Cancer Screening

Question 1

CA-125 - conditions associated with elevation (gynaecological, benign gynaecological, non-gynaecological condition, non-gynaecological cancer)

Answer 1

Gynaecological 
- Ovarian cancer 
- Endometrial cancer 
Benign gynaecological
- Benign ovarian neoplasma
- Functional ovarian cysts
- Endometriosis
- Adenomyosis
- PID, pregnancy 
Non-gynaecological conditions
- Cirrhosis
- Diverticulitis
- Pneumonia
- Pericarditis 
- UTI
- SLE
Non-gynaecological cancers 
- Breast, colon, liver, lung

Question 2

Prostate cancer (key points, screening)

Answer 2

Key points
● No benefit shown to screen for PSA
● Risk of over diagnosis and treatment
● Does not reduce mortality rate significantly (1 in every 1000 men 55-69)
● Approach is to discuss benefits vs. harms and allow for patient to decide whether to pursue
● DRE no longer recommended due to low sensitivity
Screening - on demand

Question 3

Breast cancer (risk calculator, screening)

Answer 3

Breast cancer risk calculator: 1 red flag = average, 2 red flags = moderate
● Number of relatives (>=2)
● Degree of relatives (first degree)
● Age <50
Screening
● Average = mammogram every 2 years from 50-74 years
● Moderate = consider referral to family cancer clinic, annual mammogram from 40 years may be
recommended
● High = refer to cancer specialist or family cancer clinic for assessment
** additional RF = another relative with breast/ovarian cancer, <40 years, bilateral breast cancer, breast and
ovarian cancer in same woman, Ashkenaz, male relative)

Question 4

Colorectal cancer (risk, screening)

Answer 4

Risk calculator (4 flags = Cat 2, <4 flags = Cat 1)
- First degree < 55 = 4 flags
- First degree > 55 = 2 flags
- Second degree any age = 1 flag 
Screening: Cease screening for those over 75 years
● Category 1:
○ Consider low dose aspirin
○ FOBT every 2 years from 50-74 years
● Category 2:
○ FOBT every 2 years from 40-49 years
○ Colonoscopy every 5 years from 50-74 years
○ Low dose aspirin from 50 years
● Category 3:
○ Referral to familial cancer clinic
○ FOBT every 2 years from 35-44
years
○ Colonoscopy every 5 years from
45-74 years

Question 5

Ovarian cancer (risk category, screening)

Answer 5

Risk category
- Lower = oral contraception, carried pregnancy to term
- Higher = FHx ovarian cancer, BRCA1/2 gene
Screening - no screening
* Consider increased frequency of breast and colorectal screening for higher risk

Question 6

Cervical Screening Test (key points, new pathway, self collection, hysterectomy pts, when to refer, test of cure)

Answer 6

Key points
● 5 yearly
● Start 25 years until 74 years
● Patients who have symptoms should have co-test and not screening
● Safe to perform during pregnancy with broom brush

New pathway changes 
HPV detected (not 16/18) > repeat in 12 months > detected again 
- LBC negative/LSIL = repeat in 12 months 
- Direct referral for >50 yrs, ATSI, overdue screening 

Self collection
● Eligible if:
○ > 30 yrs who have declined physician collection
○ Overdue > 2 years
○ Never been screened
● Ineligible if:
○ Pregnant
○ Symptomatic
○ Hysterectomy with HSIL
○ Under 30 years

Patients with hysterectomy
● Total, asymptomatic - no screening
● Previous HSIL - annual co-test until 2 consecutive negative results
● Subtotal (cervix present) - as usual

When to refer
● HPV detected
● High-grade squamous intraepithelial lesion

Test of cure
● Repeat co-test 12 months after treatment, yearly thereafter until patient received 2x negative co-test
● Then 5 yearly thereafter

Question 7

Ovarian cancer (presentation, screening)

Answer 7

Presentation
● Common symptoms: bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, urinary
symptoms.
● Other symptoms: fatigue, indigestion, back pain, pain with intercourse, constipation, menstrual irregularities.

Screening: no recommended screening.

Question 8

Skin cancer (prevention, questions)

Answer 8

Prevention
1. Slip, slop, slap, seek, slide - reduced UV exposure
Questions to assess risk
1. Family history of melanoma
2. History of severe sunburns/blister burns
3. Ethnic background/skin phototype
4. Current level of sun exposure (occupational/recreational)
5. Sun protection habits
6. Recent change in moles/skin blemishes
7. Any bleeding/pruritus of moles/skin blemishes
8. Use of solarium beds in the past
9. Past history of skin lesion excision for suspicion of malignancy
10. Immunodeficiency

Question 9

Skin cancer - melanoma

Answer 9

● Australia has the highest incidence in the world

● Warning signs

1. New or changing
2. Prominent/pigmented/stands out from others (‘Ugly Duckling’)
3. Rapidly growing
4. Patient concern
5. Changed on subsequent dermatoscopy

● Management
○ Excision by self or referral to specialist for excision if melanoma cannot be excluded.
○ Initial excision 2 mm margin and as deep as subcutaneous fat.

Question 10

Skin cancer - atypical melanocytic naevus (definition, dysplastic naevus, importance)

Answer 10

● Definition: mole with unusual features
● Dysplastic naevus: histological description of a particular kind of melanocytic naevus
● Importance:
○ 5x more likely to develop melanoma
○ These individuals should be taught how to do a self-examination
○ If numerous moles, then should see a GP or dermatologist for yearly checks
○ Photographic records are useful
○ Extra careful with sun protection (SPF 50+)