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Cancer Flashcards

1
Q

How many days does the Cancer Access Standards allow to diagnose and investigate and formulate a plan for a cancer referral? how many days after for plan to be enacted?

A

31 days then another 31 days

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2
Q

4 different contact points in the cancer management process?

A

Referral letter to hospital, diagnosis made with MDT, patient agrees with management, treatment starts

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3
Q

Why does pooling referral letters aid in diagnosis and treatment times?

A

Pooling all gynae referrals, red fag sifted, others down usual channels, PMB and gynae-oncology clinics

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4
Q

percentage of PMB is due to endometrial cancer?

A

10%

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5
Q

percentage of PMB is due to endometrial hyperplasia?

A

10-25%

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6
Q

What does breaching mean in terms of patient tracking

A

when targets are not met and therefore lead to investigations being needed

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7
Q

Pathway for endometrial cancer?

A

GP - PMB clinic/USS/Biopsy - Colposcopy/MRI - MDT - treat

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8
Q

Pathway for ovarian cancer?

A

GP - OPD/tumour markers/USS - CT - MDT - treat

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9
Q

Pathway for complex ovarian cancer?

A

GP - OPD/tumour markers/USS - CT - MDT - Biopsy - MDT - decision to treat

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10
Q

How does ovarian cancer rank on the most common causes of cancer death in women?

A

5th

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11
Q

Peak age for ovarian cancer?

A

65-69 years old

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12
Q

What type of chemotherapy is given to ovarian cancer predominantly?

A

Platinum based chemotherapy

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13
Q

Risk factors for ovarian cancer?

A

Smoking, early menarche, late menopause, smoking, FH, BRCA, overweight, nulliparity, HRT, diabetes, endometriosis

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14
Q

if a first line relative has ovarian cancer how much does it increase your chances of getting it?

A

3 fold

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15
Q

3 other genetic links to ovarian cancer besides BRCA?

A

RAD51, BRIP1, lynch syndrome

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16
Q

Protective factors against ovarian cancer?

A

multiparity, cOCP, breast feeding

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17
Q

Most common type of epithelial ovarian tumours?

A

high grade serous carcinoma

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18
Q

Name types of epithelial ovarian cancers?

A

high grade serous carcinoma, ovarian endometrioid, carinoma, CCC of the ovary, mucinous carcinoma, low grade serous carcinoma

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19
Q

Example of a germ cell tumour?

A

Teratoma

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20
Q

Example of a sex cord stromal cell tumour?

A

Granulosa cell

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21
Q

What is the name of the metastatic tumour presenting in the ovary?

A

Krukenberg

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22
Q

What is a mesenchymal tumour of the ovary?

A

Sarcoma

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23
Q

High grade serous carcinoma of the ovary originate where?

A

Fimbriae

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24
Q

What mutation is associated with high grade serous carcinomas of the ovary?

