Cancers of the Ovary, Uterus, Vulva Flashcards
Which genetic syndromes increase the risk of ovarian cancer?
- HNPCC
- BRAC1
- BRCA2
What are the symptoms of ovarian cancer?
- Indigestion, early satiety and poor appetite
- Altered bowel habit and pain
- Bloating, discomfort and weight gain
- Pelvic mass
How can ovarian cancer be diagnosed?
- Surgical/pathological
- USS abdo and pelvis
- CT scan
- CA 125 test (blood marker)
- Surgery
Which conditions can have a raised CA 125?
- Malignancy: ovarian, colon, pancreatic and breast
- Menstruation/endometriosis/ PID
- Liver disease, recent surgery and effusions
Describe the staging of ovarian cancer
Stage 1: limited to ovaries with capsule intact
Stage 2: one or both ovaries with pelvic extension
Stage 3: one or both ovaries with peritoneal implants outside the pelvis or nodes
Stage 4: distant metastasis
How can ovarian cancer be treated?
- Surgery
- Chemo: adjuvant and neo-adjuvant (platinum and taxane)
How can recurrence of ovarian cancer be treated?
- Chemo
- Palliation: symptomatic recurrence
- Platinum if > 6 months
- ? surgery
- Tamoxifen
What are the symptoms of endometrial cancer?
-Vaginal bleeding in between periods or after menopause
How is post menopausal bleeding investigated?
- Pelvic and speculum exam
- Transvaginal USS
- Endometrial biopsy
How can endometrial cancer be staged?
- Pathology
- MRI
Describe the staging of endometrial cancer
- 1A: inner half of myometrium
- 1B: outer half of myometrium
- 2: Invades cervix
- 3A: serosa/adnexa
- 3B: vagina/parametrium
- 3C: pelvic or para-aortic nodes
- 4: bladder/bowel/intra-abdominal/inguinal nodes
Describe the features of type 1 endometrial cancer
- Endometriol adenocarcinoma
- Commonest
- Unopposed oestrogen
- Hyperplasia with atypia precursor
Describe the features of type 2 endometrial cancer
- Uterine serous and clear cell carcinoma
- High grade, more aggressive
- Generally older women
- Serous intraepithelial carcinoma precursor
How can endometrial cancer be treated?
- Early stage: TAH/BSO/washings
- High risk: chemo
- Advanced: radiotherapy
- Palliation: progesterone
What are the risk factors for endometrial cancer?
- Post menopause
- High circulating oestrogen levels: obesity, unopposed E2 therapy, PCOS and early menarche/ late menopause
- Atypical endometrial hyperplasia
- HNPCC/Lynch syndrome