Gastrinourinary Flashcards
What is cervical ca?
- Cervical cancer is a malignant mass which originates within the cervix.
The cervix isthe organ that connects and acts as a gateway between the vagina and the uterus.
Who is most likely to get cervical Ca?
- Anyone with a uterus.
- Under the age of 45.
- A weakened immune system.
- People who have given birth to multiple children.
- Given birth under the age of 17.
- A history of cancer (6)
What screening is done for cervical carcinoma?
Where would it be done?
Screening programme for individuals that have a cervix from age 25 – 64
carried out every 5 years regardless of age bracket.
HPVtesting - looking for high-risk type that would cause cervical Ca
sample is taken and is tested in the lab
IF HPV is found then…
cytology test - (used as triage looking for abnormal cells)
primary care or sexual health clinic setting
initial pathway and referral for cervical carcinoma?
A GP may refer the patients to a specialist at the hospital.
usually agynecologist:
more tests, such as:
- colposcopy:
(look at the cervix in detail looking at the skin using a magnifying glass/coloscope)
referred when HPVinfection persists after 24 months, even if cytology is negative
- biopsy - sample of cells can be taken during colposcopy
- histopathology - process of reporting of biopsies
What imaging modalities are used in imaging cervical carcinoma?
what are the + and - of each in regard to cervical carcinoma specifically?
Ultrasound:
- First line imaging
Transabdominal or Transvaginal
Size of tumours
Doppler can beused, as tumours will demonstrate vascularity.(32,33)
MRI:
- modality of choice
- 90-100% accuracy
- infiltration and small lesions
- not used for the detection of lymph node mets
Evaluates the extent of thedisease
Allows for the development of optimised andpersonalised treatment
PET:
- most sensitive in detecting lymph node mets
- Effective for staging and looking at local extent
- cannot measure accurately/ cannot distinguish between benign and malignant
With MRI for staging andtreatment planning
Evaluating response to therapy.
CT
- useful to determine treatment and prognosis
-cannot determine local extent
Can be used to diagnose hydronephrosisand metastatic spread
Inferior modality compared to MRI, however still useful
Treatment for cervical carcinoma?
Radiotherapy:
- Use of radiation to kill Ca cells
- It can be internal (radiation placed within using a needle or catheter) or external (radiation applied to the area/prevent unnecessary exposure to other tissues).
- Killscancer cells,or used as a palliative treatment forpatients with advanced cervical cancer
Chemotherapy with Immunotherapy:
- Drugs used tostop the growth of cancer cells
- combined with a drugthat helps immune system fight cancer
Targeted Therapy:
- Drugsthat block the action ofspecific enzymes, proteins, other molecules involved ingrowth andspread of cells
Sentinel Lymph Node Biopsy:
- removes node wherespread will occur from the primary tumour
- in this case the sentinel
Total Hysterectomy:
- Uterus and cervix arecompletelyremoved
Future trends in the imaging and treatment of cervical carcinoma?
What are uterine fibroids?
- Benign growths that can grow in the uterus.
- Patients may havemore thanone and may vary in size.
Commonlyaffect 8/10 - Three types of fibroids
What are the three different types of uterine fibroids?
Submucosal
Intramural
pedunculated
What is the initial and referring pathwayfor a uterine fibroid?
Asymptomatic – incidental finding
Symptomatic:
Gp
Gynaecologist
Imaging:
us - transabdominal and transvaginal - Doppler
MRI - pelvis
Hysteroscopy - A procedure performed to look inside the uterus using a thin lighted tube.
What is the treatment of uterine fibroid?
Medicine
Reduce symptoms
Shrink fibroids
Non-surgical Procedures - non surgical/non invasive
Uterine ArteryEmbolisation (UAE) - done under interventional radiography
catheter embolic particles are delivered to the artery that supplies blood to the fibroid, this is blocked off which then shrinks the fibroid
LA is used
Surgical Procedures
Myomectomy - the surgical procedure that removes the fibroid surgically but preserves the uterus
Laparoscopic- keyhole
Laparotomy - open
Hysterectomy
Future trends in the treatment and imaging of uterine fibroids?
Ultrasound-guided high-intensity focused ablation (HIFU) for treatment of uterine fibroids
Image-guided treatment with no wound/surgical incision
Involving thermal ablation
Uses thermal heat – up to 85°C or -20°C
MRI-guided focused ultrasound ablation treatment
MRI images of the uterus and abdomen used to measure the size and shape of fibroidsin conjunction with thermal treatment
Transcervical or transvaginal (most common)
MRI-guided laser ablation (fibroids)
Magnetic resonance imaging produces
images of the woman’s uterus.
Using these images, fine needles are inserted through the skin under local anaesthetic and guided into the
fibroid to be removed.
Laser fibres are inserted down the centre of each of the needles into the
fibroid and the laser’s heat is used to destroy it
What is Ovarian carcinoma?
Formation and uncontrollable growth of abnormal cells in the ovary
Aggressive
Initial and referring pathway for ovarian carcinoma?
GP
Pelvic exam:
Ascites (collections of fluid)
Abdominal mass
Blood test:
CA125 > 35
can indicate neoplastic transformation of the ovaries
What is the imaging pathway for ovarian carcinoma?
Ultrasound - transvaginal
MRI is then used if us is inconclusive
CT - CAP
PET-CT
What is the management/treatment of ovarian carcinoma?
