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3a > Gynae cancers > Flashcards

Gynae cancers Flashcards

1
Q

Cancer strongly related to HPV and most common type

A

-Cervical
-Squamous cell carcinoma

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2
Q

HPV role in cervical cancer

A

-> E6 and E7 protein prodcution
-> Inhibit p53 and pRb tumour suppressor genes respectively
-> Type 16 and type 18 HPV strains are the biggest causes of cervical cancer

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3
Q

Risk factors for cervical cancer (7)

A

-Increased risk of HPV : increased no. of sexual partners, no condom used, early sexual activity
-Non engagement with cervical screening
-Smoking
-HIV
-COCP for >5 yrs
-Increased no. of full term pregnancies
-Fx

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4
Q

If not asymptomatic, how can cervical cancer present?

A

-> Abnormal vaginal bleeding (intermenstraul, postcoital or post-menopausal)
-Vaginal discharge
-Pelvic pain
-Dyspareunia

-If present : examine cervix with a speculum
-If cervix ulcerated, inflammed, bleeding or there is a visible tumour = urgent cancer referral for colposcopy

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5
Q

At what point are women screened for cervical cancer ?

A

-> Every 3 years aged 25-49
-> Every 5 years aged 50-64

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6
Q

How are women protected against cervical cancer and genital warts ?

A

-HPV vaccine before boys and girls become sexually active

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7
Q

If a smear comes back as HPV positive with abnormal cytology what is the outcome ?

A

-Refer for colposcopy

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8
Q

What can be diagnosed at colposcopy ?

A

-Cervical intraepithelial neoplasia -> grading system for level of dysplasia of the cells in the cervix

-CIN I -> mild, affects 1/3 and likely to return to normal if untreated.
-CIN II -> moderate, affects 2/3 of epithelial thickness. Likely to progress to cancer if untreated
-CIN III -> severe, likely to progress to cancer if untreated (cervical carcinoma in situ)

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9
Q

What are the 2 methods of tissue biopsy during a colposcopy ?

A

-Punch biopsy
-Large loop excision of the transformation zone

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10
Q

How is CIN treated at the very early stage of cervical cancer

A

-Cone biopsy

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11
Q

What are the stages of cervical cancer and how are they treated ?

A

-CIN/early stage 1A -> LLETZ or cone biopsy
-Stage 1b-2a (confined to cervix) - radical hysterectomy + removal of local lymph nodes + chemo or radio
-Stage 2 : invades uterus or upper 2/3 of vagina
-Stage 3 : invades pelvic wall or lower 1/3 of vagina
-Stage 4 : invades bladder, rectum or beyond the pelvis

-Stage 2b to 4a are treated with chemo and radiotherapy

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12
Q

What monoclonal antibody can be used in cervical cancer?

A

-Bevacizumab (avastin)
-targets VEGF-A reducing the development of new blood vessels

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13
Q

Endometrial cancer

-Type
-RF
-Presentation

A

-80% = adenocarcinomas

-Anything that increases expose to ‘unopposed oestrogen’ as it is an oestrogen-dependent cancer, obesity, T2DM and HNPCC/lynch syndrome.

-Postmenopausal bleeding !!!! + postcoital, intramenstrual or unsually heavy bleeding. Abnormal vaginal discharge, haematuria, anaemia and raised plt count.

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14
Q

What can increase a womans exposure to ‘unopposed oestrogen? (8)

A

-PCOS
-Obesity
-Increased age
-Earlier onset menstruation
-Late menopause
-Oestrogen only HRT
-No or fewer pregnancies
-Tamoxifen

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15
Q

What is endometrial hyperplasia and how is it treated ?

A

-> Precancerous condition involving thickening of the endometrium
-> 2 kinds : hyperplasia without atypia, atypical hyperplasia
-> mirena coil or continuous oral progestogens

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16
Q

What is the referral criteria in endometrial cancer suspicion

A

-2 week wait : postemenopausal bleeding
-Transvaginal USS in women over 55 : unexplained vaginal discharge or visible haematuria + raised plts, anaemia or elevated glucose levels

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17
Q

What are the 3 investigations for endometrial cancer

A

-Transvaginal USS for endometrial thickness (normal - <4mm post-menopause)
-Pipelle biopsy
-Hysteroscopy with biopsy

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18
Q

What are the stages of endometrial cancer

A

1 : confined to uterus
2 : invades the cervix
3 : Invades ovaries, fallopian tubes, vagina or lymph nodes
4 : invades bladder, rectum or beyond the pelvis

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19
Q

How are stage 1 and 2 endometrial cancers treated

A

-Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH and BSO)

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20
Q

What is the most common type of ovarian cancer ?

