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3a > Gynae cancers > Flashcards

Gynae cancers Flashcards

1
Q

CIN is diagnosed at colposcopy. What does CIN stand for?

A

Cervical intraepithelial neoplasia

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2
Q

What are the 3 grades of CIN? What do they tell you?

A
  • CIN 1, 2, 3
  • The level of dysplasia (premalignant change) in the cells of the cervix
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3
Q

How does HPV promote the development of cancer?

A

HPV produces 2 proteins (E6, E7) which inhibit tumour suppressor genes (p53, pRb)

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4
Q

What is CIN 3 sometimes known as?

A

Cervical carcinoma in situ

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5
Q

What does CIN 1 indicate? Does it require treatment?

A
  • Mild dysplasia
  • Affecting 1/3 the thickness of epithelial layer
  • Likely to return to normal without treatment
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6
Q

What does CIN 2 indicate? Does it require treatment?

A
  • Moderate dysplasia
  • Affecting 2/3 the thickness of the epithelial layer
  • Likely to progress to cancer if untreated
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7
Q

What does CIN 3 indicate?

A
  • Severe dysplasia
  • Full thickness of the epithelial layer affected
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8
Q

What are cells from cervical smear examined for?

A

Dyskaryosis (pre cancerous change)

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9
Q

What are cells from colposcopy examined for?

A

Dysplasia (pre malignant change)

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10
Q

Who requires cervical screening every 3 years vs every 5 years?

A
  • Women 25-49 = 3 years
  • Women 50-64 = 5 years
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11
Q

How long should women wait for a routine cervical smear post partum?

A

Until 12 weeks post party

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12
Q

What is the management of the following smear results?
1. Inadequate sample
2. HPV negative
3. HPV positive with normal cytology
4. HPV positive with abnormal cytology

A
  1. Repeat the smear after at least three months
  2. Continue routine screening
  3. Repeat the HPV test after 12 months
  4. Refer for colposcopy
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13
Q

What 2 stains are used in colposcopy? What do they show?

A
  1. Acetic acid - abnormal cells will appear white
  2. Iodine - healthy cells will stain brown
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14
Q

What procedure can be carried out during a colposcopy procedure under local anaesthetic?

A

Loop biopsy

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15
Q

What procedure is carried out under general anaesthetic to treat CIN?

A

Cone biopsy

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16
Q

What are the FIGO stages of cervical cancer?

A
  • Stage 1: Confined to the cervix
  • Stage 2: Invades the uterus or upper 2/3 of the vagina
  • Stage 3: Invades the pelvic wall or lower 1/3 of the vagina
  • Stage 4: Invades the bladder, rectum or beyond the pelvis
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17
Q

What monoclonal ab may be used in combination with other chemotherapies in the treatment of metastatic/recurrent cervical cancer? What does it target? What does it prevent?

A
  • Bevacizumab (Avastin)
  • Vascular endothelial growth factor A
  • The development of new blood vessels
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18
Q

What strains of HPV cause…
1. Genital warts
2. Cervical cancer

A
  1. 6/11
  2. 16/18
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19
Q

What’s the most common type of vaginal cancer?

A

Secondary vaginal cancer

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20
Q

Where has vaginal cancer typically metastasised from?

A

Cervix/endometrium

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21
Q

What is the precancerous condition from endometrial cancer? What are the two types

A

Endometrial hyperplasia
- Hyperplasia without atypia
- Atypical hyperplasia

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22
Q

How is endometrial hyperplasia treated? What are the 2 options?

A

With progestogens
- IUS
- Continuous oral progestogens

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23
Q

What are 2 risk factors for endometrial cancer that are not related to unopposed oestrogen?

A
  • Diabetes
  • Hereditary nonpolyposis colorectal cancer/Lynch syndrome
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24
Q

Who does NICE recommend referring for TVUSS with endometrial cancer in mind?

A

Women > 55 yrs with…
- Unexplained vaginal discharge
- Visible haematuria + raised platelets, anaemia or elevated glucose levels

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25
Q

What endometrial thickness is normal in post menopausal women?

A

< 4 mm

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26
Q

What biopsy is used for endometrial cancer?

A

Pipelle biopsy

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27
Q

What are the FIGO stages for endometrial cancer?

A
  • Stage 1: Confined to the uterus
  • Stage 2: Invades the cervix
  • Stage 3: Invades the ovaries, fallopian tubes, vagina or lymph nodes
  • Stage 4: Invades bladder, rectum or beyond the pelvis
28
Q

What’s the treatment of stage 1 and 2 endometrial cancer?

A

Total abdominal hysterectomy with bilateral salpingo-oophorectomy

29
Q

What is VIN?

A

Vulval intraepithelial neoplasia - a premalignant condition affecting the squamous epithelium of the skin

30
Q

What are the 3 types of VIN?

A
  • Low grade squamous intraepithelial lesion
  • High grade squamous intraepithelial lesion
  • Differentiated VIN
31
Q

What type of VIN is associated with HPV infection? What age group does this typically affect?

