Cancer Flashcards
How long does it take for HPV to develop into cancer
10 years
How long does it take for HPV to develop into cancer
10 years
Describe the NHS cervical screening programme
3 yearly 25-50yrs
5 50-64
What are the 4 categories of management after cervical cytology?
- Routine recall
- Repeat cytology
- Referral to colposcopy (standard/ urgent)
- Referral to gynaecology (urgent)
what is colposcopy
examination of cervix with bright lights through speculum in lithotomy position.
Transformation zone is identified
Biopsy
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
How is CN II/III treated
Large loop excision of transformation zone
90% of cervical cancers are of which type?
90% squamous cell carcinoma
10% adenocarcinoma
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
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
examination for cervical cancer
Examination:
Speculum examination
Bimanual examination
PR
investigations for cervical cancer
Colposcopy Cervical biopsy FBC, U&Es, LFTs MRI pelvis CT abdomen and chest (or CXR)
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
Stages 2-4 require what other treatments
radiotherapy +- chemo
Describe the typical endometrial cancer
post-menopausal, aged > 60
most common gynae cancer
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
which type of uterine cancer is the most common?
adenocarcinoma (90%)
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
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
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
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
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
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
Prognosis of uterine cancer
5 year survival rate is 80%
Adverse features for prognosis include late stage, >70 years old, high BMI, metastasis
Ovarian cancer, typical patient
> 50 caucasian
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
Most common pathology
epithelial carcinoma
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
Examination
Ascites
solid mass in upper abdomen
shifting dullness
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
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
Describe the NHS cervical screening programme
3 yearly 25-50yrs
5 50-64
What are the 4 categories of management after cervical cytology?
- Routine recall
- Repeat cytology
- Referral to colposcopy (standard/ urgent)
- Referral to gynaecology (urgent)
what is colposcopy
examination of cervix with bright lights through speculum in lithotomy position.
Transformation zone is identified
Biopsy
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
How is CN II/III treated
Large loop excision of transformation zone
90% of cervical cancers are of which type?
90% squamous cell carcinoma
10% adenocarcinoma
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
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
examination for cervical cancer
Examination:
Speculum examination
Bimanual examination
PR
investigations for cervical cancer
Colposcopy Cervical biopsy FBC, U&Es, LFTs MRI pelvis CT abdomen and chest (or CXR)
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
Stages 2-4 require what other treatments
radiotherapy +- chemo
Describe the typical endometrial cancer
post-menopausal, aged > 60
most common gynae cancer
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
which type of uterine cancer is the most common?
adenocarcinoma (90%)
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
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
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
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
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
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
Prognosis of uterine cancer
5 year survival rate is 80%
Adverse features for prognosis include late stage, >70 years old, high BMI, metastasis
Ovarian cancer, typical patient
> 50 caucasian
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
Most common pathology
epithelial carcinoma
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
Examination
Ascites
solid mass in upper abdomen
shifting dullness
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
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
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
Clinical features of vulval cancer
Lump - usually labia majora or clitoris
Lump may become ulcerated
Bleeding may occur on contact (PMB)
Vulval pain
Investigations
Biopsy
X-ray - exclude lung mets
Examine other areas - cervix, anal sphincter, inguinal and femoral nodes to determine spread & prognosis
Management
Wide local excision or vulvectomy
Lymphadenectomy - if nodes positive then post-operative radiotherapy required
