Cancer Flashcards
What clinical feature might a patient with stage 3 cervical cancer present with?
flank pain due to ureteric obstruction - hydronephrosis (stageIIIB can result in hydronephrosis)
What factors reduce the risk of ovarian cancer?
oral contraceptives, high parity, breast feeding, hysterectomy, tubal ligation, statins, SLE
what factors reduce the risk of endometrial cancer?
aspirin use, coffee consumption, SLE, mirena coil
What factors increase the risk of endometrial cancer?
PCOS, obesity, early menarche, late menopause, HRT, nulliparity, diabetes, parkinson’s, tamoxifen
What are the IOTA ultrasound rules for ovarian malignancy on ultrasound?
very high blood flow, irregular solid tumour, ascites, at least four papillary structures, irregular multilocular tumour with largest diameter >100mm
What are the IOTA ultrasound rules for benign ovarian pathology on ultrasound?
no blood flow, unilocular cysts, solid components <7mm, acoustic shadowing, smooth multilocular tumour with largest diamete <100mm
What does Gardasil vaccinate against?
HPV 6 11 16 18
Which HPV most commonly cause cervical cancer?
16 18
Which HPV most commonly cause anogenital warts?
6 and 11
How does HPV induce cancer?
Induce onco-protein E6 which inactivates tumour suppressor p53 and onco-protein E7 which inactivates tumour suppressor pRB
Management of a Simple cyst on uss 50-70mm diameter in pre-menopausal woman?
yearly ultrasound
Management of a large Simple cyst on uss >70mm diameted in pre-menopausal woman?
MRI or surgical intervention can be considered
How do you assess risk of malignancy for ovarian cancer?
Risk of malignancy 1: ultrasound score x Ca125 level x menopausal score
What abnormal features on ultrasound are suggestive of ovarian cancer?
multi-locular cyst
solid areas
ascites
intra-abdo mets
What are classic histological features of serous cystadenocarcinoma of the ovary?
psammoma bodies - round microscopic calcifications
What are the classic histrological features of mucinous tumours of the ovary?
mucin vacuoles
Definition of endometrial hyperplasia
irregular proliferation of the endometrium - increased gland to stroma ratio
What is the association between granulosa cell tumours of the ovary and endometrial hyperplasia?
granulosa cell tumours secrete oestrogen and therefore induce endometrial hyperplasia in 40% of cases
Wha tis the risk of progression from endometrial hyperplasia without atypia to carcinoma?
<5% in 20 years
Treatment of endometrial hyperplasia without atypia
removal of risk factors i.e. losing weight if high BMI
medical treatment - mirena has higher regression rate than oral progesterone
What to give patients with endometrial hyperplasia without atypia who decline local treatment with mirena
continuous progesterone: medroxyprogesterone 10-20mg or norethisterone 10-15mg
Follow up of patients with endometrial hyperplasia without atypia
6 monthly - should have 2 negative biopsies before discharge
patients at higher risk (oral treatment and high BMI) should have annual biopsies
Treatment duration for endometrial hyperplasia without atypia
minimum 6 months, advise 5 years for mirena to prevent recurrence
Treatment of endometrial hyperplasia with atypia
Total abdominal hysterectomy - laparoscopic approach
NOT ENDOMETRIAL ABLATION
What is the most common type of ovarian cancer?
epithelial (68% serous)
What are the different categories of ovarian cancer?
epithelial
germ cell
sex cord/stromal
