Gynae Cancer Flashcards
CERVICAL CANCER
i) what histol subtype are 80%? which years does it peak in?
ii) name four cancer HPV is associated with? what are the two high risk strains? how does HPV promote cancer growth?
iii) name three RFs for CC?
iv) name four presenting symptoms? name three appearances of the cervix that may suggest CC
i) 80% are SCC - peaks in reproductive years
ii) assoc with anal, vulval, penis, mouth, throat cancer
type 16 and 18 are high risk
HPV prduces E6 and E7 proteins that inhibit tumour suppressor genes (p53 and pRB)
iii) RF - early/increased sexual activity, smoking HIV, COCP >5yrs, increase pregnancies, FH
iv) px with abnormal vaginal bleeding (intermen, post coital, post meno) vaginal dc, pelvic pain, dysparunia
apperance - ulceration, inflamm, bleeding, visible tumour
CIN AND CERVICAL SCREENING
i) how is it dx? what is CIN 1? does it need tx
ii) what is CIN II? what is CIN III?
iii) what tests looks for dyskaryosis?
iv) what does colposcopy allow for? what stain is used? how to abnormal cells appear in each?
i) CIN dx at colposcopy
CIN 1 - affects 1/3 thickness of ep layer and likely to return to normal without tx
ii) CIN II aff 2/3 thickness, may progress if not tx
CIN III severe - very likely to prgoress to cancer if not tx
iii) smear looks for dyskaryosis
iv) colopscopy allows visualisation and examination of ep lining of cervix
add acetic acid and iodine solution
acetic acid - abnormal cells appear white due to inc nuc to cytoplasmic ratio
iodine - stains healthy cells brown and abnormal areas will not stain
CERVICAL CANCER TX
i) which staging system is used?
ii) what is done for CIN and early stage 1A? what is done for stage 1B-2A?
iii) what is done for stage 2B - 4A? what is done for 4B?
iv) which MAB can be used?
i) FIGO staging
ii) LLETZ or cone biopsy
stage 1b-2a - radical hysterctomy and removeal of local LN with chemo and RT
iii) 2b-4a - chemo and RT
4B - may need palliation
iv) bevacizumab
ENDOMETRIAL CANCER
i) what histol are 80%? what hormone does it depend on?
ii) what is endometrial hyperplasia? how can it be treated? (2)
iii) exposure to what increases risk? name five RF? why is PCOS a RF? what should therefore be given to people with PCOS?
iv) why is obesity a crucial RF?
v) name three protective factors?
i) 80% are adenocarcinoma
depends on oestrogen
ii) hyperplas - precancerous thickening of endometrium - may be atypical or typical
tx with progesterone eg mirena coil or continous oral proges eg levorgestrel
iii) exposure to unapposed oes increases risk
increased age, early menstruation, late meno, oes only HRT, no/few pregs, obesity, PCOS, tamoxifen, T2DM
PCOS due to uppossed oes due to anovulation
give women with PCOS the COCP, mirena or cyclical proges to induce a withdrawal bleed
iv) obesity is RF due to adipose tissue being a source of oestrogen - extra oes
v) protective - COCP, mirena, inc pregnancies, smoking
ENDOMETRIAL CANCER PX AND MX
i) what is the number 1 px symptom? name five ohters?
ii) when should 2ww refer be made? when should a TV US be done for women over 55? (2)
iii) what is normal endometrial thickeness? what can be used to assess? what type of biopsy is done?
iv) what staging is used? what is usual tx for stage 1-2
v) which hormonal tx can be used to slow progression?
i) post meno bleeding
post coital bleeding, intermens bleeding, heavy bleeding, abnormal dischaege, haematuria, anaemia, raised plats
ii) 2ww if post meno bleed
TV US if >55yrs with unexplained discharge or visible haematuria _ raised plats, anaemia or raised glucose
iii) normal thcikness is 4mm post meno - do TV US
pipelle biopsy sensitive for endo cancer can be done in outpatients
iv) FIGO staging
1-2 = TAH and BSO - total abdo hysterc with bilat salphino oopherectomy
v) can use progesterone to slow progress
OVARIAN CANCER
i) what is the most common subtype? which type are benign? what complication are benign tumours associated with?
ii) name five RF? how does number of ovulations correlate to risk? name three protective factors
iii) name five px features? which nerve may be impacted leading to hip/groin pain?
iv) which three things found on exam should prompt 2ww referral? which blood biomarker can be tested?
v) name five symptoms that should be investigated for in women over 50?
i) epithelial subtype
germ cell and dermoid cysts are benign > assoc with ovarian torsion
ii) RF - age (peaks at 60), BRCA1+2, obesity, smoking, recurrent clomifene use
increased number of ovulations inc risk therefore early onset periods, late meno and no pregnancies inc risk
protective - COCP, breastfeeding, pregnancy
iii) abdo bloating, early satiety, loss appetite, pelvic pain, urinary symptoms, weight loss, pelvic mass, ascites
can press on obturator nerve > referred hip or groin pain
iv) OE - ascites, pelvic mass, abdo mass > 2ww
v) women over 50 px with new IBS, change in bowel habit, abdo bloat, early satiety, pelvic pain, urine frequency, weight loss
OVARIAN CANCER IX AND MX
i) which two initial investigations are done in primary/secondary care?
ii) which three things does the risk of malignancy index take into account? name three other ix that may be done
iii) what may a complex ovarian mass in women under 40 be? which two blood markers should be done to test for this?
iv) name three things that can cause raised ca125 that arent related to malig?
v) what staging system is used? how is it broadly mx?
i) ca125 (>35) and pelvic US
ii) RMI - menopausal status, US findings, CA125 level
CT scan, histology and paracentesis (ascitic tap)
iii) complex mass > germ cell tumour > do AFP and beta HCG
iv) raised ca125 - fibroids, endometriosis, adenomyosis, pelvic infec, liver dsease, pregnancy
v) FIGO staging
mx with gynae MDT, surgery and chemo
VULVAL CANCER
i) what histol subtype are 90%? what other type may they be more rarely
ii) name five RF? what is a derm assoc RF?
iii) what is vulval intraep neoplasia? what infection can it be assoc with? name three tx that may be given
iv) name four symptoms? what area do vulval cancer most commonly affect?
v) what three things should be done to investigate? what staging is used? name three possible tx
i) 90% are SCC, rare can be melanoma
ii) RF - adv age >75yrs, immunosupp, HPV infec, lichen sclerosis
5% LS > vulval cancer
ii) VIN pre malignant condition aff sq ep - can be assoc with HPV
may watch and wait, wide local excise, imiquimod cream or laser ablate
iv) vulval lump, ulceration, bleeding, pain, itch, lymphado in groin
mostly aff labia majora
v) biopsy lesion, sentinel node biopsy and imaging
FIGO staging
mx dep on stage - WLE, groin LN dissec, chemo, RT
