Gyn Onc Flashcards
DES exposure
CANCER
- vaginal clear cell adenocarcinoma (40x risk of unexposed)
- breast
- pancreatic
- cervical pre-cancers e.g. high grade
STRUCTURAL
- vaginal adenosis, cervical ectropion, cervical/vaginal ridges, hypoplastic uterus, t shaped uterus.
- Cocks comb cx
PREGNANCY
-infertility, ectopic, miscarriage, PET, PTB, stillbirth
Test relatives
Annual follow up pelvic, regular mammograms
Granddaughters - small studies only, likely to be fine
Paget’s Disease
Intraepithelial neoplasia
10% have invasive Paget’s disease
4-8% underlying adenocarcinoma
Intraepithelial adenocarcinoma, <1% of vuvlar malignancy
Pruritis, eczematoid skin, well demarcated lesions on a red background with small pale islands
Assoc with other cancers 20-30%: breast. rectum, bladder, urethra, cx, ovary.
Rx: WLE, underlying dermis, positive margins common - local recurrence common
WORKUP: smear, mammogram, colonoscopy, cystoscopy, AP (uss or CT)
Surgical - vulvectomy
Surgical management ovarian cancer
Midline laparotomy. peritoneal washings, total extra fascial abdo hyst + BSO, infracolic omentectomy with primary debulking of all surfaces aiming for cytoreduction and 0% residual disease
fertility sparing surgery may be considered in select cases
Borderline Followup
Consider referral to MFM
Can be serous or mucinous
Emphasis on preserving fertility in younger age groups
Cystectomy 10-30% recurrence that ovary
Oophrectomy 1% recurrence
Good prognosis long term
If older - TAH + BSO + omental biopsy
If young, surveillance, USO
FU with TV uss, consider CA 125 (not helpful if not up initially), oophrectomy
Management endometrial cancer
Bloods: FBC, UEC, blood glucose
Staging: pelvic MRI + CXR, or consider CT CAP
Surgery
TAH + BSO + intraoperative FROZEN section
Frozen section - tumour grade + invasion, if invasion, for pelvic ln lymphadonectomy
High stages = adjunctive radiation/chemo
Most recurrence = within 2-3 years, local i.e. vaginal
Washings not part of FIGO
Consider Lynch syndrome, treat underlying condition (obesity)
Follow up
Workup cervical cancer
FBC, UEC, LFTS
CT C/A, consider MRI pelvis
Staging - EUA, cystoscopy, sigmoidoscopy
Early stage = surgery
-Stage 1A = cone or simple hysy
Radical hyst +/- para-aortic LN
Can conserve ovaries <45yo
If larger and more likely to have recurrence, chemorad
Complications radiation
Uterus - increased risk leimyosarcoma
Ovarian - POF –> CVD, osteoporosis, depression
Vagina - stenosis, fistulae, dyspareunia, adhesions
Bladder - cystitis, recurrent UTI, fitusla
Bowel - proctitis, ileitis
Bone - osteonecrosis neck of femur
SKin thinning, telangectasia
Endometrial hyerplasia WITHOUT atypia
Increased gland to stromal ratio (assoc w granulosa cell tumours (estrogen secreting)
<5% progression to cancer over 20 years
Usually regress spontaneously during FU
MANAGE risk factors - obesity/HRT
Progestogen is 1st line, can use either but mirena btter
-higher disease regression, more favourable bleeding profile, fewer adverse events
NOT cyclical progesterone, continuous
Treat for 6/12 minimum
x2 negative biopsies 6/12 apart before DC
If high risk, annual biopsies
Surgery NOT first line, consider if progression, no regression, persistent symptoms, woman edclines surveillance/compliance
Atypical hyperplasia
High risk of progression to cancer, 30% in 20 years
Hyst + bilateral salpingectomy
Fertility sparing - mirena
Hyst once fertility no longer required
sample every 3/12
Lynch Syndrome
Mismatch repair gene abnormality
Lifetime risk 10-20% ovarian, up to 60% endometrial (baseline 3%)
Colon, stomach, endometrium, prostate, pancreas, gallbaldder
Difficult re screening, consider TVUSS/sampling from 35-40, but presents early and treatable therefore consider TLHBSO when family complete
Leiomyosarcoma
Important to rule out prior to UAE
-if postop diagnosis
CT CAP to assess for residual disease
Consider surgical exploration
Poor prognosis