Early
Cytoreduction
Chemotherapy
Advanced
Chemo
debulking surgery
Surgery - hysterectomy
Staging laparotomy
Removal of tumours
Removal of affected anatomy, for example
- Bilateral salpingo-oophorectomy removal of both ovaries/fallopian tubes)
Or fertility sparing surgery. - Abdominal hysterectomy (removal of cervix/uterus)
- Removal of spread to other areas in the pelvic cavity (e.g. removing parts of the bowel).
Chemo:
before surgery - shrink tumour
After surgery to kill any remaining cancerous cells
Radiotherapy - use of high energy radiation targeted to kill cells
Utilised postoperatively to destroy remaining cancer cells and reduce the chance of recurrence (35,40)
Targeted Therapy
Used if ovarian cancer keeps recurring.
Medicine targets the mechanisms cancer uses to grow to prevent or delay future tumours
surveillance with blood tests and PET/CT
how is Ultrasound used for in imaging ovarian carcinoma?
First line imaging
Abdominal Ultrasound
Pelvic/transvaginal ultrasound
Transvaginal colour doppler
how is CT used in imaging ovarian carcinoma?
Staging
Selecting treatment options
Surgical planning
how is PET/CT used in imaging ovarian carcinoma?
Detects malignant lymph nodes
Detects metastases
Detects recurrent disease (Monitoring)
how is MRI used in imaging ovarian carcinoma?
Excellent staging capabilities
Accurate tumor characterization
Can see full extent of infiltration in soft tissue
Modality of choice in pregnant women
What is prostate carcinoma?
Cancer of the Prostate – localised, locally advanced and metastatic
What is the initial & referring pathway for prostate carcinoma?
GP
- blood test
- urinary tests
- family history
- discussion of symptoms
- physical examination
Raised PSA level,
abnormal urine sample
or lumpy prostate requires a referral
Referred to a urologist
referred to imaging
All patients should be told within 28 days, a positive or negative result for prostate carcinoma (10).
What is the imaging pathway for prostate carcinoma?
Ultrasound is initial:
Transrectal Ultrasound Scan (TRUS)
MRI
The MRI scan can indicate the area of suspicion
Multi-parametric MRI provides more detail of the prostate gland
A T1/T2 weighted sequences with contrast enhancement and DWI sequence is used
Biopsy:
Ultrasound-guided biopsies can be used to diagnose prostate cancer
A needle is used to take biopsies to gain samples of the tissue
Nuclear Medicine:
bone scans are used to detect and track any spread of cancer to the bones
A radioactive tracer is administered to patients which is used to show areas of uptake which appear darker
Whole body scans including anterior and posterior images using a gamma camera
Can be used after prostate cancer diagnosis to identify any spread of cancer to other parts of the body
PSMA PETCT:
- used for staging, the detection of a reoccurrence and detection of metastatic change
- A PSMA radiotracer is used to as it is upregulated in the presence of prostate cancer and other malignancies
- Provides a clear views of the lymph nodes and microscopic differentiation in soft tissue and bones
Can be used as an alternate to MRI or together to further improve the localisation of the lesion
What is the treatment for prostate carcinoma?
Localised:
Surgery - radical prostatectomy
External radiotherapy
Internal radiotherapy
Locally advanced prostate cancer:
Radiotherapy with hormone therapy
Hormone therapy
Surgery - followed by hormone therapy and radiotherapy
watchful waiting
Advanced prostate cancer:
Hormone therapy
clinical trials
Future trends of the imaging and management of prostate carcinoma?
New imaging techniques to improve diagnosis of recurrent prostate cancer – using PSMA and PET scanning(46).
Enhance the use of biopsies for prostate cancer
Using MRI and ultrasound
Testing the use of artificial intelligence (AI)
What is renal carcinoma?
Renal carcinoma is also known as kidney cancer.
It is a disease in which malignant cells are found in the lining of the tubules in the kidneys.
What is the initial/referring pathway for renal carcinoma?
GP:
Tests and initial consultation
Symptomatic Patients include:
flank mass,
flank pain,
haematuria
systemic symptoms suggestive of advanced disease, such as weight loss or fever
Non-symptomatic – incidental findings
A/E:
Pathological fracture from mets
Referred to ?? specialist
What is the imaging pathway for renal carcinoma?
Ultrasound:
Abdominal
CT:
Gold standard imaging technique
provideprecise informationabout the size, shapeand location of thetumour.
It can check has the cancer spread to surrounding tissues/lymph nodes or organs of the kidneys
Ultrasound
young patients no radiation
cost-effective non-ionising technique for assessing the kidneys and bladder
Ultrasound helps to tell if a structure is soft tissue or fluid filled.
Patterns on ultrasound can also help tell the difference if they are benign or malignant tumours although further imaging would be required
MRI
- higher soft tissue contrast than CT and no radiation burden
- prone to motion artefacts (long scan time)
- limited by MR contraindications and scanner availability
- Itwill be usedin the case ofpregnancy or when patients have an iodinated contrast allergy or renal failure
- MRI scans are typically used to visualise venous involvement with the tumour and extent of infiltration
- MRI is also used when the patient has an allergy to contrast die as different weighted techniques help visualise the mass .
Metastases
If the primary tumour is large or locally aggressive
chest CT should be performed in the instance of mets
Chest x-rayshould be reserved for patients at low risk of metastatic disease or those under long-term surveillance
Brain MRI and nuclear medicine bone scanning:
- generally justified only if there are symptoms and signs to suggest disease at these sites
- or if the tumour is large and locally aggressive
