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Reproduction > Formative Menti Cancer week > Flashcards

Formative Menti Cancer week Flashcards

1
Q

What are the two main types of Tx for Ovarian Cancer?

A

Surgery (salpingo-oophorectomy)
- Optimal Debulking.

or

Chemotherapy (Platinum therapy)

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2
Q

What are the main types of Tx for Uterine Cancers?

A

Surgical (Histerectomy, BSO, PLND)

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3
Q

What are the main types of treatment for cervical Cancers?

A

Surgical:
- Large Loop Excision of the Transformational Zone (LLETZ), Simple or Radical Hysterectomy, Trachelectomy (removal of cervix)
or
Radiotherapy (Radical or Adjuvant)
or
Chemotherapy

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4
Q

When would you give radical and when Adjuvant Radiotherapy in cervical cancer?

A

Radical As curative in Stage 2,3 and 4 cervical cancers. - Stage 1 if unfit for surgery.

Adjuvant if there is a large tumour diameter, positive margins on resection or +ve Lymphnodes.

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5
Q

What types of Tx are used in Endometrial cancer?

A

Surgery first line (Hysterectomy with BSO)

Progestrogens (oral progesterone as the cancers are usually Oestrogen dependant) - For older ladies not undergoing Sx

Rarely Radical Radiotherapy.

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6
Q

What type of drugs are given in Cervical cancer Chemotherapy?

A

Cisplatin,
Carboplatin,
Paclitaxel

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7
Q

What treatment is used in Tx of Vulval cancers?

A

Wide Local Excision to remove the cancer.

Sentinel Node Biopsy to check for Lymph node spread.
If Pos - Pelvic Lymph node dissection.

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8
Q

What is required for Chemotherapy to be effective.

A

High cell replication / Turnover.

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9
Q

Which cancers will chemo not work so well in?

A

Low grade serous tumours and Borderline Ovarian tumours as they are slow growing (low cell Replication)

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10
Q

What Tumour Markers are requested in a young patient with a complex ovarian mass?

A

LDH, AFP, CA125, HCG

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11
Q

What are some non-cancerous reasons for a raised CA125?

A
  • Endometriosis,
  • Fibroids,
  • Adenomyosis,
  • Pelvic infection,
  • Liver disease,
  • Pregnancy.
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12
Q

When is p53 checked in gynae cancers.

A

Checked in the tissue sample rather than as Tumour Marker.
p53 mutations are indicative of a more aggressive tumour (usually)

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13
Q

What is the first step in management of a 75-yr old women is Post-menopausal bleeding?

A

Transvaginal Ultrasound (checking thickness of endometrium)

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14
Q

What is the cut off for biopsy of endometrium on TVUS?

A

If >4mm take a biopsy for this patient. (normal <4mm in post menopausal patients)

Endometrium is thickest at ovulation and can be at 16mm.

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15
Q

What are the differentials for Post menopausal bleeding?

A

Endometrial cancer (10%).
Endometrial Hyperplasia.
Sporadic Ovulation (most common cause).
Atrophic Vaginosis.

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16
Q

A 28-yr old patient has abdominal discomfort. USS shows ovarian mass with fat content and calcification within the cyst. What is the likely diagnosis?

A

Dermoid cyst (mature benign teratoma)
- Most common ovarian germ cell tumour.

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17
Q

A 39-yr old women has heavy menstrual bleeding and a 14 week sized pelvic mass (aka. 14 cm sized). What is the most appropriate investigation for her?

A

TVUS first-line and then MRI if more info is needed.
Most likely to be a Fibroid (Intramural)

18
Q

What are the different types of Fibroids? (leiomyomas)

A

Subserosal.
Submucosal.
Intramural.

19
Q

What are typical clinical signs of each fibroid type?

A

Submucosal fibroids - Present with Intermenstrual bleeding.

Subserosal fibroids - tend to cause pressure relate symptoms.

Intramural Fibroids - Heavy menstrual bleeding.

20
Q

A 65-yr old women has ascitis and CA125 of 40. USS shows bilateral Ovarian Masses with free fluid. What is her RMI?

A

360

21
Q

How is Relative Malignancy Index (RMI) calculated?

A

Combination of Serum CA125 (CA125), Menopausal status (M) and Ultrasound score (U):

RMI = M x U x CA125

22
Q

What determines ultrasound score in RMI?

A

Ultrasound result is scored 1 point for characteristics: “BAMMS”
- Bilateral lesions
- Ascites
- Multiocular cysts
- Metastases
- Solid areas

U = 0 (none are present)
U = 1 (For ultrasound score of 1)
U = 3 (For Ultrasound score 2 to 5)

23
Q

How is Menopausal Status scored in RMI?

