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Obs and Gynae > Cancer > Flashcards

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
Q

Where do low grade serous carcinomas of the ovary originate from?

A

Benign ovarian cysts

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26
Q

There do clear cell and endometrioid cancer of the ovum arise?

A

retrograde menstruation or endometriosis

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27
Q

What 2 types of cancer are associated with mucinous ovarian cancer?

A

Upper GI malignancy or pancreas

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28
Q

Symptoms to look out for in ovarian cancer?

A

bloating, early satiety, pressure symptoms on bowel and bladder, dyspepsia, unexplained weight loss

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29
Q

Along with Ca125 what 5 other tumour markers can you ask for in suspected ovarian cancer?

A

CEA, Ca19.9, LDH, B-HCG, AFP

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30
Q

What is the staging system used for ovarian cancer?

A

FIGO staging

  1. ovaries
  2. pelvis local to ovaries
  3. abdominal cavity
  4. distant spread
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31
Q

What is the process of chemotherapy as a neoadjuvant therapy for ovarian cancer?

A

3 cycles of platinum and taxol, assessment, interval surgery and debulking, further 3 cycles

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32
Q

How many cycles of chemo are involved in adjuvant therapy to ovarian cancer treatment?

A

6 cycles of platinum and taxol

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33
Q

PCRS vs ICRS?

A

primary and interval cytoreduction surgery determining if chemo is performed as 6 cycles after surgery of as 3 before and 3 after

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34
Q

5 year survival of early ovarian cancer? % chance of relapse? % that will die?

A

90%, 50%, 30%

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35
Q

Adjuvant chemo improves recurrence free survival by what %?

A

10%

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36
Q

what does a primary cytoreductive surgery through a midline laparotomy involve?

A

peritoneal washings, total omentectomy, hysterectomy, BSO, pelvic and paraortic lymph node sampling

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37
Q

What is the Sister Mary Joseph Nodule?

A

Sign of advanced stage metastatic ovarian cancer with a umbilical nodule

38
Q

5 year survival after maximal cytoreduction leaving no residual disease of ovarian cancer?

A

50-60%

39
Q

5 year survival after maximal cytoreduction leaving less than 1cm residual disease of ovarian cancer?

A

30-40%

40
Q

5 year survival after maximal cytoreduction leaving greater than 1cm residual disease of ovarian cancer?

A

7.4-29%

41
Q

What are the DESKTOP I, II, III clinical trials are used to guide treatment using what?

A

secondary cytoreduction

42
Q

How does the BRCA gene presence effect effectiveness of chemo treatment?

A

Respond better to treatment

43
Q

What is hyperthermic intraperitoneal chemotherapy

A

bathe abdominal content in a heated fluid chemotherapy after surgery

44
Q

Peak age for vulval cancer?

A

70

45
Q

Risk factors for vulval cancer?

A

low parity, HPV infection, lichen sclerosis, preeisting VIN

46
Q

FIGO staging of vulval cancer?

A

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
Q

What 2 types of incision are used to remove deep nodes in vulval cancer?

A

Modified butterfly incision and triple incision

48
Q

5 year survival of stage 1,2,3 of vulval cancer?

A

85%, 70%, 40%

49
Q

Why are rates of endometrial cancer rising?

A

Obesity rates are rising

50
Q

Type 1 endometrial cancer - % of overall cases? type of cancer? hormone relation? risk factors (5)?

A

80% endometrioid, oestrogen related, risk factors of nulliparity, obesity, diabetes, hypertension, PCOS

51
Q

Type 2 endometrial cancer - % of overall cases? 2 types of cancer cells it can be? hormone relation? comparative to type 1?

A

20% can be serous or clear cell, not related to oestrogen production, more aggressive than type 1 and more likely in older women

52
Q

What do majority of endometrial cancer patients present with?

A

PMB and irregular bleeding

53
Q

Why do obese people have more oestrogen in their system?

A

Adipose tissue allows aromatization of androgens to endogenous oestrogens

54
Q

Which familial syndrome can lead to increased risk of endometrial cancer?

A

Lynch syndrome - HNPCC

55
Q

Which 3 mismatch repair gene mutations can lead to endometrial cancer?

A

MSH2, MSH1 or MSH6

56
Q

Where does endometrial cancer initially spread to as local invasion and which lymph nodes does it initially spread to

A

Cervix and myometrium, pelvic and para-aortic lymph nodes

57
Q

Surgical treatment of endometrial cancer?

