Gynae Cancer Flashcards
Endometrial carcinoma risk factors
Nulliparity
Early menarche + late menopause
Obesity
Presentation of ovarian cancer
Pelvic pain
Anorexia, nausea + vomiting, change in bowel habit, weightloss, abnormal PV bleed, urinary sx, malaise, DVT, virilisation, precocious puberty
Abdo/pelvic mass, ascites, pleural effusion, cervical lymphadenopathy, hepatomegaly
Types of epithelial ovarian cancer
Serous: 50% all ovarian Ca, fluid filled cysts, psamomma bodies Mucinous: Endometroid Clear cell Brenner/urothelial like
Serous ovarian cancer
Serous cystadenoma: benign
Unilocular straw coloured fluid filled cysts, 20% bilat
Serous cystadenocarcinoma:
Mixed solid areas + unilocular cysts, psammoma bodies (concentric, laminated, calcified, concretions), bilat in 30-50%
Sex cord/stromal ovarian tumours
Granulosa cell
Thecoma/fibroma
Sertoli/Leydig
Germ cell tumours
Dysgerminomas Endodermal sinus Yolk sac tumours Choriocarcinoma Teratoma (dermoidcyst)
Risk factors for endometrial cancer
Related to unopposed oestrogen exposure Incr age, obesity, PCOS, Nulliparity, early menarche, late menopause Oestrogen only HRT, tamoxifen, Oestrogen secreting tumour Hx: breast or colon Ca Fhx: breast, colon, ovarian Ca
Protective factors against endometrial cancer
COCP
progesterones
pregnancy
Presentation of endometrial cancer
Post menopausal bleeding : endometrial cancer until proven otherwise
Irreg/intermenstrual bleeding or menorrhagia in pre menopausal
Staging of endometrial tumours
1: confined to uterus
2: confined to uterus and cervix
3: invade through cervix/ uterus
4: bladder/ bowel involvement or distant mets
Side effects of radiotherapy
Acute: skin irradiation, dysuria, diarrhoea,
Chronic: urinary frequency, vaginal dryness, dyspareunia
Breast cancer in pregnancy
Tamoxifen: not safe in pregnancy or breastfeeding- teratogenic
Radiotherapy: contraindicated unless life saving
Chemo: ok 2nd and 3rd trimesters, birth 2-3 wks after last session
Bone scans / CT: insufficient benefit for radiation risk
RMI
Risk of malignancy index
CA125 x cyst characteristics on USS x menopausal status
259: 75% cancer
Conservative management of ovarian cyst
4 monthly USS
