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3a Women's health > Cancer > Flashcards

Cancer Flashcards

1
Q

Why is ovarian cancer frequently diagnosed at an advanced stage?

A

often diagnosed at an advanced stage due to non-specific symptoms, which can result in the disease being widely metastatic within the abdomen by the time it is detected

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2
Q

State the most common type of ovarian cancer and give 4 subtypes

A

epithelial cell tumours
* serous adenocarcinoma (mc)
* endometroid carcinoma
* clear cell carcinoma
* mucinous adenocarcinoma

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3
Q

How does the number of ovulations relate to the risk of ovarian cancer?

A

Factors that increase the number of ovulations increase the risk of ovarian cancer.
* Early menarche
* late menopause
* nulliparity

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4
Q

What are some risk factors for ovarian cancer?

A
  • increase age
  • FHx - BRCA1 & 2 gene
  • obesity
  • many ovulations - early, late menopause, nulliparity
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5
Q

Give 3 factors that are protective against ovarian cancer

A
  • combined contraceptive pill
  • breastfeeding
  • pregnancy
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6
Q

What are some symptoms that may indicate ovarian cancer?

A
  • persistent abdo distension (bloating)
  • early satiety (feeling full)
  • loss of appetite
  • pelvic/abdo pain
  • urinary symptoms (frequency/urgency)
  • weight loss
  • abdominal/ pelvic mass
  • ascites.
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7
Q

When should a 2-week-wait referral for suspected ovarian cancer be made based on physical examination findings?

A
  • ascites
  • pelvic mass (unless clearly due to fibroids)
  • abdominal mass
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8
Q

What are the investigations for suspected ovarian cancer

A
  • CA125 blood test (>35 IU/mL is significant)
  • abdo and pelvis ultrasound: ascites and/ or mass
  • may involve diagnostic laparotomy
  • calculate risk of malignancy index
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9
Q

What factors does the Risk of Malignancy Index (RMI) use to estimate the risk of an ovarian mass being malignant?

A
  • menopausal status
  • ultrasound findings
  • CA125 level.
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10
Q

What tumour markers are required for women under 40 years with a complex ovarian mass to assess for a possible germ cell tumour

A
  • Alpha-fetoprotein (α-FP)
  • Human chorionic gonadotropin (HCG)
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11
Q

What are the stages of ovarian cancer according to the International Federation of Gynaecology and Obstetrics (FIGO) staging system?

A
  • Stage 1: Confined to the ovary.
  • 2: Spread past the ovary but inside the pelvis.
  • 3: Spread past the pelvis but inside the abdomen.
  • 4: Spread outside the abdomen (distant metastasis).
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12
Q

How is ovarian cancer managed surgically

A

total hysterectomy, bilateral salpingo-oophrectomy and partial omentectomy

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13
Q

How is ovarian cancer managed medically

A
  • managed by a specialist gynaecology oncology MDT
  • platinum-based chemotherapy
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14
Q

What is endometrial hyperplasia

A

a precancerous condition involving thickening of the endometrium

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15
Q

What are the types of endometrial hyperplasia

A
  • simple
  • complex
  • simple atypical
  • complex atypical
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16
Q

How does endometrial hyperplasia present

A

abnormal vaginal bleeding e.g. intermenstrual

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17
Q

How is endometrial hyperplasia managed

A
  • Intrauterine system (e.g. Mirena coil)
  • Continuous oral progestogens (e.g. medroxyprogesterone or levonorgestrel)
  • repeat sampling in 3-4 months
  • Atypical: total hysterectomy with bilateral salpingo-oophorectomy
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18
Q

Give 5 RFs of endometrial cancer related to unopposed endogenous/exogenous oestrogen

A
  • obesity (endo)
  • PCOS - prolonged amenorrhea (endo)
  • early menarche (endo)
  • nulliparity (endo)
  • late menopause (endo)
  • tamoxifen therapy (exo)
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19
Q

Give 3 RFs of endometrial cancer that are NOT associated with unopposed oestrogen

A
  • T2DM
  • > 55yo
  • Lynch 2 syndrome (hereditary non-polyposis colorectal carcinoma)
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20
Q

Give 3 protective factors of endometrial cancer

A
  • combined contraceptive pill
  • pregnancy/ multiparity
  • smoking
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21
Q

Give 3 symptoms of endometrial cancer

A
  • postmenopausal bleeding (10% risk) - mc presentation
  • intermenstrual bleeding
  • unusually heavy menstrual bleeding
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22
Q

What is the referral criteria for a 2-week-wait urgent cancer referral for endometrial cancer?

