Cancer Flashcards
What type of cancer makes up the majority of cervical cancers?
Squamous cell carcinoma
What is HPV?
Human papilloma virus
DNA virus
What is a persons lifetime risk of coming into contact with HPV?
80%
What strains of HPV cause cervical cancer?
16/18
CIN is the precursor lesion of invasive cancer, how is it graded?
Via biopsy:
CIN1: dyskaryosis in basal 1/3rd
CIN2: dyskaryosis in 2/3rds of epithelium
CIN3: full thickness dyskaryosis
Why is CIN so important?
progresses to cancer but begins young
can take 20 years for CIN3 to develop into an invasive cancer
When does cervical screening start?
age 25+
How often do people have smear tests?
age 25-49; every 3 years
age 50-64: every 5 years
HIV, transplant patients: annual
Based on results of smear (cytology), women may be asked to return for repeat smear/testing. If inflammation is seen when will they be seen again?
3 months
Based on results of smear (cytology), women may be asked to return for repeat smear/testing. If mild dyskaryosis is seen when will they be seen again?
6 months
Based on results of smear (cytology), women may be asked to return for repeat smear/testing. If moderate dyskaryosis is seen when will they be seen again?
refer to colposcopy
Based on results of smear (cytology), women may be asked to return for repeat smear/testing. If severe dyskaryosis is seen when will they be seen again?
refer to colposcopy (4 weeks)
Based on results of smear (cytology), women may be asked to return for repeat smear/testing. If invasive CIS is seen when will they be seen again?
urgent referral to colposcopy (2 weeks)
What is colposcopy?
looking at cervix, with speculum and microscope
allows for diagnosis, biopsy and management
Lesions are identified how in colposcopy?
Stains -
acetic acid - turns abnormal areas white
iodine - normal areas turn brown
When do we intervene in management of CIN?
CIN2/3
What management do we offer for CIN 2/3?
cold coagulation
LLETZ: large loop excision biopsy
When do we use LLETZ?
when woman has no intention of further pregnancy
as risk of cervical incompetence and preterm labour/miscarriage
If CIN 1 identified on colposcopy what do we do?
Repeat smear in 12 months
If smear found a glandular abnormality (gCIN) what do we do?
Send them directly for LLETZ
as possible risk of adenocarcinoma of the endocervix
After treatment how do we test to see if its been effective?
repeat smear at 6 months
oncogenic HPV tested for too
If cervical cancer is diagnosed what is the management?
Stage 1a: cone biopsy
Stage 1a2 - 2a: radical hysterectomy with bilateral pelvic node dissection
Stage 2b-4: radiotherapy +/- chemotherapy
How can we prevent cervical cancer?
HPV vaccine
regular smear tests (screening)
What are the 3 types of endometrial hyperplasia?
simple (0% risk of ca)
complex (1-2% risk of ca)
atypical (20% risk of ca)
What type of tumour are endometrial cancers?
majority adenocarcinoma
80% arise from hyperplasia - endometriod
20% dont arise from hyperplasia - squamous and clear cell
other types:
stromal sarcoma, carcinocarcinoma, leiomyosarcoma
How may someone with endometrial cancer present?
PMB
abnormal intermenstrual bleeding
menorrhagia
How do we assess suspected endometrial cancer?
PV + speculum TVU endometrial biopsy (pipelle) hysteroscopy staging (MRI) CTCAP
On TVU what thickness of endometrium is suspicious for endometrial cancer?
post menopausal >4mm
pre menopausal >16mm
How might someone with ovarian cancer present?
often vague symptoms for a few months:
SoB Fatigue, weight loss Urinary freq/urgency irregular bleeding/pelvic pain abdo pain, bloating, early satiety, reduced appetite change in BO ascited
How do we investigate for ovarian cancer?
Blood: tumour markers CA125 Imaging: 1st line TVUS Tissue sampling: ascetic tap (cytology) laparotomy/laparoscopy for biopsy