A

p53

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25
Where do low grade serous carcinomas of the ovary originate from?
Benign ovarian cysts
26
There do clear cell and endometrioid cancer of the ovum arise?
retrograde menstruation or endometriosis
27
What 2 types of cancer are associated with mucinous ovarian cancer?
Upper GI malignancy or pancreas
28
Symptoms to look out for in ovarian cancer?
bloating, early satiety, pressure symptoms on bowel and bladder, dyspepsia, unexplained weight loss
29
Along with Ca125 what 5 other tumour markers can you ask for in suspected ovarian cancer?
CEA, Ca19.9, LDH, B-HCG, AFP
30
What is the staging system used for ovarian cancer?
FIGO staging 1. ovaries 2. pelvis local to ovaries 3. abdominal cavity 4. distant spread
31
What is the process of chemotherapy as a neoadjuvant therapy for ovarian cancer?
3 cycles of platinum and taxol, assessment, interval surgery and debulking, further 3 cycles
32
How many cycles of chemo are involved in adjuvant therapy to ovarian cancer treatment?
6 cycles of platinum and taxol
33
PCRS vs ICRS?
primary and interval cytoreduction surgery determining if chemo is performed as 6 cycles after surgery of as 3 before and 3 after
34
5 year survival of early ovarian cancer? % chance of relapse? % that will die?
90%, 50%, 30%
35
Adjuvant chemo improves recurrence free survival by what %?
10%
36
what does a primary cytoreductive surgery through a midline laparotomy involve?
peritoneal washings, total omentectomy, hysterectomy, BSO, pelvic and paraortic lymph node sampling
37
What is the Sister Mary Joseph Nodule?
Sign of advanced stage metastatic ovarian cancer with a umbilical nodule
38
5 year survival after maximal cytoreduction leaving no residual disease of ovarian cancer?
50-60%
39
5 year survival after maximal cytoreduction leaving less than 1cm residual disease of ovarian cancer?
30-40%
40
5 year survival after maximal cytoreduction leaving greater than 1cm residual disease of ovarian cancer?
7.4-29%
41
What are the DESKTOP I, II, III clinical trials are used to guide treatment using what?
secondary cytoreduction
42
How does the BRCA gene presence effect effectiveness of chemo treatment?
Respond better to treatment
43
What is hyperthermic intraperitoneal chemotherapy
bathe abdominal content in a heated fluid chemotherapy after surgery
44
Peak age for vulval cancer?
70
45
Risk factors for vulval cancer?
low parity, HPV infection, lichen sclerosis, preeisting VIN
46
FIGO staging of vulval cancer?
stage 1 - less than 2cm and node negative stage 2 - more than 2cm but node negative stage 3 - over 2cm and node positive stage 4 - any size, positive or negative nodes, loval invasion present and distant metastases
47
What 2 types of incision are used to remove deep nodes in vulval cancer?
Modified butterfly incision and triple incision
48
5 year survival of stage 1,2,3 of vulval cancer?
85%, 70%, 40%
49
Why are rates of endometrial cancer rising?
Obesity rates are rising
50
Type 1 endometrial cancer - % of overall cases? type of cancer? hormone relation? risk factors (5)?
80% endometrioid, oestrogen related, risk factors of nulliparity, obesity, diabetes, hypertension, PCOS
51
Type 2 endometrial cancer - % of overall cases? 2 types of cancer cells it can be? hormone relation? comparative to type 1?
20% can be serous or clear cell, not related to oestrogen production, more aggressive than type 1 and more likely in older women
52
What do majority of endometrial cancer patients present with?
PMB and irregular bleeding
53
Why do obese people have more oestrogen in their system?
Adipose tissue allows aromatization of androgens to endogenous oestrogens
54
Which familial syndrome can lead to increased risk of endometrial cancer?
Lynch syndrome - HNPCC
55
Which 3 mismatch repair gene mutations can lead to endometrial cancer?
MSH2, MSH1 or MSH6
56
Where does endometrial cancer initially spread to as local invasion and which lymph nodes does it initially spread to
Cervix and myometrium, pelvic and para-aortic lymph nodes
57
Surgical treatment of endometrial cancer?
Total abdominal hysterectomy, BSO, pelvic washing, consider pelvic and para-aortic node dissection
58
Treatment of endometrial cancer of young women who want to preserve their treatment?
High dose progesterones like mirena coil or oral provera
59
Ia,b and c of the FIGO staging of endometrial cancer?
``` 1A = confined to endometrium 1B = less than half of myometrium invades 1C = more than half of myometrium invaded ```
60
Grade 2 endometrial cancer is characterised by what?
Cervical invasion
61
Stage 111A,B,C of endometrial cancer?
``` 3A = serosa/adnexa of the uterus invovled 3B = vaginal invovlement 3C = paraaortic or pelvic node invovlement ```
62
Stage 4A and 4B of endometrial cancer?
``` 4A = bladder or bowel invasion 4B = distant metastases ```
63
5 year survival of stage 1,2,3,4 of endometrial cancer?
``` 1 = 80-91% 2 = 71-78% 3 = 52-60% 4 = 14-17% ```
64
When is radiotherapy offered in endometrial cancer?
When there is invasion in over half of the myometrium?
65
5 year survival for serous cancer of the endometrium?
58%
66
5 year survival of clear cell carcinoma of the endometrium?
68%
67
How is cervical cancer ranked in terms of most common cause of cancer mortality?
9th
68
Most common age of diagnosis for cervical cancer?
30-45
69
2 most common types of cervical cancer?
Squamous cell (70%) and adenocarcinoma (15%)
70
Rare types of cervical cancer (6)?
Clear cell, classy cell, neuroendocrine, melanoma, lymphoma
71
Predisposing factors for cervical cancer?
Smoking, HPV!!!!, STDs, immunosuppression, cOCP
72
By the age of 50 what % of population have HPV infection?
80%
73
what usually happens to someone infected with HPV?
Bodys immune system will eradicate the infection within 12-24 months
74
2 strains of HPV which are oncogenic and non-oncogenic
6,11 ok 16,18 bad
75
What type of virus is HPV
double stranded DNA
76
How often is cervical cancer screening performed?
25-50 every 3 years then 50-65 every 5 years
77
How is the sample taken and tested in cervical cancer screening?
Smears with a liquid based cytology
78
Define dyskaryosis
abnormal epithelial cells found in cervical sample and can be graded from low to high
79
How is treatment of CIN usually carried out?
LLETZ or cold coagulation under LA
80
When does CIN III become established?
with greater than 2/3 of epithelium involvement
81
Another term for koilocytosis?
CIN I
82
How is CIN I classified?
basal 1/3 of the epithelium involved
83
What is a potential chronic complication of a LLETZ procedure and what can it lead to?
Cervical stenosis leading to late miscarriage and pre-term delivery
84
How do you exclude bladder and rectal spread in cervical cancer?
cystoscopy and proctoscopy
85
How is FIGO stage 2 seen in cervical cancer?
Spread beyond cervix but not lower 1/3 of vagina or pelvic side wall
86
How is stage Ia1 treated in cervical cancer and the difference between fertile and non-fertile women?
LLETZ or cone biopsy for fertile and modified laparoscopic radical hysterectomy and PLND
87
How is stage Ia2 treated in cervical cancer and the difference between fertile and non-fertile women?
Laparoscopic radical trachelectomy and PLND in fertile women and laparoscopic radical hysterectomy and PLND with or without BSO
88
Primary chemo treatment of cervical cancer involves which 3 components?
Brachytherapy, Chemotherapy and External beam
89
When is primary chemo useful for cervical cancer?
Tumour size over 4cm, stage 2B onwards, local tumour factors, aggressive subtype
90
What drug is given to patients with cervical cancer post op? how much and how often?
cisplatin 50mg/m2 weekly
91
5 year survival of cervical cancer stage 1, 2, 3, 4
``` 1 = 99% 2 = 82% 3 = 50% 4 = 2% ```

Obs and Gynae (27 decks)

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