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GOSH > Cancer > Flashcards

Cancer Flashcards

1
Q

How long does it take for HPV to develop into cancer

A

10 years

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2
Q

How long does it take for HPV to develop into cancer

A

10 years

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3
Q

Describe the NHS cervical screening programme

A

3 yearly 25-50yrs

5 50-64

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4
Q

What are the 4 categories of management after cervical cytology?

A
  • Routine recall
  • Repeat cytology
  • Referral to colposcopy (standard/ urgent)
  • Referral to gynaecology (urgent)
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5
Q

what is colposcopy

A

examination of cervix with bright lights through speculum in lithotomy position.

Transformation zone is identified

Biopsy

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6
Q

Describe the 3 histological diagnosis from biopsy

A

Cerival intraepithelial neoplasia (premalignant)
CIN1 – lower one-third of epithelium: mild dysplasia
CIN2 – lower two-thirds of epithelium: moderate dysplasia
CIN3 – full thickness of epithelium: severe dysplasia

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7
Q

How is CN II/III treated

A

Large loop excision of transformation zone

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8
Q

90% of cervical cancers are of which type?

A

90% squamous cell carcinoma

10% adenocarcinoma

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9
Q

Describe stage 0,1,2,3,4 of cervical cancer

A 
0 = carcinoma in situ
1= confined to cervix
2= disease beyond cervix but not to pelvic was or lower 1/3 of vagina
3= disease to pelvic wall or lower 1/3 of vagina
4= invades bladder, rectum or mets
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10
Q

Hx of cervical cancer

A

History:
Post-coital bleeding, inter-menstrual bleeding and postmenopausal bleeding
Persistent, offensive, blood-stained discharge
Pain in late disease
Swollen leg- thrombosis in the pelvis

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11
Q

examination for cervical cancer

A

Examination:
Speculum examination
Bimanual examination
PR

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12
Q

investigations for cervical cancer

A 
Colposcopy
Cervical biopsy
FBC, U&Es, LFTs 
MRI pelvis
CT abdomen and chest (or CXR)
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13
Q

Surgery:

1) Stage 1 A
2) 1B-4
3) preserve fertility

A

1) LLETTZ
2) hysterectomy (total or radical) + pelvic node resection
3) Radical trachelectomy: 80% of cervix & vagina

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14
Q

Stages 2-4 require what other treatments

A

radiotherapy +- chemo

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15
Q

Describe the typical endometrial cancer

A

post-menopausal, aged > 60

most common gynae cancer

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16
Q

risk factors for uterine cancer

A

Think things that ↑ oestrogen exposure

obesity 
diabetes
sedentary lifestyle 
menstrual factorsL early menarche, late menopause, low parity
anovulatory amenorrhoea e/.g PCOS 
oestrogen secreting tumours 
tamoxifen 
Fix: colorectal, endometrial or breast cancer
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17
Q

which type of uterine cancer is the most common?

A

adenocarcinoma (90%)

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18
Q

Typical Hx of uterine cancer?

A 
Postmenopausal bleeding (PMB) –  vaginal bleeding  1 year after the cessation of periods
10% of women with PMB will have a malignancy
Premenopausal women – irregular, heavy or inter-menstrual bleeding especially if < 40 year old
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19
Q

Examination of suspected uterine cancer

A

Speculum examination to exclude other causes such as cervical or vaginal lesions
Fixed or bulky uterus occurs with advanced disease

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20
Q

Investigation for suspected uterine cancer

A
  • Transvaginal ultrasound with endometrial thickness >4mm
  • Biopsy
    Pipelle in clinic
    Hysteroscopy and biopsy
    MRI – depth of invasion, cervical involvement, lymphadenopathy
    CT abdomen and chest if high-risk cancer, e.g. sarcoma
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21
Q

Spread of uterine cancer

A

Spread is directly through myometrium to cervix & vagina
Ovaries may be involved
Lymph drainage to pelvic then para-aortic LN
Blood borne spread occurs late

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22
Q

Explain stage 1-4 of uterine cancer

A

Stage I – confined to body of uterus
Stage II - involving the cervix
Stage III - spread outside the uterus
Stage IV - with bowel, bladder or distant organ involvement

