein inhibits pRb. Therefore, HPV promotes the development of cancer by inhibiting tumour suppressor genes.

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8
Q

risk fx of cervical cancer

A

Increased risk of catching HPV
Later detection of precancerous and cancerous changes (non-engagement with screening)
Other risk factors
Smoking
HIV (patients with HIV are offered yearly smear tests)
Combined contraceptive pill use for more than five years
Increased number of full-term pregnancies
Family history
Exposure to diethylstilbestrol during fetal development (this was previously used to prevent miscarriages before 1971)

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9
Q

increased risk of catching HPV

A

Early sexual activity
Increased number of sexual partners
Sexual partners who have had more partners
Not using condoms

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10
Q

presentation of cervical cancer

A

asx - screening
Abnormal vaginal bleeding (intermenstrual, postcoital or post-menopausal bleeding)
Vaginal discharge
Pelvic pain
Dyspareunia (pain or discomfort with sex)

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11
Q

ix for cervical cancer

A

examine cervix with speculum and swab
if abnormal - urgent referral for colposcopy

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12
Q

cervical appearance requiring 2WW

A

Ulceration
Inflammation
Bleeding
Visible tumour

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13
Q

grading system for dysplasia in cervical cancer

A

CIN
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/carcinoma in situ

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14
Q

how screening for cervical cancer

A

The cells are deposited from the brush into a preservation fluid. This fluid is transported to a lab where the cells are examined under a microscope for precancerous changes (dyskaryosis). This way of transporting the cells is called liquid-based cytology.
tested for high risk HPV, if -ve, cells not examined and smear is negative

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15
Q

when attend cervical screening

A

Every three years aged 25 – 49
Every five years aged 50 – 64

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16
Q

cervical screening additional testing circumstances

A

Women with HIV are screened annually
Women over 65 may request a smear if they have not had one since aged 50
Women with previous CIN may require additional tests (e.g. test of cure after treatment)
Certain groups of immunocompromised women may have additional screening (e.g. women on dialysis, cytotoxic drugs or undergoing an organ transplant)
Pregnant women due a routine smear should wait until 12 weeks post-partum

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17
Q

infections found on smear

A

BV
candidiasis
trichomoniasis

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18
Q

IUS infection associated

A

Actinomyces-like organisms are often discovered in women with an intrauterine device (coil). These do not require treatment unless they are symptomatic. Where the woman is symptomatic (e.g. pelvic pain or abnormal bleeding), removal of the intrauterine device

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19
Q

Summary of mx from 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

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20
Q

What is colposcopy

A

inserting a speculum and using equipment (a colposcope) to magnify the cervix. This allows the epithelial lining of the cervix to be examined in detail. During colposcopy, stains such as acetic acid and iodine solution can be used to differentiate abnormal areas
If abnormal - white with acetate, not stain wirh iodine

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21
Q

How get tissue sample during colposcopy

A

Punch biopsy
Large loop excision of transformation zone

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22
Q

Large loop excision of the transformation zone how work

A

Local anaesthetic
using a loop of wire with electrical current (diathermy) to remove abnormal epithelial tissue on the cervix. The electrical current cauterises the tissue and stops bleeding.
S/e - bleeding and abnormal discharge, increases risk of pre term labour
C/i - using tampons or sex after

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23
Q

Cone biopsy how work

A

Indications - can be used for tx for CIN and very early stage cancer
General anaesthetic
Sent for histology
Risks -Pain
Bleeding
Infection
Scar formation with stenosis of the cervix
Increased risk of miscarriage and premature labour

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24
Q

Staging cervical cancer

A

FIGO
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

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25
Q

Mx of cervical cancer

A

Cervical intraepithelial neoplasia and early-stage 1A: LLETZ or cone biopsy
Stage 1B – 2A: Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy
Stage 2B – 4A: Chemotherapy and radiotherapy
Stage 4B: Management may involve a combination of surgery, radiotherapy, chemotherapy and palliative care

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26
Q

Survival cervical cancer

A

The 5-year survival drops significantly with more advanced cervical cancer, from around 98% with stage 1A to around 15% with stage 4.