A

women over the age of 55 with Postmenopausal bleeding should be investigated within two weeks by TVUS for endometrial cancer

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23
Q

How is endometrial cancer investigated

A
  • transvaginal ultrasound for endometrial thickness (normal endometrial thickness < 4 mm)
  • Pipelle biopsy - highly sensitive
  • Hysteroscopy with endometrial biopsy (GS)
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24
Q

What are the stages of endometrial cancer according to the FIGO staging system?

A
  • 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 the bladder, rectum, or beyond the pelvis.
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25
Q

How is endometrial cancer managed surgically

A

total abdominal hysterectomy with bilateral salpingo-oophrectomy

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26
Q

How is endometrial cancer managed medically

A
  • external beam radiotherapy
  • adjuvant chemotherapy
  • progesterone hormone Tx
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27
Q

What are the most common types of cervical cancer?

A
  • 80% of cervical cancers are squamous cell carcinoma
  • adenocarcinoma - 2nd mc
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28
Q

What is the most common cause of cervical cancer

A

infection with human papillomavirus (HPV)

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29
Q

Which 2 HPV strains are most associated with cervical cancer and targeted with the HPV vaccine

A

16 and 18

30
Q

At what age are children vaccinated against certain strains of HPV to help reduce the risk of cervical cancer?

A

aged 12 to 13 years

31
Q

Explain the mechanism of HPV causing cervical cancer

A
  • HPV 16 & 18 produces the oncogenes E6 and E7 genes respectively
  • E6 inhibits the p53 tumour suppressor gene
  • E7 inhibits RB suppressor gene
32
Q

Give 5 RFs of cervical cancer

A
  • HPV (serotypes 16,18 & 33)
  • smoking
  • lower socioeconomic status
  • Immunosuppression - HIV/ transplant
  • early onset of sexual activity, multiple sexual partners
  • high parity
  • COCP
33
Q

What is cervical intraepithelial neoplasia

A

histological abnormality of the cervix in which abnormal epithelial cells occupy varying degrees of the squamous epithelium

34
Q

What test is used to diagnose Cervical Intraepithelial Neoplasia (CIN) ?

A

colposcopy

35
Q

What are the grades of Cervical Intraepithelial Neoplasia (CIN) and their characteristics?

A

CIN I: Mild dysplasia affecting 1/3 of the thickness of the epithelial layer
CIN II: Moderate dysplasia affecting 2/3 of the thickness of the epithelial layer
CIN III: Severe dysplasia affecting full thickness of epithelium

36
Q

What is the cervical screening schedule for women and transgender men with a cervix?

A
  • Every three years for those aged 25–49.
  • Every five years for those aged 50–64.
37
Q

What are the notable exceptions to the cervical screening program?

A
  • Women with HIV are screened annually.
  • Women >65 can request a smear if they haven’t had one since age 50.
  • Women with previous CIN may need additional tests (e.g. test of cure after treatment).
  • Pregnant women due for a smear should wait until 3 months post-partum
  • symptomtic women e.g. vaginal bleeding: screening is only for asymptomatic women
38
Q

What is the aim of cervical cancer screening

A

aims to detect women that are likely to have cervical intraepithelial neoplasia and therefore at risk of subsequent development of cancer

39
Q

What term is used for cellular abnormalities identified in cervical smears?

A

dyskaryosis

40
Q

What are the possible cytology results in cervical screening?

A
  • Inadequate
  • Normal
  • Borderline changes
  • Low-grade dyskaryosis
  • High-grade dyskaryosis (moderate/severe)
  • invasive squamous cell carcinoma
  • cervical glandular intraepithelial neoplasia (any grade)
41
Q

What happens if a sample tests positive or negative for high-risk HPV in cervical screening?

A

The samples are first tested for high-risk HPV.
* negative hrHPV - no cytology, woman returns to routine recall
* hrHPV positive -> cytology.

42
Q

Cervical screening: What is the next step if the patient is hrHPV positive and cytology is abnormal

A

refer for colposcopy

43
Q

Cervical screening: What is the next step if cytology is normal but the patient is hrHPV positive?

A

Repeat the test in 12 months.

44
Q

Cervical screening: What should be done if the 1st repeat smear test at 12 months is now hrHPV negative?

A

Return to normal recall.

45
Q

Cervical screening: What is the next step if the first repeat smear test at 12 months is still hrHPV positive but cytology remains normal?

A

Perform a further repeat test in 12 months.

