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Gynaecology > Cancer > Flashcards

Cancer Flashcards

1
Q

Which is most common site for ovarian malignancy?

A

Germinal Epithelium

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2
Q

What are some malignant epithelial ovarian tumours?

A

Serious Adenocarcinoma - 50%

Mucinous Adenocarcinoma

Endometrioid Carcinoma - 25%

Clear cell carcinoma - 10%

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3
Q

What are some malignant ovarian germ cell tumours?

A

Dysgerminoma - most common ovarian malig in young women, associated with Turner’s

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4
Q

What is are common sites for ovarian metastases? What is a metastases from the gut called?

A

Breasts and GI

Krukenberg tumours

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5
Q

What is a malignant sex cord tumour?

A

Granulosa Cell Tumours - Produces oestrogen leading to precoucious puberty if in children or endometrial hyperplasia in adults.

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6
Q

What are risk factors for Ovarian cancer?

A

Number of ovulations :

Early Menarche

Late Menopause

Nulliparity

BRCA1

BRCA2

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7
Q

What are protective of Ovarian cancer?

A

COCP

Pregnancy

Lactation

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8
Q

What are the screening programmes for ovarian cancer?

A

THERE ARE NONE

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9
Q

When and How does Ovarian cancer present?

A

80% >50 y/o, and have advanced disease

bloating

feeling full

loss of appetite

pelvic or abdo pain

increased urgency/frequency

*similar to IBS

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10
Q

Besides regularly pelvic and abdominal symptoms, what other symptoms should be asked pertaining to ovarian cancer? Why?

A

Breast and GI symptoms

metastases

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11
Q

How is Ovarian cancer staged?

A
  1. disease macroscopically confined to ovaries
  2. disease beyond ovaries but in pelvis
  3. disease beyond pelvis but in abdomen (omentum,small bowel, peritoneum)
  4. disease beyond abdomen (lung/liver)
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12
Q

What would you investigate in Ovarian cancer?

A

> 50 - CA125 > if over 35IU/mL > USS of abdo and pelvis

<40 - AFP and hCG > raised levels in germ cell tumours

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13
Q

How would you manage Ovarian cancer?

A

Hysterectomy, bilateral salpingo-oophorectomy and partial omentectomy is performed

Biopsy of lymph nodes

Chemo - carboplatin > carboplatin + cisplatin

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14
Q

What benign condition is a risk for vulval cancer?

A

lichen sclerosus

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15
Q

What are risk factors for Vulval Carcinoma?

A

Age

Human papilloma virus (HPV) infection

Vulval intraepithelial neoplasia (VIN)

Immunosuppression

Lichen sclerosus

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16
Q

What cell type is the majority of vulval cancers?

A

Squamous Cell

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17
Q

How does vulval carcinoma present?

A

pruritus, bleeding or discharge

mass

inguinal lymph nodes are enlarged, hard and immobile

*often presents late due to embarassment or undetected

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18
Q

How would you stage vulval cancer?

A

stage 1 - vulva/perineum

stage 2 - urethra, vagina or anus

stage 3 - inguinofemoral lymph nodes

stage 4 - invasion of bladder, upper urethra/vagina, rectum, bone or distant mets

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19
Q

How would you treat vulval cancer?

A

stage 1 - wide local excision

other stages - wide local excision and groin lymphadectomy

radiotherapy to shrink large tumours

20
Q

What are the cancers of the vagina?

A

Secondary from cervix, endometrium or vulva

Primary - squamous (older women), clear cell (late teen years)

21
Q

What are some features of endometrial cancer?

A

most common genital tract cancer

prevalence highest at 60

usually present early

22
Q

What cell type is endometrial cancer?

A

adenocarcinoma of columnar endometrial gland cells (90%)

adenosquamose

23
Q

What are risk factors for endometrial cancers?

A 
obesity
nulliparity
early menarche
late menopause
unopposed oestrogen
diabetes mellitus
tamoxifen
polycystic ovarian syndrome

*progestogen decreases risk

24
Q

What are protective of endometrial cancer?