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23
Q

Management of uterine cancer

A

75% present with stage 1 ⇒ laparoscopic hysterectomy + salpingectomy is appropriate & most common treatment

In those with high grade tumours, hysterectomy + LN excision. Adjuvant radiotherapy then performed

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24
Q

Prognosis of uterine cancer

A

5 year survival rate is 80%

Adverse features for prognosis include late stage, >70 years old, high BMI, metastasis

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25
Q

Ovarian cancer, typical patient

A

> 50 caucasian

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26
Q

risk factors of ovarian cancer

A

Nulliparity (continuous ovulation causing repeated trauma to ovarian epithelium)
Early menarche, late menopause (increased no. of ovulations)
5% of familial -
• BRCA1 - 80%
• BRCA2 - 15%
• HNPCC - 5%

Obesity
Smoking - mucinous tumours only
Endometriosis - x2-3
Difficulty conceiving

27
Q

Most common pathology

A

epithelial carcinoma

28
Q

History

A 
abdo pain &amp; swelling
pressure effects on bladder or rectum
dysponea
GI upset &amp; anorexia 
abdo vaginal bleeding 
15% asymptomatic

Typically presents late 75% stage III to IV

29
Q

Examination

A

Ascites
solid mass in upper abdomen
shifting dullness

30
Q

Investgation

A

pelvic USS
CA125 (raised in 80%)
FBC, U&E, LFT
Chest x-ray

caution germ cell markers: AFP, HCG, LDH- can be treated

CT ab & pelvic
paracetesis

31
Q

Management

A

Surgical
Midline laparotomy ideal for thorough assessment of abdomen & pelvis
Total hysterectomy, bilateral salpingectomy & particle omentectomy performed
LN sampled in grade 1. In grade 2 and above LN removed

Chemotherapy: 2/3 relapse within 2 years

32
Q

Describe the NHS cervical screening programme

A

3 yearly 25-50yrs

5 50-64

33
Q

What are the 4 categories of management after cervical cytology?

A
  • Routine recall
  • Repeat cytology
  • Referral to colposcopy (standard/ urgent)
  • Referral to gynaecology (urgent)
34
Q

what is colposcopy

A

examination of cervix with bright lights through speculum in lithotomy position.

Transformation zone is identified

Biopsy

35
Q

Describe the 3 histological diagnosis from biopsy

A

Cerival intraepithelial neoplasia (premalignant)
CIN1 – lower one-third of epithelium: mild dysplasia
CIN2 – lower two-thirds of epithelium: moderate dysplasia
CIN3 – full thickness of epithelium: severe dysplasia

36
Q

How is CN II/III treated

A

Large loop excision of transformation zone

37
Q

90% of cervical cancers are of which type?

A

90% squamous cell carcinoma

10% adenocarcinoma

38
Q

Describe stage 0,1,2,3,4 of cervical cancer

A 
0 = carcinoma in situ
1= confined to cervix
2= disease beyond cervix but not to pelvic was or lower 1/3 of vagina
3= disease to pelvic wall or lower 1/3 of vagina
4= invades bladder, rectum or mets
39
Q

Hx of cervical cancer

A

History:
Post-coital bleeding, inter-menstrual bleeding and postmenopausal bleeding
Persistent, offensive, blood-stained discharge
Pain in late disease
Swollen leg- thrombosis in the pelvis

40
Q

examination for cervical cancer

A

Examination:
Speculum examination
Bimanual examination
PR

41
Q

investigations for cervical cancer

A 
Colposcopy
Cervical biopsy
FBC, U&amp;Es, LFTs 
MRI pelvis
CT abdomen and chest (or CXR)
42
Q

Surgery:

1) Stage 1 A
2) 1B-4
3) preserve fertility

A

1) LLETTZ
2) hysterectomy (total or radical) + pelvic node resection
3) Radical trachelectomy: 80% of cervix & vagina

43
Q

Stages 2-4 require what other treatments

A

radiotherapy +- chemo

44
Q

Describe the typical endometrial cancer

A

post-menopausal, aged > 60

most common gynae cancer

45
Q

risk factors for uterine cancer

A

Think things that ↑ oestrogen exposure

obesity 
diabetes
sedentary lifestyle 
menstrual factorsL early menarche, late menopause, low parity
anovulatory amenorrhoea e/.g PCOS 
oestrogen secreting tumours 
tamoxifen 
Fix: colorectal, endometrial or breast cancer
46
Q

which type of uterine cancer is the most common?