46
Q

Cervical screening: What is the next step if the 2nd repeat smear test at 24 months is hrHPV negative?

A

Return to normal recall.

47
Q

Cervical screening: What should be done if the 2nd repeat smear test at 24 months is still hrHPV positive?

A

Refer for colposcopy.

48
Q

Cervical screening: When should individuals treated for CIN1, CIN2, or CIN3 be invited for a follow-up test?

A

should be invited for a test of cure repeat cervical sample 6 months after treatment in the community

49
Q

Cervical screening: What is the next step if a sample comes back as ‘inadequate’

A

repeat test in 3 months

50
Q

Cervical screening: What is the next step if two consecutive cervical samples are ‘inadequate’?

A

The patient should be referred for colposcopy.

51
Q

Treatment of cervical intraepithelial neoplasia

A

Large loop excision of transformation zone (LLETZ)
cryotherapy is an alternative

52
Q

What symptoms should prompt consideration of cervical cancer as a differential diagnosis?

A
  • abnormal vaginal bleeding (intermenstrual, postcoital, or post-menopausal bleeding)
  • Offensive vaginal discharge
    Late features:
  • Pelvic pain
  • Dyspareunia (pain or discomfort during sex)
53
Q

How is cervical cancer investigated

A
  • speculum - mass/ bleeding
  • colposcopy
  • cone biopsy or large loop excision of transformation zone (LLETZ)- confirm diagnosis
  • MRI - lymph node involvement
54
Q

How is cervical cancer staged using the FIGO system?

A
  • 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
55
Q

Management of stage IA cervical cancer

A
  • hysterectomy +/- lymph node clearance
  • For patients wanting to maintain fertility, a cone biopsy with negative margins can be performed
  • Radical trachelectomy (remove cervix)
56
Q

Management of stage IB cervical cancer

A
  • radiotherapy with concurrent chemotherapy (cisplatin)
  • Radiotherapy: bachytherapy or external beam radiotherapy
  • radical hysterectomy with pelvic lymph node dissection
57
Q

Management of stage 2 and 3 cervical cancer

A

Radiation with concurrent chemotherapy

58
Q

Management of stage 4 cervical cancer

A
  • Radiation and/or chemotherapy
  • Palliative chemotherapy may be best option for stage IVB
59
Q

What are the complications of cone biopsy

A
  • bleeding
  • preterm labour
  • pain
60
Q

What is vulval intraepithelial neoplasia (VIN), and what can it lead to if untreated?

A

pre-cancerous condition affecting the squamous epithelium of the skin, which can lead to vulval cancer if left untreated

61
Q

Give 4 RFs for vulval intraepithelial neoplasia

A
  • HPV 16 & 18
  • Smoking
  • lichen sclerosus
  • HSV-2
62
Q

What are the two types of vulval intraepithelial neoplasia (VIN), and what are their associations?

A
  • Usual: High-grade squamous intraepithelial lesion (HSIL) - associated with HPV
  • Differentiated VIN - associated with lichen sclerosis
63
Q

At what ages do the 2 types of VIN typically occur?

A
  • High-grade squamous intraepithelial lesion - younger women aged 35–50 years.
  • Differentiated VIN - older women aged 50–60 years.
64
Q

Give 3 features of vulval intraepithelial neoplasia

A
  • itching
  • burning
  • raised, well-defined skin lesion
65
Q

How is vulval intraepithelial neoplasia investigated

A
  • Punch/ excisional biopsy - histological diagnosis
  • HPV testing
66
Q

How is vulval intraepithelial neoplasia managed

A
  • Topical: imiquimod (immune response modifier)
  • Surgical: wide local excision or laser ablation
  • follow-up: rpt colposcopy and biopsy if recurrence/ progression is suspected
67
Q

What type of cancer makes up the majority of vulval cancers?

A

Around 90% of vulval cancers are squamous cell carcinomas.

68
Q

Give 5 RFs of vulval cancer

A
  • Advanced age >75
  • immunosuppression
  • lichen sclerosus
  • HPV infection
  • Vulval intraepithelial neoplasia
  • smoking
69
Q

Give 4 clinical features of vulval cancer

A
  • lump or ulcer of labia majora
  • Inguinal lymphadenopathy
  • itching or irritation
  • bleeding
70
Q

How is vulval cancer diagnosed

A
  • biopsy of the lesion
  • sentinel node biopsy - demonstrate lymph node spread
71
Q

How is vulval cancer treated

A
  • wide local excision
  • groin lymphadenectomy
  • chemo and radiotherapy

3a Women's health (12 decks)

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