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Repro and Sexual Health > Cervical Cancer > Flashcards

Cervical Cancer Flashcards

1
Q

What are the signs and symptoms of cervical cancer?

A 
Inter-menstrual bleeding
Post coital bleeding
Post menopausal bleeding
Abnormal appearance of cervix 
Vaginal discharge (blood stained)
Pelvic pain
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2
Q

What are risk factors for cervical cancer?

A

HPV infection
Cigarette smoking
Socioeconomic status

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3
Q

What test should be performed with pre-menopausal women presenting with abnormal vaginal bleeding?

A

Chlamydia trachomatis

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4
Q

What should pathology reports of cervical tumours include?

A 
Tumour size and type 
Extent of tumour; involvement of vaginal wall or parametrium
Depth of invasion 
Pattern of invasion; infiltrative or cohesive invasive front 
Lymphovascular space invasion 
Status of resection margins
Status of lymph nodes
PResence of pre0-invasive disease
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5
Q

How is cervical cancer staged?

A

FIGO criteria

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6
Q

What method of radiology is most accurate for staging of cervical cancer?

A

MRI; t2 weighted perpendicular to cervix and sequences to include urinary tract and para-aortic nodal areas

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7
Q

When should post contrast spiral CT be considered as an alternative to MRI?

A

If MRI contraindicated

Or stage 4 disease

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8
Q

What is the recommended management for FIGO 1B1 disease?

A

Radical surgery

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9
Q

What can be performed if a woman wants to preserve her fertility with cervical cancer?

A

Radial trachelectomy and pelvic lymph node dissection providing the tumour diameter is less than 2cm and no lymphatic vascular space invasion is present

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10
Q

Is chemo recommended in cervical cancer?

A

Any patient with cervical cancer who is suitable for radical radiotherapy should have concurrent platinum based chemo

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11
Q

Who should be considered for radiotherapy with cervical cancer?

A

Those who have undergone surgery with positive nodes
Those who have undergone surgery, with negative nodes but;
Greater than a third stromal invasion
Lymphovascular space invasion
Tumour diameter >4 cm

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12
Q

What is brachytherapy?

A

Short wave radiotherapy delivered by insertion of applicators into the uterus via vagina

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13
Q

What is recommended for women who have lost ovarian function as a result of treatment for cervical cancer?

A

HRT to reduce post menopausal symptoms

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14
Q

What are the common symptoms of ovarian cancer?

A 
Persistent abdominal distention 
Early satiety
Loss of appetite
Pelvic or abdo pain
Increased urinary urgency +/- frequency
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15
Q

What test should be performed in women with symptoms that suggest ovarian cancer?

A

Ca-125

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16
Q

What is the next step if serum Ca-125 is greater than 35 IU/ ml?

A

USS of abdo and pelvis

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17
Q

Who should be urgently referred to gynae in terms of ovarian cancer?

A

Serum Ca125 over 35 IU/ ml with a USS suggestive of ovarian cancer
Physical exam identified ascites and/or pelvic mass

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18
Q

On top of Ca-125 what blood test should be performed on women who are under 40 that present with symptoms of ovarian cancer?

A

AFP
b-HCG
Rule out epithelial ovarian cancer

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19
Q

What score is calculated in secondary care to quantify risk of ovarian cancer?

A 
RMI 1 (risk of malignancy index) 
Includes; ultrasound scan, menopausal status and serum Ca-125 level
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20
Q

What needs to performed first if offering cytotoxic chemo to women with suspected ovarian cancer?

A

Confirmed tissue diagnosis by histology

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21
Q

How can a tissue diagnosis be obtained in suspected ovarian cancer?

A

Percutaneous image guided biopsy

Laparoscopic biopsy

22
Q

How is early (stage 1) ovarian cancer managed?

A

Performed retroperitoneal lymph node assessment as part of optimal surgical staging
If high risk stage 1 disease; sex cycles of carboplatin

23
Q

How is advanced ovarian cancer managed?

A

Complete resection of all macroscopic disease

24
Q

What is the most common type of cervical cancer?

A

Squamous cell

Adenocarcinoma makes up around 15-25%

25
Q

Management of cervical cancer with a negative sentinel lymph node biopsy?

A

Radical hysterectomy or radical trachelectomy and lymphadenectomy
If low risk; no adjuvant post op treatment required

26
Q

Management of cervical cancer with a positive sentinel lymph node biopsy?