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27
Q

Mx of advanced cervical cancer

A

Pelvic exenteration - removing most or all of the pelvic organs, including the vagina, cervix, uterus, fallopian tubes, ovaries, bladder and rectum.

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28
Q

Chemo Tx of cervical cancer

A

Bevacizumab (avastin) - targets vascular endothelial growth factor A (VEGF-A), which is responsible for the development of new blood vessels. Therefore, it reduces the development of new blood vessels. You may also come across this medication as a treatment for wet age-related macular degeneration

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29
Q

HPV strains causing genital warts

A

6 and 11

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30
Q

When HPV vaccine given?

A

Before sexually active

31
Q

Type of epithelium endometrial cancer

A

Adenocarcinoma

32
Q

Typical presentation of endometrial cancer

A

any woman presenting with postmenopausal bleeding has endometrial cancer until proven otherwise

33
Q

Key risk fx for endometrial cancer

A

Obesity
DM

34
Q

Endometrial hyperplasia types

A

Hyperplasia without atypia
Atypical hyperplasia

35
Q

How endometrial hyperplasia tx

A

Intrauterine system (e.g. Mirena coil)
Continuous oral progestogens (e.g. medroxyprogesterone or levonorgestrel)

36
Q

Risk fx endometrial cancer

A

Unopposed oestrogen
stimulates the endometrial cells and increases the risk of endometrial hyperplasia and cancer

37
Q

Risk fx of unopposed oestrogen

A

Increased age
Earlier onset of menstruation
Late menopause
Oestrogen only hormone replacement therapy
No or fewer pregnancies
Obesity
Polycystic ovarian syndrome
Tamoxifen

37
Q

PCOS unopposed oestrogen

A

Usually, when ovulation occurs, a corpus luteum is formed in the ovaries from the ruptured follicle that released the egg. It is this corpus luteum that produces progesterone, providing endometrial protection during the luteal phase of the menstrual cycle (the second half of the menstrual cycle). Women with polycystic ovarian syndrome are less likely to ovulate and form a corpus luteum.

38
Q

Main cause of unopposed oestrogen in postmenopausal women

A

Obesity - Adipose tissue contains aromatase, which is an enzyme that converts androgens such as testosterone into oestrogen. Androgens are produced mainly by the adrenal glands. In women with more adipose tissue, and therefore more aromatase enzyme, more of these androgens are converted to oestrogen
Also not ovulating so no corpus luteum to produce progesterone

39
Q

Drug that increases risk of endometrial cancer

A

Tamoxifen

40
Q

Risk fx of endometrial cancer unrelated to unopposed oestrogen

A

Type 2 diabetes
Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome

41
Q

Protective fx against endometrial cancer

A

Combined contraceptive pill
Mirena coil
Increased pregnancies
Cigarette smoking

42
Q

Presentation of endometrial cancer

A

Post menopausal bleeding!
Postcoital bleeding
Intermenstrual bleeding
Unusually heavy menstrual bleeding
Abnormal vaginal discharge
Haematuria
Anaemia
Raised platelet count

43
Q

Referral for endometrial cancer

A

a 2-week-wait urgent cancer referral for endometrial cancer is:

Postmenopausal bleeding (more than 12 months after the last menstrual period)

NICE also recommends referral for a transvaginal ultrasound in women over 55 years with:

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

44
Q

Ix for endometrial cancer

A

Transvaginal ultrasound for endometrial thickness (normal is less than 4mm post-menopause)
Pipelle biopsy, which is highly sensitive for endometrial cancer making it useful for excluding cancer
Hysteroscopy with endometrial biopsy

45
Q

Stages of endometrial cancer

A

FIGO
Stage 1: Confined to the 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

46
Q

Mx of endometrial cancer

A

stage 1 and 2 endometrial cancer is a total abdominal hysterectomy with bilateral salpingo-oophorectomy, also known as a TAH and BSO (removal of uterus, cervix and adnexa
radical hysterectomy involves also removing the pelvic lymph nodes, surrounding tissues and top of the vagina
Radiotherapy
Chemotherapy
Progesterone may be used as a hormonal treatment to slow the progression of the cancer

