Gynae Cancers Flashcards
summary: endometrial hyperplasia
- precancerous
- treated with progesterone (IUS or POP)
presentation endometrial cancer
- PMB
- IMB/PCB/HMB
- abnormal PV discharge
- haematuria
def: endometrial cancer
80% adenocarcinomas
oestrogen dependent
RFs: endometrial cancer
- age
increased number ovulation: - nulliparity
- late menopause
- early menarche
exposure to unopposed oestrogen: - obesity
- PCOS
- tamoxifen
- T2DM
- HNPCC (lynch syndrome)
protective factors: endometrial cancer
- COCP
- mirena coil
- multiparity
- smoking
ix: endometrial cancer
- TVUSS for endometrial thickness >4mm
- pipelle biopsy
- OP hysteroscopy with biopsy
- FIGO staging
FIGO staging: endometrial cancer
stage 1 = confined to uterus
stage 2 = invades the cervix
stage 3 = invades ovaries, fallopian tubes, vagina or lymph nodes
stage 4 = involves bladder, rectum or beyond pelvis
referral criteria: endometrial cancer
- PMB = 2ww
- unexplained vaginal discharge in >55yo = refer for TVUSS
rx: endometrial cancer
- TAH and BSO
- radical hysterectomy
- radiotherapy
- chemotherapy
- progesterone if palliative to slow progression
common types: ovarian cancer
epithelial cell tumours (serous - most common)
def: Krukenberg tumour
metastasis in ovary from GI tract cancer (mainly stomach)
SIGNET RINGS on histology
key word: signet rings
Krukenberg tumour
RFs: ovarian cancer
- age - peaks at 60
- BRCA 1 and 2 (family hx)
- increased number ovukations (early menarche, late menopause, nulliparity)
- obesity
- smoking
- recurrent use clomifene
protective factors: ovarian cancer
- COCP
- breast feeding
- pregnancy
- late menarche
- early menopause
presentation: ovarian cancer
no specific symptoms
* abdominal bloating
* early satiety
* loss of appetite
* pelvic pain
* urinary symptoms
* weight loss
* abdominal/pelvic mass
* ascites
* referred hip/groin pain if mass pressing on obturator nerve
referral criteria: ovarian cancer
2 week wait if:
* ascites
* pelvic mass
* abdominal mass
further investigations (CA125) if over 50 and new symptoms of IBS/change in biwel habit
* abdominal bloating
* early satiety
* pelvic pain
* urinary frequency/urgency
* weight loss
ix: ovarian cancer
- CA125 >35IU/mL significant)
- pelvic ulstrasound
(CT scan, histology and paracentesis)
risk of malignancy: ovarian/endometrial cancer
- menopausal status
- ultrasound findings
- CA125 level
ix: germ cell tumour
- CA125
- alpha-fetoprotein
- hCG
women under 40 with complex ovarian mass
staging: ovarian cancer
FIGO staging
1. confined to ovary
2. spread past ovary but inside pelvis
3. spread past pelvis but inside abdomen
4. spread outside abdomen
rx: ovarian cancer
surgery and chemotherapy
assoc: cervical cancer
HPV 16 and18
HPV vaccine at 12-13 to prevent this
RFs: cervical cancer
increased risk of catching HPV:
* early sexual activity
* increased number of sexual partners
* sexual parters who have had more partners
* not using condoms
non-engagement with cervical screening
others:
* smoking
* HIV
* COCP for more than 5 years
* increased number FT pregnancies
* Fhx
* diethylstilbestrol during fetal development
presentation: cervical cancer
- may be asymptomatic picked up on screening
- abnormal vaginal bleeding (IMB, PCB, PMB)
- vaginal discharge
- pelvic pain
- dyspareunia
appearance: cervical cancer
- ulceration
- inflammation
- bleeding
- visible tumour
staging: CIN
diagnosed at colposcopy
CIN I - mild dysplasia affecting 1/3 thickness of epithelial layer - likely to return with no treatment
CIN II - moderate dysplasia, affecting 2/3 epithelial thickness and likely to progress to cancer if untreated
CIN III - severe dysplasia and very likely to progress to cancer in untreated (cervical carcinoma in situ)
screening: cervical cancer
smear test every 3 years 25-49 and every 5 years 50-64
DO NOT SMEAR IF LESION SEEN - only for asymptomatic women
checks for dyskaryosis
- HIV - screened annually
- women over 65 may request if they have not had since age 50
- women with previous CIN or immunocompromised may require additional rests
- pregnancy women due routine smear should wait 12 weeks post-partum
rx: smear results
- Inadequate sample – repeat the smear after at least three months
- HPV negative – continue routine screening
- HPV positive with normal cytology – repeat the HPV test after 12 months
- HPV positive with abnormal cytology – refer for colposcopy
steps: colposcopy
speculum and using acetic acid and iodeine solution
* acetic acid causes abnormal cells to appear white (aceetowhite) - CIN or cervical cancer
* Schiller’s iodine test with stain normal cells brown and with not stain abnormal areas
punch biopsies and large loop excision of transfomation zone can be performed
rx: CIN
LLETZ - diathermy removes abnormal cells - can cause preterm labour) - local anaesthetic
cone biopsy - treatment for CIN and early stage cancer - GA
staging: cervical cancer
FIGO staging
1. confined to cervix
2. invades uterus or upper 2/3 vagina
3. invades pelvic wall or lower 1/3 vagina
4. invades bladder, rectum or beyond pelvis
rx: cervical cancer
CIN or early stage 1A - LLETZ or cone biopsy
stage 1B-2A radical hysterectomy and removal of local lympth nodes + chemo + radio
stage 2B-4A chemo and radio
stage 4B - surgery, radio, chemo and palliative
rx: recurrent cervical cancer
Bevacizumab (avastin) targets VEGF-A
HPV 6 and 11
genital warts
HPV 16 and 18
cervical cancer
type: vulval cancer
squamous cell carcinoma (90%)
very few malignant melanoma
RFs: vulval cancer
- advanced age (75+)
- immunosuppresion
- HPV
- LICHEN SCLEROSIS
presentation: vulval cancer
- vulval lump
- ulceration
- bleeding
- pain
- itching
- lymphadeopathy in groin
main affected area: vulval cancer
labia majora
* irregular mass
* fungating lesion
* ulceration
* bleeding
high grade squamous intraepithelial lesion: vulval cancer
associated with HPV infection 16 and 18
RF - smoking
low grade squamous intraepithelial lesion: vulval cancer
HpV 6 and 11
differntiated VIN: vulval cancer
older women
not associated with HPV
diagnosis: vulval cancer
- biopsy of lesion
- sentinel node biopsy
- CTAP
staging: vulval cancer
FIGO staging
* WLE
* groin node dissection
* chemotherapy
* radiotherapy
rx: atypical endometrial hyperplasia
total hysterectomy
rx: post-menopausal atypical endometrial hyperplasia
TAH and BSO
