Cancer

Question 1

What type of cancer makes up the majority of cervical cancers?

Answer 1

Squamous cell carcinoma

Question 2

What is HPV?

Answer 2

Human papilloma virus

DNA virus

Question 3

What is a persons lifetime risk of coming into contact with HPV?

Answer 3

80%

Question 4

What strains of HPV cause cervical cancer?

Answer 4

16/18

Question 5

CIN is the precursor lesion of invasive cancer, how is it graded?

Answer 5

Via biopsy:

CIN1: dyskaryosis in basal 1/3rd
CIN2: dyskaryosis in 2/3rds of epithelium
CIN3: full thickness dyskaryosis

Question 6

Why is CIN so important?

Answer 6

progresses to cancer but begins young

can take 20 years for CIN3 to develop into an invasive cancer

Question 7

When does cervical screening start?

Answer 7

age 25+

Question 8

How often do people have smear tests?

Answer 8

age 25-49; every 3 years
age 50-64: every 5 years
HIV, transplant patients: annual

Question 9

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?

Answer 9

3 months

Question 10

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?

Answer 10

6 months

Question 11

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?

Answer 11

refer to colposcopy

Question 12

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?

Answer 12

refer to colposcopy (4 weeks)

Question 13

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?

Answer 13

urgent referral to colposcopy (2 weeks)

Question 14

What is colposcopy?

Answer 14

looking at cervix, with speculum and microscope

allows for diagnosis, biopsy and management

Question 15

Lesions are identified how in colposcopy?

Answer 15

Stains -
acetic acid - turns abnormal areas white
iodine - normal areas turn brown

Question 16

When do we intervene in management of CIN?

Answer 16

CIN2/3

Question 17

What management do we offer for CIN 2/3?

Answer 17

cold coagulation

LLETZ: large loop excision biopsy

Question 18

When do we use LLETZ?

Answer 18

when woman has no intention of further pregnancy

as risk of cervical incompetence and preterm labour/miscarriage

Question 19

If CIN 1 identified on colposcopy what do we do?

Answer 19

Repeat smear in 12 months

Question 20

If smear found a glandular abnormality (gCIN) what do we do?

Answer 20

Send them directly for LLETZ

as possible risk of adenocarcinoma of the endocervix

Question 21

After treatment how do we test to see if its been effective?

Answer 21

repeat smear at 6 months

oncogenic HPV tested for too

Question 22

If cervical cancer is diagnosed what is the management?

Answer 22

Stage 1a: cone biopsy
Stage 1a2 - 2a: radical hysterectomy with bilateral pelvic node dissection
Stage 2b-4: radiotherapy +/- chemotherapy

Question 23

How can we prevent cervical cancer?

Answer 23

HPV vaccine

regular smear tests (screening)

Question 24

What are the 3 types of endometrial hyperplasia?

Answer 24

simple (0% risk of ca)
complex (1-2% risk of ca)
atypical (20% risk of ca)

Question 25

What type of tumour are endometrial cancers?

Answer 25

majority adenocarcinoma 80% arise from hyperplasia - endometriod 20% dont arise from hyperplasia - squamous and clear cell other types: stromal sarcoma, carcinocarcinoma, leiomyosarcoma

Question 26

How may someone with endometrial cancer present?

Answer 26

PMB abnormal intermenstrual bleeding menorrhagia

Question 27

How do we assess suspected endometrial cancer?

Answer 27

``` PV + speculum TVU endometrial biopsy (pipelle) hysteroscopy staging (MRI) CTCAP ```

Question 28

On TVU what thickness of endometrium is suspicious for endometrial cancer?

Answer 28

post menopausal >4mm | pre menopausal >16mm

Question 29

How might someone with ovarian cancer present?

Answer 29

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 ```

Question 30

How do we investigate for ovarian cancer?

Answer 30

``` Blood: tumour markers CA125 Imaging: 1st line TVUS Tissue sampling: ascetic tap (cytology) laparotomy/laparoscopy for biopsy ```