Endometrial, Cervical, Vulval and Ovarian Cancer Flashcards
why is the prognosis of ovarian cancer often poor?
because it has vague symptoms so often presents late
what investigations are carried out to diagnose ovarian cancer?
- abdo/pelvic ultrasound
- abdo/chest/pelvic CT
- marker: CA 125
- laparotomy
what marker can be raised in ovarian cancer that can also be found in other cancer and benign conditions?
CA 125
what are the stages of ovarian cancer?
1 - ovaries only
2 - pelvic involvement
3 - peritoneal/nodal involvement
3 - distant metastases
how is ovarian cancer managed?
- surgery (biopsy/staging/resection/debulking)
- chemotherapy
which genetic condition can cause higher risk of developing ovarian cancer?
- HNPCC/Lynch syndrome
- BRCA gene mutation
what is BRCA gene?
a tumor suppressor gene
name a few symptoms that women with ovarian cancer may present with
- abdominal discomfort
- indigestion/early satiety
- constipation
- bloating/weight gain
- ascites
- pelvic mass
which type of contraception provides some protection against ovarian cancer?
oral combined pill
what type of surgery is carried out for ovarian cancer?
laparotomy
how is the risk of malignancy (RMI) identified for ovarian cancer?
- Ultrasound
- Menopausal status
- CA 125
what is the average age for ovarian cancer to develop?
50-60
what are the risk factors for developing vulval cancer?
- lichen sclerosus
- vulval intraepithelial neoplasia (VIN)
- smoking
- immunosuppression
name a few symptoms of VIN/vulval cancer
- itch
- pain
- burning
- bleeding from site
- lump/ulcer
how is vulval cancer diagnosed?
punch biopsy or excision biopsy
how is vulval cancer treated?
- excision of lesion
- excision of lymph nodes
- chemotherapy/radiotherapy
how is vulval cancer staged?
- <2cm in size
- > 2cm in size
- inguinal/femoral lymph node involvement
- pelvic lymph node involvement
what type of cancer is vulval cancer?
squamous cell carcinoma
what are the subtypes of vulval intraepithelial neoplasia (VIN), and what is the usual population presenting with each?
- usual type VIN: HPV infection related, commonly younger women
- differentiated VIN: not HPV related, common in older women
what red flag symptom indicates potential cervical cancer?
post-coital bleeding
name a few symptoms of cervical cancer
abnormal bleeding: - post-coital bleeding - heavy menstrual bleeding - intermenstrual bleeding discharge pain
what is the cause of cervical cancer?
HPV infection
what are the two strains of HPV that cause cervical cancer?
HPV 16 and HPV 18
what type of cancer is the majority of cervical cancers?
squamous cell carcinoma
what staging is used for cancers of the female reproductive tract?
FIGO staging
what are the FIGO stages?
0 - carcinoma in situ 1 - larger area of same tissue 2 - spread to adjacent organs 3 - spread to pelvic organs 4 - distant metastases
how is cervical cancer staged?
biopsy
PET-CT scan
MRI scan
which area of the cervix is most likely to develop cancer?
transformation zone
what are the management options for cervical treatment?
- excision of transformation zone
- radical hysterectomy + chemo/radiotherapy
- chemo/radiotherapy
- brachytherapy
what is the most effective way to prevent cervical cancer?
cervical cancer screening program - smear test
what are the subsets of Stage 1 cervical cancer?
Stage 1A - cancer only visible microscopically
Stage 1B - cancer visible on examination of cervix
what chemotherapy treatment is used for cervical cancer among others?
cisplatin
what are the main symptoms of endometrial cancer?
abnormal vaginal bleeding
post-menopausal bleeding
what are the risk factors for endometrial cancer?
- post-menopause
- increase/unopposed levels of oestrogen (early menarche, late menopause, low parity, OCP, PCOS)
- obesity
- smoking
- atypical endometrial hyperplasia
- Lynch syndrome
what are the main investigations carried out to diagnose endometrial cancer?
- transvaginal ultrasound
- endometrial biopsy
- hysteroscopy
- MRI for staging
what is the cut off for normal endometrial thickness in post-menopausal women?
4mm`
why is measuring endometrial thickness not a reliable diagnostic tool for endometrial cancer in pre-menopausal women?
because during normal cycle endometrium thickness varies a lot
histologically, what are the two types of endometrial carcinoma?
- endometrioid adenocarcinoma: commonest type, younger women, fairly good prognosis if caught early
- uterine serous/clear cell carcinoma: older women, rapidly aggressive, can be fatal
what is the management of endometrial cancer?
- total hysterectomy + bilateral salpingo-oophorectomy
- chemotherapy
- radiotherapy
- progesterone (palliative)
what staging method is used for endometrial cancer?
FIGO staging