A

adenocarcinoma (90%)

47
Q

Typical Hx of uterine cancer?

A 
Postmenopausal bleeding (PMB) –  vaginal bleeding  1 year after the cessation of periods
10% of women with PMB will have a malignancy
Premenopausal women – irregular, heavy or inter-menstrual bleeding especially if < 40 year old
48
Q

Examination of suspected uterine cancer

A

Speculum examination to exclude other causes such as cervical or vaginal lesions
Fixed or bulky uterus occurs with advanced disease

49
Q

Investigation for suspected uterine cancer

A
  • Transvaginal ultrasound with endometrial thickness >4mm
  • Biopsy
    Pipelle in clinic
    Hysteroscopy and biopsy
    MRI – depth of invasion, cervical involvement, lymphadenopathy
    CT abdomen and chest if high-risk cancer, e.g. sarcoma
50
Q

Spread of uterine cancer

A

Spread is directly through myometrium to cervix & vagina
Ovaries may be involved
Lymph drainage to pelvic then para-aortic LN
Blood borne spread occurs late

51
Q

Explain stage 1-4 of uterine cancer

A

Stage I – confined to body of uterus
Stage II - involving the cervix
Stage III - spread outside the uterus
Stage IV - with bowel, bladder or distant organ involvement

52
Q

Management of uterine cancer

A

75% present with stage 1 ⇒ laparoscopic hysterectomy + salpingectomy is appropriate & most common treatment

In those with high grade tumours, hysterectomy + LN excision. Adjuvant radiotherapy then performed

53
Q

Prognosis of uterine cancer

A

5 year survival rate is 80%

Adverse features for prognosis include late stage, >70 years old, high BMI, metastasis

54
Q

Ovarian cancer, typical patient

A

> 50 caucasian

55
Q

risk factors of ovarian cancer

A

Nulliparity (continuous ovulation causing repeated trauma to ovarian epithelium)
Early menarche, late menopause (increased no. of ovulations)
5% of familial -
• BRCA1 - 80%
• BRCA2 - 15%
• HNPCC - 5%

Obesity
Smoking - mucinous tumours only
Endometriosis - x2-3
Difficulty conceiving

56
Q

Most common pathology

A

epithelial carcinoma

57
Q

History

A 
abdo pain &amp; swelling
pressure effects on bladder or rectum
dysponea
GI upset &amp; anorexia 
abdo vaginal bleeding 
15% asymptomatic

Typically presents late 75% stage III to IV

58
Q

Examination

A

Ascites
solid mass in upper abdomen
shifting dullness

59
Q

Investgation

A

pelvic USS
CA125 (raised in 80%)
FBC, U&E, LFT
Chest x-ray

caution germ cell markers: AFP, HCG, LDH- can be treated

CT ab & pelvic
paracetesis

60
Q

Management

A

Surgical
Midline laparotomy ideal for thorough assessment of abdomen & pelvis
Total hysterectomy, bilateral salpingectomy & particle omentectomy performed
LN sampled in grade 1. In grade 2 and above LN removed

Chemotherapy: 2/3 relapse within 2 years

61
Q

Describe the aetiology of vulval cancers.

In younger & older women and common histology

A

HPV associated - younger women
Non-HPV associated - older women, usually associated with lichen planus & other skin conditions
95% are squamous cell carcinomas

62
Q

Clinical features of vulval cancer

A

Lump - usually labia majora or clitoris
Lump may become ulcerated
Bleeding may occur on contact (PMB)
Vulval pain

63
Q

Investigations

A

Biopsy
X-ray - exclude lung mets
Examine other areas - cervix, anal sphincter, inguinal and femoral nodes to determine spread & prognosis

64
Q

Management

A

Wide local excision or vulvectomy

Lymphadenectomy - if nodes positive then post-operative radiotherapy required

GOSH (13 decks)

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