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Year 4 - Obs and Gynae > Gynae Cancers > Flashcards

Gynae Cancers Flashcards

1
Q

What are the RFs for endometrial cancer?

A

Anovulation

  • Early menarche and/or late menopause
  • Low parity
  • Polycystic ovarian syndrome
  • HRT with oestrogen alone.
  • Tamoxifen

Age: 65 and 75

Obesity

Hereditary Factors: HNPCC Lynch. 2

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2
Q

How does endometrial cancer present?

A
  • postmenopausal bleeding (PMB)
  • IMB
  • Uncommon: clear or white vaginal discharge, or with abnormal cervical smears.
  • Rare in premenopausal women: irregular bleeding or IMB
  • Advanced: abdominal pain or weight loss.
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3
Q

Give some differential dx for PMB

A
  • Vulval – vulval atrophy, vulval pre-malignant or malignant conditions.
  • Cervical – cervical polyps, cervical cancer
  • Endometrial – hyperplasia without malignancy, benign endometrial polyps, endometrial atrophy.
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4
Q

How is endometrial cancer ixd?

A
  • TVS: measure endometrial thickness
  • >4mm in PMB - hysteroscopy + endometrial biopsy
  • Staging (if cancer): MRI / CT
  • baseline bloods: FBC, U&Es, LFTs, G+S
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5
Q

What staging is used for endometrial cancer?

A

Stage I – Carcinoma confined to within uterine body.

Stage II – Carcinoma may extend to cervix but is not beyond the uterus.

Stage III – Carcinoma extends beyond uterus but is confined to the pelvis.

Stage IV – Carcinoma involves bladder or bowel, or has metastasised to distant sites.

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6
Q

How is endometrial cancer mxd?

A

Stage I – lap. TAH+ BSO, Peritoneal washings

Stage II – Radical hysterectomy + removal of pelvic lymph nodes (lymphadenectomy) (stage Ic or II) - +/- adjuvant radiotherapy.

Stage III – Maximal de-bulking surgery + chemo (prior to radiotherapy)

Stage IV – Maximal de-bulking surgery. Palliative: low dose radiotherapy, or high dose oral progestogens.

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7
Q

What are the RFs for ovarian cancer?

A

Nulliparity

Early menarche

Late menopause

Hormone replacement therapy containing oestrogen only

Smoking

Obesity

FH: BRAC1/2 + HNPCC

Protective: COCP, breastfeeding, multiparity

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8
Q

How does ovarian cancer present?

A
  • Bloating
  • Change in bowel habit
  • Change in urinary frequency
  • Weight loss
  • Irritable bowel syndrome
  • Bleeding per vagina
  • Incidental and asymptomatic
  • Chronic pain – may develop secondary to pressure on the bladder or bowel also causing frequency or constipation.
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9
Q

HOW is ovarian cancer ixd?

A

bloods: FBC, U&E, LFT and albumin. CA125

Abdominal + pelvic US pelvic masses - calculate RMI

Confirmed cancer: CXR + CT abdomen/pelvis - staging

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10
Q

How is ovarian cancer mxd?

A
  • Staging laparotomy
  • TAH+BSO: Total abdomino hysterectomy, bilateral salpingo-oophorectomy, omentectomy
  • Para aortic pelvic lymph node sampling
  • Peritoneal washing + biopsy
  • Adjuvant Chemotherapy: Platinum (Cisplatin, carboplatin) and Taxane (paclitaxel)
  • Follow up – involves clinical examination and monitoring of CA125 level for 5 years
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11
Q

How is ovarian cancer staged?

A
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12
Q

What are some RFs for cervical cancer?

A
  • Smoking
  • STIs: HPV
  • Other sexually transmitted infections
  • Long-term (> 8 years) COCP use
  • Immunodeficiency (e.g. HIV)
  • HPV
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13
Q

How can HPV causes cancer?

A

HPV (esp 16 & 18) -> produce proteins (E6&7) -> suppress the products of ‘p53’ tumour suppressor gene in keratinocytes

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14
Q

How does cervical cancer presnent?

A
  • Abnormal vaginal bleeding (PCB, IMB, PMB)
  • Vaginal discharge (blood-stained, foul-smelling)
  • Dyspareunia
  • Pelvic pain
  • weight loss.
  • Asymptomatic
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15
Q

What are some late fx of cevical cancer?