A

Chemoradiotherapy

27
Q

When do most cervical cancer recurrences happen?

A

Within 2 years

28
Q

What is the follow up post treatment of cervical cancer?

A

Rectovaginal exam
Nodal assessment (esp supraclavicular)
Cervical smears
Every 3-4 months in first 3 years

29
Q

What is the most common form of endometrial cancer?

A

Adenocarcinoma

30
Q

How is endometrial cancer diagnosed?

A

Biopsy or D+C

Staging and histology confirmed at surgery

31
Q

What is the most important prognostic information obtained for endometrial cancer?

A 
Stage
Histological subtype
Tumour grade
Patient age
Presence of lymphovascular space invasion
32
Q

For stage 1 and 2 endometrial cancer, what has been shown to reduce local failure rates and improve progression free survival?

A

Adjuvant vaginal brachytherapy or pelvic external beam radiotherapy

33
Q

What is the definition of endometrial cancer?

A

Epithelial malignancy of uterine corpus mucosa

34
Q

What genetic syndrome is linked with endometrial cancer?

A

Lynch syndrome

35
Q

What are risk factors for the development of endometrial cancer?

A 
Family history 
Lynch syndrome 
Ovarian cancer
Obesity
Age >50 
Diabetes
Nulliparity 
HRT
Tamoxifen use
Chronic anovulation 
PCOS
Radiotherapy
36
Q

What is the chief complaint in pre-menopausal women with endometrial cancer?

A

Abnormal menstruation or abnormal vaginal bleeding

37
Q

What physical examination should be performed in women with suspected endometrial cancer?

A

Bi-manual exam; uterine size, uterine mass, fixed uterus, adnexal mass
Vulva, vagina and cervix should be inspected via speculum

38
Q

How is suspected endometrial cancer investigated?

A

Endometrial biopsy or curettage for histological eval

Pelvic (transvaginal USS); if over 5mm BAD

39
Q

How is endometrial cancer staged?

A

Surgically - hysteroscopy

Surgical histopathology for; extent of local and distant tumour spread, tumour grade

40
Q

What are prognostic factors for endometrial cancer?

A

Depth of myometrial invasion
Lymphovascular invasion
Cervical involvement

41
Q

What ancillary tests are performed in the work up for endometrial cancer?

A 
FBC 
LFT; mets 
Renal function; obstructive uropathy
CXR; lung mets 
CT of chest, abdo and pelvis 
MRI of uterus, pelvis and abdomen (shows myometrial invasion)
42
Q

What is the key diagnostic factor for endometrial cancer?

A

Post menopausal bleeding; 5-10% of women with PVB have endometrial cancer

43
Q

Aside from PMB what are other diagnostic factors for endometrial cancer?

A

Uterine mass, fixed mass or adnexal mass
Abnormal menstruation in premenopausal women
Pain and wt loss (rare)
Signs of mets (rare)

44
Q

DDx of endometrial cancer?

A 
Endometrial hyperplasia (do biopsy) 
Endometrial polyp (TVUSS will show uneven thickened endometrium) 
Endometriosis (biopsy will show hemosiderin laden macrophages) 
Cervical ca (colposcopy will show mass lesion on cervix, biopsy shows squamous cell carcinoma
45
Q

What are the 2 important roles surgery plays in management of endometrial cancer?

A

Used to stage disease

Removes malignant disease

46
Q

In what stages of endometrial cancer is chemo used?

A

Stages 3 and 4 as an adjuvant

Has a palliative role for metastatic or recurrent disease

47
Q

What is the standard curative surgery for endometrial cancer?

A

Total hysterectomy
BSO
Node dissection

48
Q

What chemotherapies are used for endometrial cancer?

A

Paclitaxel and carboplatin

49
Q

What is the histology of the majority of ovarian cancers?

A

Epithelial; serous carcinoma
Rare; clear cell, endometrioid, mucinous
Non-epithelial; germ cell, stromal

50
Q

What are type 1 ovarian cancers?

A

Slow growing, indolent

Clear cell, mucinous, endometrioid, low grade serous

51
Q

What are type 2 ovarian cancers?

A

Fast growing, spread early

High grade serous

52
Q

What risk factors are assoc with ovarian cancer?

A 
Number or ovulatory cycles is proportional to risk; OCP and pregnancy are protective 
Nulliparity
Hx of breast cancer
HRT 
Post-menopausal

Repro and Sexual Health (77 decks)

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