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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
Ovarian cancer, typical patient
>50 caucasian
26
risk factors of ovarian cancer
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
Most common pathology
epithelial carcinoma
28
History
``` abdo pain & swelling pressure effects on bladder or rectum dysponea GI upset & anorexia abdo vaginal bleeding 15% asymptomatic ``` Typically presents late 75% stage III to IV
29
Examination
Ascites solid mass in upper abdomen shifting dullness
30
Investgation
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
Management
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
Describe the NHS cervical screening programme
3 yearly 25-50yrs | 5 50-64
33
What are the 4 categories of management after cervical cytology?
- Routine recall - Repeat cytology - Referral to colposcopy (standard/ urgent) - Referral to gynaecology (urgent)
34
what is colposcopy
examination of cervix with bright lights through speculum in lithotomy position. Transformation zone is identified Biopsy
35
Describe the 3 histological diagnosis from biopsy
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
How is CN II/III treated
Large loop excision of transformation zone
37
90% of cervical cancers are of which type?
90% squamous cell carcinoma | 10% adenocarcinoma
38
Describe stage 0,1,2,3,4 of cervical cancer
``` 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
Hx of cervical cancer
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
examination for cervical cancer
Examination: Speculum examination Bimanual examination PR
41
investigations for cervical cancer
``` Colposcopy Cervical biopsy FBC, U&Es, LFTs MRI pelvis CT abdomen and chest (or CXR) ```
42
Surgery: 1) Stage 1 A 2) 1B-4 3) preserve fertility
1) LLETTZ 2) hysterectomy (total or radical) + pelvic node resection 3) Radical trachelectomy: 80% of cervix & vagina
43
Stages 2-4 require what other treatments
radiotherapy +- chemo
44
Describe the typical endometrial cancer
post-menopausal, aged > 60 | most common gynae cancer
45
risk factors for uterine cancer
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
which type of uterine cancer is the most common?
adenocarcinoma (90%)
47
Typical Hx of uterine cancer?
``` 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
Examination of suspected uterine cancer
Speculum examination to exclude other causes such as cervical or vaginal lesions Fixed or bulky uterus occurs with advanced disease
49
Investigation for suspected uterine cancer
- 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
Spread of uterine cancer
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
Explain stage 1-4 of uterine cancer
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
Management of uterine cancer
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
Prognosis of uterine cancer
5 year survival rate is 80% | Adverse features for prognosis include late stage, >70 years old, high BMI, metastasis
54
Ovarian cancer, typical patient
>50 caucasian
55
risk factors of ovarian cancer
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
Most common pathology
epithelial carcinoma
57
History
``` abdo pain & swelling pressure effects on bladder or rectum dysponea GI upset & anorexia abdo vaginal bleeding 15% asymptomatic ``` Typically presents late 75% stage III to IV
58
Examination
Ascites solid mass in upper abdomen shifting dullness
59
Investgation
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
Management
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
Describe the aetiology of vulval cancers. | In younger & older women and common histology
HPV associated - younger women Non-HPV associated - older women, usually associated with lichen planus & other skin conditions 95% are squamous cell carcinomas
62
Clinical features of vulval cancer
Lump - usually labia majora or clitoris Lump may become ulcerated Bleeding may occur on contact (PMB) Vulval pain
63
Investigations
Biopsy X-ray - exclude lung mets Examine other areas - cervix, anal sphincter, inguinal and femoral nodes to determine spread & prognosis
64
Management
Wide local excision or vulvectomy | Lymphadenectomy - if nodes positive then post-operative radiotherapy required

GOSH (13 decks)

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