Gynae cancer

Question 1

Cervical cancer screening - how often, what is assessed

Answer 1

3 yearly 25-50 5 yearly 50-64 Swept over transformation zone - assessing dyskaryosis

Question 2

Assessment of dyskaryosis - what are the histological findings

Answer 2

Nuclear enlargement, variation in size + shape of nuclei, hyperchromasia, reduction in cytoplasm

CIN appears white when stained with 5% acetic acid

Question 3

CIN - causes

Answer 3

Cervical intraepithelial neoplasia Needs infection with HPV 16, 18, 31, 33

Question 4

RF for CIN

Answer 4

Persistent HPV infection Multiple partners Smoking Immunocompromise COCP

Question 5

S+S cervical cancer

Answer 5

PCB PMB Vaginal discharge Advanced: heavy bleeding, ureteric obstruction, weight loss, bowel disturbance, swollen legs, fistulas

Question 6

Cervical cancer investigations + management (stage 1a1, 1a2-1b1, 1b2 + >1b2)

Answer 6

Colposcopy, histology, MRI for staging

Stage 1a1: local excision (cone biopsy)

Stage 1a2 - 1b1: lymphadectomy + Wertheims hysterectomy

Stage 1b2: RT + lymphadectomy + Wertheims hysterectomy

>1B2: RT

Question 7

Endometrial cancer causes

Answer 7

Unopposed oestrogen leads to hyperplasia Oestrogen comes from: Peripheral conversion in adipose tissue Granulosa cell tumour PCOS Oestrogen only HRT Tamoxifen

Question 8

RF for endometrial cancer

Answer 8

Obesity Nulliparity PCOS Early menarche/ late menopause HNPCC Breast cancer - tamoxifen use

Question 9

S+S endometrial cancer

Answer 9

PMB Menstrual disturbance PV discharge

Question 10

Diagnosis of endometrial cancer

Answer 10

TVUSS (endometrial thickness) MRI pelvis CXR (for staging) Endometrial biopsy if >4mm

Question 11

Endometrial cancer staging

Answer 11

I = confined to uterus II = involving cervix III = spread outside the uterus IV = bowel, bladder or distant organ involvement

Question 12

Management of endometrial cancer

Answer 12

Total abdominal hysterectomy with bilateral salpingo-oophrectomy

Question 13

Types of ovarian tumours

Answer 13

Epithelial - from Mullerian epithelium Sex cord Germ cell

Question 14

Causes/RF of ovarian cancer

Answer 14

Irritation of ovarian epithelium, due to damage during ovulation RF: multiple ovulations Nulliparity, endometriosis, early menarche, late menopause, HRT BRCA 1 (39% chance of developing ovarian cancer) BRCA 2 (11%) HNPCC (12%)

Question 15

S+S ovarian cancer

Answer 15

Abdo distension, pain Pressure effects on bladder + rectum SOB, GI upset Abnormal vaginal bleeding Ascites Presents late

Question 16

Ovarian cancer investigations

Answer 16

CA125, Pelvic USS, CXR

Question 17

Ovarian cancer management

Answer 17

Laparotomy, hysterectomy, BSO Adjuvant chemo

Question 18

Vulval carcinoma

Answer 18

90% squamous cell Commonly arise on a background of lichen sclerosus or VIN VIN = associated with HPV (16) S+S: lump, pain, irritation, bleeding Surgery + groin lymphadenopathy

Ulcer with indurated base + everted margins

Question 19

Classification of CIN

Answer 19

lower 1/3 of epithelium, CIN 2 = lower 2/3 epithelium, CIN 3 – full thickness of endothelium

Question 20

management of CIN 2-3

Answer 20

treat with excision to depth of 8mm via LLETZ (large loop excision of transformation zone) – increases risk of preterm labour

Question 21

Follow up after CIN findings

Answer 21

Cytology at 6 months

Question 22

Staging of ovarian cancer

Answer 22

1 = limited to ovaries, 2 = pelvic implantation, 3 = peritoneal implants/ small bowel/ omentum 4 = distant mets