Cancer Flashcards
WHat are the main causes of cervical cancer
- human papilloma virus (type 16, 18, 33)
- Early sexual activity with many partners (greater chance of contracting HPV)
- Smoking
- HIV
- COCP
What typ of cancer is cervical cancer
Occurs in younger women in peak reproductive years.
80% are squamous cell, 20% are adenocarcinoma
What is the main presentation of cervical cancer
Abnormal bleeding (intermenstrual, postcoital, post-menopause) Vaginal discharge Pelvic pain Urinary symptoms (dysuria, frequency)
How is cervical cancer staged
Stage 1: Confined to cervix
Stage 2: Invades uterus / upper 2/3 of vagina
Stage 3: Invades pelvic wall / lower 1/3 of vagina
Stage 4: Invades bladder / rectum / beyond pelvis
What does Cervical Intraepithelial Neoplasia 1 (CIN) mean
mild dysplasia, likely to return to normal without treatment
What does Cervical Intraepithelial Neoplasia 2 (CIN) mean
moderate dysplasia, likely to progress to cancer without treatment
What does Cervical Intraepithelial Neoplasia 3 (CIN) mean
severe dysplasia, will progress to cancer if untreated. Sometimes called “cervical carcinoma in situ”
What is the aim of cervical screening
- Involves a cervical smear test that picks up cells from the cervix that are then looked at under a microscopy to assess for any cancerous changes.
- Smears are tested for HPV, if negative, they are not further analysed
At what ages do you get screened for cervical cancer
Aged 25-49 every 3 years
Aged 50-64 every 5 years
Which strain of HPV are responsible for cervical cancer and genital warts
6 and 11: genital warts
16 and 18: cervical cancer
What is HPV (Human Papilloma Virus)
The most common cause of cervical cancer.
Also linked to anal, vulval, vaginal, penis, mouth and throat cancers
Invades cells and interrupts the normal replication process, inhibiting tumour suppressor genes p53 and pRb.
Sexually transmitted.
What are the risk factors for endometrial cancer
Age Exposure to oestrogen: Early onset of menstruation Late menopause Hormone replacement therapy (particularly oestrogen without progesterone) No pregnancies Obesity Tamoxifen
What is the presentation of endometrial cancer
Post-menopausal bleeding
Inter-menstrual bleeding
How do we investigate for endometrial cancer
Transvaginal ultrasound for endometrial thickness (normal is <4mm)
Hysteroscopy with endometrial biopsy
What is the management of endometrial cancer
- Total abdominal hysterectomy with bilateral salpingo-oophorectomy (removal of uterus and adnexa)
- Wertheim’s Hysterectomy involves also removing the pelvic lymph nodes
- Radiotherapy
- Progesterone can be used as a hormonal treatment to slow progression of the cancer where surgery is inappropriate
What are the risk factors for ovarian cancer
Age (peaks age 60) BRCA1 and BRCA2 genes (family history) More ovulations = greater risk: Early onset of periods Late menopause No pregnancies Obesity Hormone replacement therapy (greater in oestrogen only therapy) Smoking
What are protective factors for ovarian cancer
breast feeding
What is the presentation of ovarian cancer
Bloating Pelvic pain Urinary symptoms Weight loss Abdominal mass
Which marker is raised in ovarian cancer
Ca125
What other conditions is Ca125 raised in
Ovarian cancer During menstruation Endometriosis Liver cirrhosis Benign ovarian cysts Fibroids
What investigations should you complete for suspected ovarian cancer
CA125 blood test
Abdominal/pelvic ultrasound
Diagnostic laparoscopy
What is the management of ovarianc cancer
Surgery
Chemotherapy
What are the stages of ovarian cancer
Stage 1: only in the ovary
Stage 2: out of the ovary but inside the pelvis
Stage 3: out of the pelvis but inside the abdomen
Stage 4: spread outside the abdomen (distant metastasis)
What is Krukenberg Tumour
This is an ovarian malignancy that is a secondary metastatic tumour from another site.
What are the risk factors of vulval cancer
Advanced age
HPV infection
Lichen Sclerosus (around 4% of women with lichen sclerosus get vulval cancer)
What is Vulval Intraepithelial Neoplasia (VIN)
- Pre-malignant condition which precedes vulval cancer
- 2 Types:
- HPV related (30-40yrs)
- Lichen sclerosis (50-60yrs)
How do we diagnose and manage Vulval Intraepithelial Neoplasia
Diagnosis is by biopsy and management is surgical, by wide local excision.
What is the presentation of vulval cancer
- often incidental finding
- Pain
- Itching
- Discomfort
- Discharging
- Bleeding
- Abnormal appearance or palpation on self examination
- Lymphadenopathy in groin (inguinal and femoral nodes)
What is the appearance of a vulval cancer
- Most frequently affecting the labia majora
- Irregular mass
- Fungating
- Ulcerating
- Bleeding
What is the management of vulval cancer
- 2ww
- Incisional biopsy for diagnosis if low concern for cancer
- Sentinel node biopsy
- Wide local excision to remove the cancer
- Groin lymph node dissection to stage and clear cancerous nodes
What is a cervical ectropion
cells normally seen on the inside of the cervix are seen on the outside surface.
Who gets cervical ectropion
o Normal in teens, pregnancy and on pill
o Can bleed esp. after sex
o Usually resolves on own
What is the management of mild changes on cervical smear
colposcopy or repeat smear in 6 months, then need 3 normal 6 monthly smears then discharged back to normal screening
How can you treat an abnormal smear
o Laser ablation, cold coagulation, LLETZ, cone biopsy (local anaesthetic)
What is colposcopy
Colposcopy is very similar to smear but uses a magnifying glass and they may take a biopsy
What happens with a moderate to severely abnormal smear
- referred for colposcoy
- treatment
What advice should be given to patients with treatment of their abnormal smear
Treatment may cause period type pains, have paracetamol/ibuprofen
No sex or tampons for 4 weeks as increase risk of infection
Who gets HPV vaccine
- All girls 12-13 (Can have catch up until 18)
- All boys 12-13
Why do we give the HPV vaccine so young
Spread from skin to skin contact and is found on hands, mouth and genitals
This means the virus can be passed on during any kind of sexual contact including touching
The vaccine works best if girls have it before they come in contact wih the virus, in other words before theyre sexually active
So by vaccinating at this age we hope that no one will have been exposed to the virus yet making it most effective in preventing issues later on
Studies have not shown an increase in prosmicuity seen the programmes has been introduced
