Gynae Cancers

Question 1

What type of cancer is cervical cancer most commonly?

Answer 1

Squamous Cell Carcinoma

Question 2

What is strongly associated with cervical cancer?

Answer 2

HPV (16+18)

Question 3

What is the treatment for HPV?

Answer 3

Mostly self-limiting.

Nooooo treatment.

Question 4

What are non-intercourse related risk factors for cervical cancers?

Answer 4

HIV
COCP >5 years
Increased number of full term pregnancies
Family history

Question 5

How can cervical cancer present?

Answer 5

Abnormal bleeding
Discharge
Pelvic pain
Dyspareunia

Question 6

When observing a patients uterus what signs would indicate an urgent referral for colposcopy?

Answer 6

Ulceration
Inflammation
Bleeding
Visible tumour

(Still refer even if smear is normal)

Question 7

What is the recommended cervical screening programme?

Answer 7

Starts at 25
Every 3 years until 49

Then every 5 years until 64.

(HIV+ screened yearly
Post-partum wait 12 weeks)

Question 8

What type of cancer is most commonly seen in Endometrial Cancer?

Answer 8

Adenocarcinoma

Oestrogen-dependent

Question 9

What are the treatment options for endometrial hyperplasia?

Answer 9

Progestogens:

• Mirena Coil (IUD)
• Continuous oral progestogens (medroxypreogesterone or levonorgesterl)

Question 10

What is a risk factor for endometrial cancer?

Answer 10

Large exposure to unopposed oestrogen:

• increased age
• early menarche
• late menopause
• no preggo
• obesity
• PCOS
• Tamoxifen

(not oestrogen related - HNPCC/Lynch)

Question 11

What are the signs and symptoms of endometrial cancer?

Answer 11

Postmenopausal bleeding

Urgent referral.

Question 12

What investigations would be suitable for suspected endometrial cancer?

Answer 12

• Transvaginal US (see thickness, should be <4mm in postmeno)
• Pipelle biopsy
• Hysteroscopy

Question 13

What is Stage 3 Endometrial Cancer?

Answer 13

Invaded ovaries, fallopian tubes, vagina or lymph nodes.

Question 14

What are the treatment options for endometrial cancer?

Answer 14

S1+2: TAH + BSO (remove uterus, cervix and adnexa)

Progesterone can slow the cancer.

Question 15

What is a Krukenberg tumour?

Answer 15

Metastasis in the ovary typically from a primary GI cancer, normally stomach.

“signet ring” on histology.

Question 16

What are risk factors for ovarian cancers?

Answer 16

> 60
BRCA
Increased ovulations
Frequent use of clomifene

Question 17

What are signs and symptoms of ovarian cancer?

Answer 17

Abdo bloating
Early satiety
Loss of appetite
Urinary symptoms
Ascites
Hip/groin pain

Question 18

What is the referral criteria for ovarian cancer?

Answer 18

If physical examination reveals

• ascites
• pelvic mass
• abdo mass

Question 19

What is the most important initial investigation in suspected ovarian cancer?

Answer 19

CA125 (>35 is signif)

Question 20

What tumour markers should be tested in women under 40 with suspected ovarian cancer?

Answer 20

AFP + HCG

Question 21

What are risk factors for vulval cancer?

Answer 21

> 75
HPV
Lichen sclerosus

Question 22

How will vulval cancer typically present?

Answer 22

Labia majora

Irregular mass
Ulceration
Bleeding