Cervical Cancer Flashcards
What are the signs and symptoms of cervical cancer?
Inter-menstrual bleeding Post coital bleeding Post menopausal bleeding Abnormal appearance of cervix Vaginal discharge (blood stained) Pelvic pain
What are risk factors for cervical cancer?
HPV infection
Cigarette smoking
Socioeconomic status
What test should be performed with pre-menopausal women presenting with abnormal vaginal bleeding?
Chlamydia trachomatis
What should pathology reports of cervical tumours include?
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
How is cervical cancer staged?
FIGO criteria
What method of radiology is most accurate for staging of cervical cancer?
MRI; t2 weighted perpendicular to cervix and sequences to include urinary tract and para-aortic nodal areas
When should post contrast spiral CT be considered as an alternative to MRI?
If MRI contraindicated
Or stage 4 disease
What is the recommended management for FIGO 1B1 disease?
Radical surgery
What can be performed if a woman wants to preserve her fertility with cervical cancer?
Radial trachelectomy and pelvic lymph node dissection providing the tumour diameter is less than 2cm and no lymphatic vascular space invasion is present
Is chemo recommended in cervical cancer?
Any patient with cervical cancer who is suitable for radical radiotherapy should have concurrent platinum based chemo
Who should be considered for radiotherapy with cervical cancer?
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
What is brachytherapy?
Short wave radiotherapy delivered by insertion of applicators into the uterus via vagina
What is recommended for women who have lost ovarian function as a result of treatment for cervical cancer?
HRT to reduce post menopausal symptoms
What are the common symptoms of ovarian cancer?
Persistent abdominal distention Early satiety Loss of appetite Pelvic or abdo pain Increased urinary urgency +/- frequency
What test should be performed in women with symptoms that suggest ovarian cancer?
Ca-125
What is the next step if serum Ca-125 is greater than 35 IU/ ml?
USS of abdo and pelvis
Who should be urgently referred to gynae in terms of ovarian cancer?
Serum Ca125 over 35 IU/ ml with a USS suggestive of ovarian cancer
Physical exam identified ascites and/or pelvic mass
On top of Ca-125 what blood test should be performed on women who are under 40 that present with symptoms of ovarian cancer?
AFP
b-HCG
Rule out epithelial ovarian cancer
What score is calculated in secondary care to quantify risk of ovarian cancer?
RMI 1 (risk of malignancy index) Includes; ultrasound scan, menopausal status and serum Ca-125 level
What needs to performed first if offering cytotoxic chemo to women with suspected ovarian cancer?
Confirmed tissue diagnosis by histology
How can a tissue diagnosis be obtained in suspected ovarian cancer?
Percutaneous image guided biopsy
Laparoscopic biopsy
How is early (stage 1) ovarian cancer managed?
Performed retroperitoneal lymph node assessment as part of optimal surgical staging
If high risk stage 1 disease; sex cycles of carboplatin
How is advanced ovarian cancer managed?
Complete resection of all macroscopic disease
What is the most common type of cervical cancer?
Squamous cell
Adenocarcinoma makes up around 15-25%
Management of cervical cancer with a negative sentinel lymph node biopsy?
Radical hysterectomy or radical trachelectomy and lymphadenectomy
If low risk; no adjuvant post op treatment required
Management of cervical cancer with a positive sentinel lymph node biopsy?
Chemoradiotherapy
When do most cervical cancer recurrences happen?
Within 2 years
What is the follow up post treatment of cervical cancer?
Rectovaginal exam
Nodal assessment (esp supraclavicular)
Cervical smears
Every 3-4 months in first 3 years
What is the most common form of endometrial cancer?
Adenocarcinoma
How is endometrial cancer diagnosed?
Biopsy or D+C
Staging and histology confirmed at surgery
What is the most important prognostic information obtained for endometrial cancer?
Stage Histological subtype Tumour grade Patient age Presence of lymphovascular space invasion
For stage 1 and 2 endometrial cancer, what has been shown to reduce local failure rates and improve progression free survival?
Adjuvant vaginal brachytherapy or pelvic external beam radiotherapy
What is the definition of endometrial cancer?
Epithelial malignancy of uterine corpus mucosa
What genetic syndrome is linked with endometrial cancer?
Lynch syndrome
What are risk factors for the development of endometrial cancer?
Family history Lynch syndrome Ovarian cancer Obesity Age >50 Diabetes Nulliparity HRT Tamoxifen use Chronic anovulation PCOS Radiotherapy
What is the chief complaint in pre-menopausal women with endometrial cancer?
Abnormal menstruation or abnormal vaginal bleeding
What physical examination should be performed in women with suspected endometrial cancer?
Bi-manual exam; uterine size, uterine mass, fixed uterus, adnexal mass
Vulva, vagina and cervix should be inspected via speculum
How is suspected endometrial cancer investigated?
Endometrial biopsy or curettage for histological eval
Pelvic (transvaginal USS); if over 5mm BAD
How is endometrial cancer staged?
Surgically - hysteroscopy
Surgical histopathology for; extent of local and distant tumour spread, tumour grade
What are prognostic factors for endometrial cancer?
Depth of myometrial invasion
Lymphovascular invasion
Cervical involvement
What ancillary tests are performed in the work up for endometrial cancer?
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)
What is the key diagnostic factor for endometrial cancer?
Post menopausal bleeding; 5-10% of women with PVB have endometrial cancer
Aside from PMB what are other diagnostic factors for endometrial cancer?
Uterine mass, fixed mass or adnexal mass
Abnormal menstruation in premenopausal women
Pain and wt loss (rare)
Signs of mets (rare)
DDx of endometrial cancer?
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
What are the 2 important roles surgery plays in management of endometrial cancer?
Used to stage disease
Removes malignant disease
In what stages of endometrial cancer is chemo used?
Stages 3 and 4 as an adjuvant
Has a palliative role for metastatic or recurrent disease
What is the standard curative surgery for endometrial cancer?
Total hysterectomy
BSO
Node dissection
What chemotherapies are used for endometrial cancer?
Paclitaxel and carboplatin
What is the histology of the majority of ovarian cancers?
Epithelial; serous carcinoma
Rare; clear cell, endometrioid, mucinous
Non-epithelial; germ cell, stromal
What are type 1 ovarian cancers?
Slow growing, indolent
Clear cell, mucinous, endometrioid, low grade serous
What are type 2 ovarian cancers?
Fast growing, spread early
High grade serous
What risk factors are assoc with ovarian cancer?
Number or ovulatory cycles is proportional to risk; OCP and pregnancy are protective Nulliparity Hx of breast cancer HRT Post-menopausal
