Gynae Cancer Flashcards
What is endometrial cancer?
The majority are adenocarcinomas and are related to excessive exposure to unopposed oestrogen.
What age group does endometrial cancer effect?
Postmenopausal women
Investigate all postmenopausal bleeding to rule out endometrial cancer
What are the risk factors of endometrial cancer?
Obesity, T2DM, hypertension (peripheral oestrogen)
Nulliparity (pregnancy associated with high progesterone)
Early menarche and late menopause
Anovulatory cycles e.g. PCOS (no corpus luteum)
Oestrogen-only HRT
Breast cancer (similar lifestyle factors + tamoxifen use)
Genetic predisposition - HNPCC (Lynch II syndrome) increases chance of ovarian, endometrial and colorectal cancer
What are the protective factors for endometrial cancer?
COCP use
Parity
What is the presentation of endometrial cancer?
PMB
Heavy/irregular uterine bleeding or abnormal smear or discharge and pyometra in pre-menopausal women
How is endometrial cancer diagnosed?
TVS - endometrial thickness >4mm (if under no need for further tests)
Then hysteroscopy and biopsy
CT/MRI to stage pre-operatively
Describe the staging of endometrial cancer.
I - in the body of the uterus
II - in the body and cervix
III - beyond the uterus, but remaining in the pelvis e.g. vagina, ovary, pelvic lymph nodes
IV - beyond the pelvis e.g. bowel and bladder
What is the treatment for endometrial cancer?
Total hysterectomy with bilateral salpingo-oophorectomy and peritoneal washings
Advanced disease - high dose progesterone and external beam radiotherapy
What are group does cervical cancer affect?
30-39 and over 70
What are the risk factors for cervical cancer?
Persistent high-risk HPV infection
Smoking
Multiple partners
Oral contraceptive (due to decrease in barrier contraceptive use)
Immunocompromised (HIV, immunosuppressants, organ transplantation)
What are the signs and symptoms of cervical cancer?
Abnormal cervical smear Post-coital/post-menopausal bleeding Watery vaginal discharge Incidental finding on treatment of CIN Features of advanced disease: heavy vaginal bleeding, weight loss, vesicovaginal fistula, bowel disturbance, ureteric obstruction, pain
What are the investigations for cervical cancer?
FBC, U&Es, LFTs
Colposcopy and punch biopsy
CT and MRI for staging
Describe the stages of cervical cancer.
Stage I: confined to the cervix
Stage II: involves the upper 2/3 of the vagina
Stage III: involves the lower 1/3 of the vagina
Stage IV: involves the bladder/rectum
What is the treatment for cervical cancer?
Local excision (fertility-sparing) or hysterectomy
Chemoradiotherapy
Lymphadenectomy
What is the peak age of onset for ovarian cancer?
75-84Y
What are the risk factors for ovarian cancer?
Nulliparity
Early menarche/late menopause
BRCA1/BRCA2 gene mutations
HNPCC (Lynch II syndrome)
What are the protective factors for ovarian cancer?
COCP
Pregnancy
Breast feeding
What is the presentation of ovarian cancer?
Very vague presentation leading to late presentation and higher mortality Abdo/pelvic pain Weight loss, early satiety Vaginal bleeding Fatigue Urinary symptoms Change in bowel habit Mass felt per abdomen
What are the investigations for ovarian cancer?
FBC, U&Es, LFTs
CA125
Chest X-ray looking for mets/pleural effusion - needed for staging
CT CAP - to find mets
MRI - shows ovarian mass in more detail and distinguishes from benign mass
Can send samples of ascites and pleural effusion off for cytology
Describe the staging of ovarian cancer.
Stage I: limited to one or both ovaries
Stage II: limited to the pelvis
Stage III: limited to the abdomen
Stage IV: distant mets
What is the treatment for ovarian cancer?
Full staging laparotomy
Removal of all cancer
Chemotherapy wit platinum-based agents
What is the pre-invasive form of cervical cancer called?
CIN (cervical intra-epithelial neoplasia)
Which viruses are CIN associated with?
Ocogenic HPV 16,18, 31 and 33
What are the types of CIN and what are the differences between them?
CIN I affects the lower basal 1/3 of the cervical epithelium and 60% regress within 2 years.
CIN II affects 1/3 - 2/3 of the cervical epithelium
CIN III affects 2/3 to the full thickness of the cervical epithelium
CIN II and III are less likely to regress and more likely to progress to invasive squamous cell carcinoma
What is the function of the smear test?
It collects cervical cells for microscopy to identify dyskaryosis which indicates CIN.
How often are cervical smears conducted?
3 yearly for women between 25 and 50
And then 5 yearly until the age of 64
Annually for women who are HIV positive
What is the management for different types of abnormal smear?
Borderline/mild dyskaryosis
- sample tested for HPV
- if negative back to routine recall
- if positive referred for routine colposcopy
Moderate/severe dyskaryosis or suspected invasive cancer
- refer for urgent colposcopy (within 2 weeks)
Inadequate
- repeat smear
- if 3 inadequate samples - refer for routine colposcopy
What are the complications of LLETZ?
Haemorrhage
Infection
Small chance of cervical incompetence and premature delivery
- increased risk with multiple procedures/biopsy depth over 1cm
Cervical stenosis
Vasovagal episodes
Anxiety