A
  • High grade squamous intraepithelial lesion
  • Younger women aged 35 – 50 years
32
Q

What type of VIN is associated with lichen sclerosis? What age group does this typically affect?

A
  • Differentiated VIN
  • Older women aged 50-60
33
Q

What can be used to estimate the risk of an ovarian mass being malignant? What does it take into account?

A
  • Risk of malignancy index
  • Menopausal status, ultrasound findings, Ca 125
34
Q

What are the FIGO stages for ovarian cancer?

A
  • Stage 1: Confined to the ovary
  • Stage 2: Spread past the ovary but inside the pelvis
  • Stage 3: Spread past the pelvis but inside the abdomen
  • Stage 4: Spread outside the abdomen
35
Q

Give 3 examples of dopamine agonists?

A
  • Ropinirole
  • Bromocriptine
  • Cabergoline
36
Q

Give 3 examples of MAOis?

A
  • Isocarboxazid
  • Phenelzine
  • Selegiline
37
Q

What is first line imaging when investigating possible…
- Cervical cancer
- Endometrial
- Ovarian

A
  • Cervical cancer - colposcopy
  • Endometrial - TVUSS
  • Ovarian - pelvic USS
38
Q

What imagining is used to stage gynae cancer?

A

CT

39
Q

What is the most common gynaecological malignancy?

A

Endometrial cancer

40
Q

Endometrial cancer is caused by ………. . What can cause this?

A

Unopposed oestrogen
Caused by…
Late menopause
Ovarian tumours
Oestrogen only HRT
PCOS
Obesity
Lynch syndrome

41
Q

What gynae cancers present with bleeding?

A

Endometrial cancer
Cervical cancer

42
Q

RF for cervical cancer?

A

High risk HPV
Missed vaccination
Early age intercourse
Multiple sexual partners
STDs
Smoking
OCP usage

43
Q

Clinical manifestations of ovarian/Fallopian tube cancer

A

Bloating
Abdo pain
Mass
Change in bowel habit
Increased urinary frequency

44
Q

Investigations for breast cancer

A

Imaging - USS or mammography
Biopsy - fine needle aspiration of core biopsy

45
Q

When are USS used to investigate breast cancer

A

In younger women (<30). They are used to distinguish between solid lumps and cystic lumps

46
Q

Breast cancer cells may have receptors that can be targeted with treatment. Name the 3 different receptors

A

Oestrogen receptors
Progesterone receptors
Human epidermal growth factor (HER2)

47
Q

Name the breast cancer that doesn’t express any of the three receptors. Does it carry a better/worse prognosis?

A

Triple-negative breast cancer
Worse prognosis

48
Q

Where does breast cancer typically metastasise?

A

Lungs
Liver
Bones
Brain

49
Q

Surgical options for breast cancer

A

Breast conservation (lumpectomy)
Mastectomy
Full/limited axillary clearance

50
Q

When is full axillary clearance indicated in breast cancer?

A

If the axillary lymph nodes are clinically involved

51
Q

What does axillary clearance in breast cancer increase the risk of?

A

Chronic lymphoedema in that arm

52
Q

When is radiotherapy used in breast cancer?

A

Following breast conserving surgery to reduce the risk of recurrence

53
Q

Name three scenarios chemo is used in breast cancer

A

Neoadjuvant therapy - to shrink the tumour before surgery
Adjuvant chemo - after surgery to reduce recurrence
Treatment of metastatic or recurrent breast cancer

54
Q

When is hormonal treatment indicated in breast cancer?

A

If the breast cancer is oestrogen receptor positive

55
Q

Name two hormonal treatments for breast cancer

A

Tamoxifen
Aromatase inhibitors

56
Q

What group of women is tamoxifen used in?

A

Premenopausal women

57
Q

What group of women is aromatase inhibitors used in?

A

Post menopausal women

58
Q

Name a aromatase inhibitor

A

Letrozole

59
Q

How does tamoxifen treat breast cancer?

A

It blocks oestrogen receptors in breast tissue and stimulates them in the uterus and bones

60
Q

Name one thing tamoxifen prevents and one it increases the risk of

A

Prevents osteoporosis
Increases risk of endometrial cancer

61
Q

How do aromatase inhibitors treat breast cancer?

A

Aromatase converts androgens to oestrogen. After menopausal this is the primary source of oestrogen. Aromatase inhibitors block this process.

62
Q

What options are there for breast reconstruction?

A

Breast implants
Flap reconstruction

63
Q

What is flap reconstructions?

A

When tissue from another part of the body is used to reconstruct the breast

64
Q

Why are women with PCOS at increased risk of endometrial cancer?

A

Normally after ovulation the corpus luteum releases progesterone. Women with PCOS ovulate infrequently/not at all -> insufficient progesterone. This means their endometrium proliferates in the presence of unopposed oestrogen -> endometrial hyperplasia -> rf for endometrial cancer

65
Q

Give 2 options for reducing the risk of endometrial hyperplasia and cancer in PCOS

A
  1. Mirena coil - provides continuous endometrial protection
  2. Induce bleed every 3/4 months with COCP/cyclical progesterone

3a (34 decks)

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