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Gynaecology > Gynae cancer > Flashcards

Gynae cancer Flashcards

1
Q

What is the most common type of ovarian cancer?

A

epithelial

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2
Q

How does ovarian cancer present?

A

non-specific and normally late onset of IBS-like symptoms from mass eg abdo pain, change in bowel habit, increase urinary frequency, bowel obstruction

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3
Q

What may you find on examination of ovarian cancer?

A

fixed pelvic mass, omental mass, ascites

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4
Q

What are risk factors for ovarian cancer?

A

BRAC1 and 2 and HNPCC (lynch syndrome) genes, more exposure to oestrogen eg more ovulation

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5
Q

What are protective factors for ovarian cancer?

A

protective factors are parity, breast feeding and COCP as there is less ovulation

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6
Q

What investigations do you do for ovarian cancer?

A

CA125 and USS!!! malignancy risk score-If risk score high then do a CT
US - multifollicular css, solids cysts, ascites, mets, bilateral changes

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7
Q

What is a malignancy risk score?

A

for ovarian cancer: CA125 x USS x pre or post-menopausal scores

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8
Q

What is the staging for ovarian cancer?

A
  1. Just ovary
  2. Pelvis
  3. Abdomen
  4. Chest
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9
Q

What is the management for ovarian canver?

A

oophorectomy, chemo, normally palliative, remove as much as you think is helpful

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10
Q

What is the most common type of endometrial cancer?

A

adnenocarcinoma

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11
Q

What is strongly linked to endometrial cancer?

A

unopposed oestrogen

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12
Q

Why does a higher BMI put you at higher risk of endometrial cancer?

A

Fatty tissue converts androgens to oestrogen so higher BMI means a more increased risk of cancer

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13
Q

What are risk factors for endometrial cancer?

A

T2DM, htn, high BMI, nulliparity (more unopposed periods of oestrogen), HRT, late menopause, tamoxifen, PCOS, HNPCC

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14
Q

What are protective factors for endometrial cancer?

A

OCP (due to progestins) and those who smoke as more likely to have an earlier menopause

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15
Q

How does endometrial cancer present?

A

PMB!!, in the pre-menopause get heavy/irregular periods, may get PV discharge and pyometra

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16
Q

How do you investigate endometrial cancer?

A

transvaginal US to measure endometrial thickness and if more than 4mm do biopsy via hysteroscopy - can be with pipelle is gold standard, MRI for staging (MRI good in pelvis)

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17
Q

What is the staging for endometrial cancer?

A
  1. uterus only
  2. Cervix
  3. pelvis
  4. Mets beyond pelvis
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18
Q

What is the management for endomterial cancer?

A

hysterectomy +/- pelvic lymph nodes, radiotherapy and progesterone therapies

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19
Q

What is the most common type of cervical cancer?

A

Squamous cell carcinoma

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20
Q

What is the major risk factor for cervical cancer?

A

HPV

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21
Q

What are the risk factors for cervical cancer?

A

STI, missed vaccinations, early intercourse, OCP (raises STI risk), multiparity, smoking

22
Q

Where does CIN develop?

A

Cervical intraepithelial neoplasia develops in the transitional zone

23
Q

What is the transitional zone of the cervix?

A

There is a transformational zone in the cervix where columnar epithelium is converted to squamous epithelium through process of metaplasia (partially caused by the slight PH change in vagina)

24
Q

What happens during a cervical smear test?

A

Cellular abnormalities are called dyskaryosis which are graded from high to low. Dyskaryosis is a cytological diagnosis but the degree it is done via CIN on histology

25
Q

When does colposcopy take place and what happens?

A

If significant dyskaryosis on smear (cytology), then proceed to colposcopy. Colposcopy use acetic acid to stain the CIN white (as protein coagulates and CIN has high protein), may be mosaic pattern where white parts are separated by blood vessels. May also be an irregular surface
Burn if minor, LLETZ if more significant

26
Q

How does cervical cancer present?

A

PCB/ PMB
Vaginal discharge
Heavy PV bleed, obstruction, weight loss, vesicovaginal fistula, bowel disturbance –in late stages
Smear test

27
Q

What will you find O/E of cervical cancer?