A

-Epithelial cell tumour

21
Q

Give 6 RF for ovarian cancer

A

-Age (peaks at 60)
-BRCA1 and BRCA2
-Increased no. of ovulations : early onset periods, late menopause, no pregnancies
-Obesity
-Smoking
-Recurrent use of clomifene

22
Q

Why would ovarian cancer cause referred hip or groin pain ?

A

-> If the mass presses on the obturator nerve

23
Q

What are the initial investigations for an ovarian cancer

A

-CA125 blood test (>35 significant)
-Pelvic USS
-Risk of malignancy index

24
Q

Women under 40 with complex ovarian mass require tumour markers for a possible germ cell tumour, what are they :

A

-Alpha-fetoprotein
-Human chorionic gonadrotropin (HCG)

25
Q

Give 6 other causes of raised CA125

A

-Endometriosis
-Fibroids
-Adenomyosis
-Pelvic infection
-Liver disease
-Pregnancy

26
Q

If a smear test is hrHPV positive, what is done

A

-Examined cytologically
-If cyctology abnormal -> coloposcopy

27
Q

If a smear is hrHPV + but cytologically normal, when is the smear repeated

A

12 mnths
If hrHPV is negative, return to normal recall
If hrHPV is + repeat at 12 mnths
-If sample is inadequate, repeat smear in 3 mnths

27
Q

If a smear is hrHPV + but cytologically normal, when is the smear repeated

A

12 mnths
If hrHPV is negative, return to normal recall
If hrHPV is + repeat at 12 mnths
if hrHPV -ve at 24 mnths return to normal recall
If hrHPV +ve ar 24 mnths -> colposcopy

28
Q

why does obesity increase unopposed oestrogen exposure ?

A

-Adipose tissue contains atomatase
-Aromatas converts adrogens to oestrogen.

29
Q

Why does PCOS increase exposure to unopposed oestrogen?

A

-Lack of ovulation leads to lack of corpus luteum formation
-Progesterone is therefore not produced

30
Q

What should women with PCOS be given for endometrial protection ?

A

-COCP
-Mirena coil
-Cyclical progestogens to induce a withdrawal bleed

31
Q

what are 4 protective factors against endometrial cancer

A

COCP
Mirena coil
Increased pregnancies
Cigarette smoking

32
Q

What is the most common type of ovarian cancer ?

A

Epithelial cell tumour -> serous

33
Q

Give 3 protective factors against ovarian cancer

A

-COCP
-Breastfeeding
-Pregnancy

They all stop or reduce the no. of ovulations

34
Q

how doers ovarian cancer present

A

Bloating
Eaely satiety
Loss of appetite
Pelvic pain
Urinary sx
Weight loss
Abdominal or pelvic mass
Ascites

35
Q

What 3 things are taken into account in the risk of malignancy index

A

-Estimates risk of avarian mass being malignant

-Menopausal status, USS findings and CA125 level

36
Q

what are the stages of ovarian cacner

A

1 : confined to ovary
2 : Spread past ovary but inside the pelvis
3 : spread past pelvis but inside the abdomen
4 : spread outside of abdomen

37
Q

Explain the referral criteria for ovarian cancer

A
  • 2 week wait : ascites, pelvic mass, abdo mass
38
Q

What can germ cell tumours cause a rise in

A

-hCG
-Alpha-fetoprotein

39
Q

what is a krukenberg tumour

A

-Metastasis in the ovary, usually from a GI cancer
-‘Signet ring’ cells on histology

40
Q

Give 4 RF for vulval cancers

A

-Advances age (>75)
-Immunosuppression
-HPV
-Lichen sclerosis

41
Q

what is the most common type of vulval cancer

A

squamous cell

42
Q

how does vulval cancer present and where does it more frequently affect

A

-Vulval lump, ulceration, bleeeding, pain, itching, lymphadenopathy
-Labia majora

43
Q

what is vulval intraepithelial neoplasia

A

-Premalignant condition affecting squamous epithelium of the skin preceding vulval cancer
-High grade squamous intraepithelial lesion (VIN) -> associated with HPV
-Differentiated VIN -> associated with lichen sclerosis

44
Q

How can VIN be treated

A

Watch and wait
Wide local excision
Imiquimod
Laser ablation

45
Q

How is vulval cancer diagnosed and stage

A

-Diagnose : biopsy lesion
-Check lymph nodes : sentinel node biopsy
-CT abdo and pelvis for staging

46
Q

Most common gynae cancer

A

Endometrial

47
Q

Vulval carcinoma vs VIN

A
  • Carcinoma : ulcerated, labium majora
  • VIN : white or plaque like, don’t ulcerate

3a (45 decks)

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