47
Q

Types of ovarian cancer

A

Epithelial cell tumours
Dermoid cysts
Sex cord stromal tumours
Mets

48
Q

Types of epithelial cell tumours

A

Serous tumours (the most common)
Endometrioid carcinomas
Clear cell tumours
Mucinous tumours
Undifferentiated tumours

49
Q

Dermoid cysts clinical do

A

tissue types, such as skin, teeth, hair and bone.

50
Q

Associations of Dermoid cysts

A

Ovarian torsion

51
Q

Germ cell tumours markers

A

alpha-fetoprotein (α-FP) and human chorionic gonadotrophin (hCG)

52
Q

Types of sex cord stromal tumours

A

Sertoli–Leydig cell tumours and granulosa cell tumours.

53
Q

Term for metastatic ovarian cancer

A

Krukenberg tumour refers to a metastasis in the ovary, usually from a gastrointestinal tract cancer, particularly the stomach

54
Q

Krukenberg tumours on histology

A

Signet ring cells

55
Q

Risk fx for ovarian cancer

A

Age (peaks age 60)
BRCA1 and BRCA2 genes (consider the family history)
Increased number of ovulations
Obesity
Smoking
Recurrent use of clomifene

56
Q

Protective fx of ovarian cancer

A

Combined contraceptive pill
Breastfeeding
Pregnancy

57
Q

Ovarian cancer clinical fx

A

Abdominal bloating
Early satiety (feeling full after eating)
Loss of appetite
Pelvic pain
Urinary symptoms (frequency / urgency)
Weight loss
Abdominal or pelvic mass
Ascites
may press on the obturator nerve and cause referred hip or groin pain.

58
Q

Referral criteria ovarian cancer

A

2-week-wait referral if a physical examination reveals:

Ascites
Pelvic mass (unless clearly due to fibroids)
Abdominal mass

59
Q

Ix for ovarian cancer

A

Ca125
(>35 IU/mL is significant)
Pelvic ultrasound
Further:
CT
Histology
Paracentesis

60
Q

Risk scoring of ovarian mass being malignant

A

Risk of malignancy index
Menopausal status
Ultrasound findings
CA125 level

61
Q

When germ cell tumours more likely

A

<40 with complex ovarian mass

62
Q

Other causes of raised ca 125

A

Non specific -
Endometriosis
Fibroids
Adenomyosis
Pelvic infection
Liver disease
Pregnancy

63
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)

64
Q

Mx of ovarian cancer

A

gynaecology oncology MDT. It usually involves a combination of surgery and chemotherapy.

65
Q

Types of epithelium vulval cancer

A

S.c.c
Malignant melanoma

66
Q

Risk fx for vulval cancer

A

Advanced age (particularly over 75 years)
Immunosuppression
Human papillomavirus (HPV) infection
Lichen sclerosus

67
Q

Premalignant vulval cancer

A

VIN :
High grade squamous intraepithelial lesion is a type of VIN associated with HPV infection that typically occurs in younger women aged 35 – 50 years.

Differentiated VIN is an alternative type of VIN associated with lichen sclerosus and typically occurs in older women (aged 50 – 60 years).

68
Q

Diagnosis of VIN

A

Biopsy

69
Q

Tx of VIN

A

Watch and wait with close followup
Wide local excision (surgery) to remove the lesion
Imiquimod cream
Laser ablation

70
Q

VIN clinical fx

A

Vulval lump
Ulceration
Bleeding
Pain
Itching
Lymphadenopathy in the groin

71
Q

O/E vulval cancer

A

Labia majors - Irregular mass
Fungating lesion
Ulceration
Bleeding

72
Q

Mxof vulval cancer

A

Wide local excision to remove the cancer
Groin lymph node dissection
Chemotherapy
Radiotherapy

73
Q
A

obs and gynae (7 decks)

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