A

COCP and Pregnancy

25
Q

What is the premalignant disease of endometrial cancer? How does it present?

A

endometrial hyperplasia with atypia

menstrual abnormalities, postmenopausal bleeding

normally exists with carcinoma elsewhere in uterine cavity

26
Q

How would endometrial cancer present?

A

postmenopausal bleeding

abnormal columnar cells on cervical smear

normal pelvis with atrophic vaginitis

27
Q

How is endometrial cancer treated?

A

localised disease is treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy.

Patients with high-risk disease may have post-operative radiotherapy

progestogen therapy is sometimes used in frail elderly women not consider suitable for surgery

28
Q

What cell type is the endocervix?

A

columnar glandular

29
Q

What cell type is the ectocervix?

A

stratified squamous

30
Q

What is the grading of cervical intraepithelial neoplasia?

A

CIN I - atypical cells only found in lower third of epithelium

CIN II - atypical cells found in lower 2/3rds of epithelium

CIN III - atypical cells occupy full thickness of epithelium

31
Q

What is the progression of CIN III?

A

malignancy if these cells invade basement membrane

1/3rds progress to cervical cancer in 10 yrs

32
Q

When does CIN present? What are the causes?

A

25-29, then to be younger than 45

Caused mostly by HPV 16 & 18

33
Q

What are some risk factors for CIN?

A

OCP

smoking

immunocompromised

34
Q

What are the vaccinations against CIN? What organisms are they against and when are they taken?

A

Cevarix - HPV 16/18

Gardasil - HPV 16/18/6/11

3 doses - first (wait one month), second (wait two months) and then third

35
Q

What is the cervical cancer screening programme?

A

Cervical smear starting at the age of 25

25-49 - every 3 years
50-64 - every 5 years

36
Q

What are the methods of cervical smear? What are the advantages?

A

moving away from traditional Papanicolaou (Pap) smears to liquid-based cytology (LBC).

LBC : less inadequate smears, more sensitivity and specificity

37
Q

When is the best time to do a smear? What kind of cancer does it not detect?

A

mid cycle

cervical adenocarcinomas

38
Q

What is being looked for during a cervical smear? What would be the next step?

A

Dyskaryosis - mild, moderate or severe

borderline/mild - HPV triage > if negative the patient goes back to routine recall
if positive the patient is referred for colposcopy

moderate/severe - urgent colposcopy

columnar glandular intraepithelial neoplasia - colposcopy, if normal then hysteroscopy

39
Q

What tool is used for cervical smear? What is used for staining?

A

Cusco’s speculum

acetic acid and/or iodine

40
Q

What is management of CIN?

A

large loop excision of transformation zone (LLETZ)

specimen examined histologically

complications : haemorrhage, increased risk of prem delivery

41
Q

What are the cell types for cervical cancer?

A

squamosa cell carcinomas : 70%

mixed : 15 %

adenocarcinoma : 15 % ( from columnar epithelium and worse prognosis)

42
Q

What is the staging of cervical cancer?

A

1 - lesions continued to cervix

2- invasion is into vagina, not pelvic side wall

3 - invasion into lower vagina or pelvic wall or causing ureteric obstruction

4 - invasion of bladder or rectal mucosa, beyong true pelvis

43
Q

How does cervical cancer present?

A

post-coital bleeding

offensive vaginal discharge

IMP or PMB

44
Q

What are some extra-vaginal presentations of cervical cancer?

A

uraemia, haematuria, rectal bleeding and pain

leg oedema, pain, hydropnephrosis

45
Q

What would you do to investigate cervical cancer?

A

colposcopy to biopsy tumour

vaginal/rectal exam

cystoscopy

MRI

46
Q

How would you manage cervical cancer?

A

stage 1a(i) - core + biopsy + hysterectomy

stage 1a(ii) to 2a - surgery or chemotherapy, weitheims hysterectomy

stage 2b or worse - chemo-radio

Gynaecology (3 decks)

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