A

oedema, loin pain, rectal bleeding, radiculopathy and haematuria

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16
Q

What are some differentials for cervical cancer?

A

STIs, cervical ectropion, polyp, fibroids, and pregnancy related bleeding.

17
Q

How is suspected cervical cancer ixd?

A
  • Pre-menopausal – STI (chlamydia trachomatis) -> +ve -> mx -> sx persist -> refer for colposcopy and biopsy.
  • Post-menopausal – urgent colposcopy (acetic acid) + biopsy.
  • If diagnosed:
  • Basic blood tests –FBC, LFT, UE
  • Staging: CT Chest-Abdomen-Pelvis, MRI pelvis, PET.
  • +/- EUA
18
Q

What are the stages of cervical cancer?

A

Stage 0 – Carcinoma in-situ

Stage 1 – Confined to cervix

Stage 2 – Beyond cervix but not pelvic sidewall/ involves vagina but not lower 1/3

Stage 3 – Extends to pelvic sidewall/ involves lower 1/3 vagina/ hydropnephrosis not explained by another cause.

Stage 4 – Extends to bladder or rectum, or metastases

19
Q

How is cervical cancer mxd?

A
  • Stage 1a: Radical trachelectomy/ cone biopsy (rare) - fertility preserving. Family complete - lap. hysterectomy + pelvic lymphadenectomy
  • Stage 1b/2a: Radical (Wertheim’s) hysterectomy :removal of the uterus, vagina and parametrial tissues up to the pelvic sidewall, + lymphadenectomy.
  • Stage 4a or Recurrent disease: Anterior/posterior/total pelvic extenteration. Removal of all pelvic adnexae plus bladder (anterior)/rectum (posterior or both (total).
  • Chemoradiation: can be offered stage 1b - 3 as alternative to surgery Radiotherapy can be delivered in the form of intracavity brachytherapy.
  • Chemotherapy: cisplatin-based (neo/adjuvant). Palliative.
  • Follow-Up: reviewed by a gynaecologist every 4 months after treatment has been completed for the first 2 years, and every 6-12 months for the subsequent 3 years.
    *
20
Q

How is CIN mxd?

A

1: Watch + wait, most regress spont.

II/III: LLETZ, cold knife cone. 6 monthly smears (HPV testing) for test of cure. If +ve -> repeat assessment via colposcopy. -ve -> return to routine 3y (or 5) yearly smears

21
Q

What are cervical extropions how are they mxd

A

TZ: stratified squamous meets columnar.

Raised oestrogen: pregnancy, COCP, ovulation -> larger area of columnar epithelium on ectocervix

Sx: PCB, vaginal discharge

Mx: ablative tx, cold coagulation if troublesome

22
Q

How is `VIN mxd

A

Conservative: Antihistamine

Medical: Imiquimod

Surgical: Excision. Surveillance + biopsy. Bad: laser, excision -> high rate of recurrence

23
Q

What are some RFs for vulval cancer

A

RFs: HPV, HSV 2, Smoking, Immunosuppression, Chronic vulvar irritation, Lichen Sclerosis

24
Q

How does vulval cancer present

A

Sx: lump, ulcer (often unnoticed), late: pain, bleeding

Mainly SCC: 50% by HPV. 50% Chronic skin disease. Others: BCC, melanoma

25
Q

How is vulval cancer mxd

A

Mx: Surgery: anatomical considerations, neoadjuvant radiotherapy/ chemoradiotherapy (shrink tumour)

SURGERY: vulvectomy +/- skin grafts

<2cm width <1mm depth: lymph node excision not required

>over: do WLE. + removal of inguinal glands

Chemoradiotherapy: palliative/ unsuitable for surgery/ shrink large tumours pre op

26
Q

How does lichen sclerosis present?

A

Fx: itch, skin fissuring/ erosions, white atrophic patches in anogenital region

Examination: clitoral hood fusion, fusion of labia minora to majora, posterior fusion -> loss of vaginal opening

27
Q

What are some RFs for lichen sclerosis

A

RFs: FH, autoimmune (thyroid, T1DM, alopecia areata)

28
Q

How does lichen sclerosis get mx

A

Mx: immunosuppression. 1st: topical steroids (clobetasol propionate) OD (night) x 4 weeks. FU: risk of SCC

Year 4 - Obs and Gynae (7 decks)

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