A

Total abdominal hysterectomy, BSO, pelvic washing, consider pelvic and para-aortic node dissection

58
Q

Treatment of endometrial cancer of young women who want to preserve their treatment?

A

High dose progesterones like mirena coil or oral provera

59
Q

Ia,b and c of the FIGO staging of endometrial cancer?

A 
1A = confined to endometrium
1B = less than half of myometrium invades
1C = more than half of myometrium invaded
60
Q

Grade 2 endometrial cancer is characterised by what?

A

Cervical invasion

61
Q

Stage 111A,B,C of endometrial cancer?

A 
3A = serosa/adnexa of the uterus invovled
3B = vaginal invovlement
3C = paraaortic or pelvic node invovlement
62
Q

Stage 4A and 4B of endometrial cancer?

A 
4A = bladder or bowel invasion
4B = distant metastases
63
Q

5 year survival of stage 1,2,3,4 of endometrial cancer?

A 
1 = 80-91%
2 = 71-78%
3 = 52-60%
4 = 14-17%
64
Q

When is radiotherapy offered in endometrial cancer?

A

When there is invasion in over half of the myometrium?

65
Q

5 year survival for serous cancer of the endometrium?

A

58%

66
Q

5 year survival of clear cell carcinoma of the endometrium?

A

68%

67
Q

How is cervical cancer ranked in terms of most common cause of cancer mortality?

A

9th

68
Q

Most common age of diagnosis for cervical cancer?

A

30-45

69
Q

2 most common types of cervical cancer?

A

Squamous cell (70%) and adenocarcinoma (15%)

70
Q

Rare types of cervical cancer (6)?

A

Clear cell, classy cell, neuroendocrine, melanoma, lymphoma

71
Q

Predisposing factors for cervical cancer?

A

Smoking, HPV!!!!, STDs, immunosuppression, cOCP

72
Q

By the age of 50 what % of population have HPV infection?

A

80%

73
Q

what usually happens to someone infected with HPV?

A

Bodys immune system will eradicate the infection within 12-24 months

74
Q

2 strains of HPV which are oncogenic and non-oncogenic

A

6,11 ok 16,18 bad

75
Q

What type of virus is HPV

A

double stranded DNA

76
Q

How often is cervical cancer screening performed?

A

25-50 every 3 years then 50-65 every 5 years

77
Q

How is the sample taken and tested in cervical cancer screening?

A

Smears with a liquid based cytology

78
Q

Define dyskaryosis

A

abnormal epithelial cells found in cervical sample and can be graded from low to high

79
Q

How is treatment of CIN usually carried out?

A

LLETZ or cold coagulation under LA

80
Q

When does CIN III become established?

A

with greater than 2/3 of epithelium involvement

81
Q

Another term for koilocytosis?

A

CIN I

82
Q

How is CIN I classified?

A

basal 1/3 of the epithelium involved

83
Q

What is a potential chronic complication of a LLETZ procedure and what can it lead to?

A

Cervical stenosis leading to late miscarriage and pre-term delivery

84
Q

How do you exclude bladder and rectal spread in cervical cancer?

A

cystoscopy and proctoscopy

85
Q

How is FIGO stage 2 seen in cervical cancer?

A

Spread beyond cervix but not lower 1/3 of vagina or pelvic side wall

86
Q

How is stage Ia1 treated in cervical cancer and the difference between fertile and non-fertile women?

A

LLETZ or cone biopsy for fertile and modified laparoscopic radical hysterectomy and PLND

87
Q

How is stage Ia2 treated in cervical cancer and the difference between fertile and non-fertile women?

A

Laparoscopic radical trachelectomy and PLND in fertile women and laparoscopic radical hysterectomy and PLND with or without BSO

88
Q

Primary chemo treatment of cervical cancer involves which 3 components?

A

Brachytherapy, Chemotherapy and External beam

89
Q

When is primary chemo useful for cervical cancer?

A

Tumour size over 4cm, stage 2B onwards, local tumour factors, aggressive subtype

90
Q

What drug is given to patients with cervical cancer post op? how much and how often?

A

cisplatin 50mg/m2 weekly

91
Q

5 year survival of cervical cancer stage 1, 2, 3, 4

A 
1 = 99%
2 = 82%
3 = 50%
4 = 2%

Obs and Gynae (27 decks)

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