A

Pre-menopausal = Menopausal status of 1

Post-menopausal = status of 3

Post-menopausal is defined as a women who has had no period for > 1 yr.

24
Q

What RMI score Constitutes as Low, Intermediate or High?

A

< 30 is Low (3% risk of Ovarian Cancer)

30 - 200 is Intermediate. (20% risk of Ovarian Cancer)

> 200 is high. (75% risk of Ovarian cancer)

25
Q

16-yr old girl has a 20cm large complex ovarian mass with no other disease seen on CT. What is the most likely diagnosis?

A

Malignant Ovarian Mass.

(in a young patient you could think of a benign ovarian cyst. But in a patient so young, who’ll likely only just have started ovulating. A mass thats managed to get this big would likely indicated malignancy).

26
Q

62-yr old women with 16cm complex right ovarian mass has pleural effusion and ascites seen on CT scan, what is the most likely pathology?

A

Malignant ovarian mass.

27
Q

What is Meig’s syndrome?

A

Meig’s syndrome is an uncommon presentation where a benign ovarian tumour presents alongside ascites and pleural effusion.

Triad:
- Benign ovarian tumour.
- Ascites
- Pleural effusion
typically in older patients.

28
Q

23-yr old with severe right sided abdominal pain which settles on analgesics has a 4cm right ovarian cyst on scan. What is the likely diagnosis?

A

Haemorrhagic ovarian Cyst.

Haemorrhage will (unlike Torsion of the ovary) Settle with analgesics.

29
Q

When does torsion of the Ovary occur?

A

Usually due to an ovarian mass >5cm. Such as a Cyst or Tumour, it is more likely to occur with benign tumours.
Also more likely to occur during pregnancy.

30
Q

How does an Ovarian torsion present?

A

Sudden onsent severe unilateral pelvic pain. Pain gets worse over time.

Nausea and Vomiting.
Pain doesn’t settle with analgesics.

O/E - Localised Tenderness and Palpable mass.

31
Q

What is the Ix and Tx of Ovarian Torsion?

A

Ix:
- Pelvic Ultrasound is initial Investigation of choice. TVUS slightly better than Trans Abdominal.
“whirlpool sign” and “Free Fluid in pelvis”.
Oedema of Ovary.

Tx:
- Laparoscopic surgery. Either un-twist or Removal of effected ovary.

Complications:
- necrosis > infection > Abscess > Sepsis.
or
- Rupture > Peritonitis and Adhesions.

32
Q

23-yr old with severe abdominal pain and 6 cm ovarian cyst on scan. Pain not settling with analgesics. How would you manage?

A

laparoscopy

33
Q

A 72-yr old women has new onset bloating and early satiety. What investigation would you organise for her?

A

CA125 and Ultrasound.

Nice guidelines suggest doing CA125 and TVUS for any new onset bloating/ abdominal distension especially women > 50 yrs.

Worried about Ovarian Cancer

34
Q

When are patients invited for there first cervical smear?

A

25 years old (until they hit 65 years)

35
Q

If an individual has a negative hr HPV (high-risk) on routine screening, when is there next smear test due?

A

5 years.

36
Q

If an individual has a positve HPV test on routine screening but is their cells look normal on cytology, when is there next smear test due?

A

1 year - Most individuals will be negative at this point . (back to 5 yearly screening)

If pos again - 1 more year and re-test.

If positive for 3rd time in 2 years - refer to Colposcopy.

37
Q

Following the treatment of high grade Cervical Intraepithelial Neoplasia, when is the test for cure done?

A

6 months with one smear.
If negative then there is no need for further follow-up.
Back to 5 yearly review.

38
Q

What interventions can effectively reduce the chance of cervical cancer?

A

Cervical Screening.
HPV vaccination.
Smoking cessation.

39
Q

Gardasil 9 vaccine offers protection from what Lr and Hr HPVs?

A

Low-risk: 6 and 11

High risk: 16, 18, 31, 33 and 3 others.

40
Q

What is the most effective treatment in Endometrial cancer?

A

Hysterectomy

41
Q

What is PID?

A

An ascending infection of the pelvis.
Complication of STIs e.g. Gonorrhoea or Chlamydia.

42
Q

How is PID treated?

A

Treatment is typically with Abx depending on the causative organism.
Individual can be treated as out-patient as long as temp <38.
>38 may require laparoscopic drainage of pus to make Abx more effective.

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