A

Bimanual: cervix rough and hard

Speculum: irregular and bleeds on contact

28
Q

What investigations do you do for cervical cancer?

A

blds, punch biopsy, CT, MRI pelvis and colposcopy

29
Q

What is the management for cervical cancer?

A

hysterectomy if severe, LLETZ (large loop excision of the transitional zone- can take biopsy at same time to check all parameters of CIN ar gone ), laser or cold coagulation
radiotherapy

30
Q

What is the staging for cervical cancer?

A

Cervix
Top part of vagina
Rest of pelvis
mets

31
Q

What is vulval cancer associated with?

A

Associated with HPV and lichen sclerosis

32
Q

What is the most common type of vulval cancer?

A

Squamous cell carcinoma most common

33
Q

How does vulval cancer present?

A

vulval itching, bleed and soreness, persistent lump dysuria, PMH of lichen sclerosis or VIN

34
Q

What is GTD?

A

gestational trophoblastic disease of which a hydatiform mole is the most common type

35
Q

What is a complete molar pregnancy?

A

Complete molar pregnancy caused by sperm fertilising empty ovum resulting in two haploid sets of paternal DNA. Karyotype will be 46 XX which all genetics being from father.

36
Q

What is a partial molar pregnancy?

A

A partial molar pregnancy is where two separate sperm fertilise the ovum. This will have a karyotype of 69 XXY

37
Q

Why are there exaggerated symptoms of pregnancy in a molar pregnancy?

A

A molar pregnancy is where proliferating chorionic villi have swollen and degenerated —> lots of beta hCG as derived from the chorion —> exaggerated pregnancy symptoms

38
Q

When does the “bunch of grapes/ frogspawn” appearance of fetal material occur?

A

In a complete molar pregnancy there is no fetal material. There will be the bunch of grapes appearance due to hyperplasia of placenta and vesicular swelling of villi

39
Q

How may a molar pregnancy pesent?

A

failed miscarriage, “frogspawn” like bleeding, severe morning sickness, a uterus that is big for date, hyperthyroid like sx/ cysts (due to alpha hcg mimicking thyroid and LH/FSH)

40
Q

What may you see on a U/S of a molar pregnancy?

A

snowstorm effect

41
Q

What is the management of a molar pregnancy?

A

suction removal and send to histology to confirm.
Give anti-D injection if rhesus negative.
Avoid pregnancy for six months- as need to be able to tell if rise from hCG is cancer or baby.
Follow up in case of choriocarcinoma

42
Q

What is a Choriocarcinoma?

A

Choriocarcinoma= malignancy of placenta

43
Q

Most common gynae cancer in uk?

A

Endometrial

44
Q

What is lichen sclerosis?

A

autoimmune skin condition, itchy white patch on genitals or other parts of body. More common over 50
itchy, white, smooth/crinkled, easily damaged skin patch.
Most often around vulva and anus (or foreskin in men)
Tret w high dose steroids

45
Q

What is cervical ectropion?

A

cells from inside the cervical canal, ( softer glandular cells), are present on the outside surface of the cervix ( harder squamous epithelial) cells
area where the two cells meet = transformation zone.
Seen on smear as glandular cells are red

46
Q

What causes cervical ectropion?

A

It is related to oestrogen and is therefore more common in young women, pregnant women and those taking combined oral contraceptive pills

47
Q

How may cervical ectropion present?

A

as soft cells bleed more easily and can produce more mucus than hard cells, cervical ectropion may cause discharge, or PCB/ deep dysparaunia

48
Q

mx for cervical ectropion?

A

Cold coagulation which uses heat to cauterise/burn off the soft cells /
Silver nitrate to cauterise/burn off the soft cells

49
Q

What is Meig’s syndrome?

A

Meigs syndrome is defined as the triad of benign ovarian tumor with ascites and pleural effusion that resolves after resection of the tumor.

50
Q

What should be done if a smear test is HPV positive but cytology normal?

A

Cervical cancer screening: if sample is hrHPV +ve + cytologically normal → repeat smear at 12 months

Gynaecology (12 decks)

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