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Finals > 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

Risk factors for cervical cancer

A
  • Increased risk of HPV = multiple partners, unprotected sex
  • Smoking
  • Increased no. full term pregnancies
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3
Q

If not asymptomatic, how can cervical cancer present?

A
  1. Abnormal vaginal bleeding (intermenstraul, postcoital or post-menopausal)
  2. Pain : pelvic pain / dyspareunia
  3. Vaginal discharge

Examination - cervical ulceration, visible mass, inflammation, bleeding.

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4
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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5
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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6
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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7
Q

If a smear test is hrHPV positive, what is done

A

-Examined cytologically
-If cyctology abnormal -> coloposcopy

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8
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

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9
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

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10
Q

Explain the cervical smear testing process

A
  1. Testing for high risk HPV (hrHPV)
  2. Cytological examination if HPV (+ve)
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11
Q

how are the smear results managed in HPV -VE

A

Return to normal recall

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12
Q

How are the smear tests results managed in HPV +ve

A

sample examined cytologically

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13
Q

If cervical smear cytology abnormal ?

A

colposcopy

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14
Q

If cervical smear cytology normal ?

A
  • Repeat smear @12 mnths
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15
Q

When is repeat test done if cervical smear test is inadequate

A

3 mnths

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16
Q

RF for endometrial cancer

A
  1. Excess oestrogen : nulliparity, early menarche, late menopause, unopposed oestrogen
  2. Metabolic syndrome : obesity, DM, PCOS
  3. Long term tamoxifen use
  4. Hereditary non-polyposis colorectal carcinoma
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17
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
-> SImple : mirena coil or high dose progestogens with repeat sampling 3-4 nths
-> Atypica = hysterectomy advised

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18
Q

What is the referral criteria in endometrial cancer suspicion

A

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

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19
Q

What are the 3 investigations for endometrial cancer

A

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

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20
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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21
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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22
Q

What is the most common type of ovarian cancer ?

A
  • Epithelial cell tumour (70-80% = serous carcinomas)
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23
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

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24
Q

Why would ovarian cancer cause referred hip or groin pain ?

A

-> If the mass presses on the obturator nerve

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25
Q

What are the initial investigations for an ovarian cancer

A

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

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26
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)

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27
Q

Give 6 other causes of raised CA125

A

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

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 five RF for vulval cancers

A

-Advances age (>75)
-Immunosuppression
-HPV
-Lichen sclerosis
- Vulval intraepithelial hyperplasia

41
Q

what is the most common type of vulval cancer

A

squamous cell carcinoma

42
Q

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

A
  • Vulval lump, ulceration, bleeding, pain, itching
  • Inguinal 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
48
Q

what epithelium normally lines the ectocervix ?

A

stratified squamous non-keratinized epithelium

49
Q

when are women screened for cervical cancer?

A

all women are initially screened for high-risk HPV between the ages of 25-64

50
Q

Treatment of CIN

A

Large loop excision of transformation zone

51
Q

FIGO stage IA of cervical cancer

A
  • IA : confined to cervix, only visible by microscopy and <7mm wide (1A1 = <3mm deep, 1A2 = 3-5mm deep)
52
Q

FIGO stage 1B of cervical cancer

A
  • Confined to cervix, clinically visible or >7mm wide
  • 1B1 = <4cm diameter
  • 1B2 = >4cm diameter
53
Q

FIGO stage 2 cervical cancer

A
  • Extension of tumour beyond cervix but not to the pelvic wall
  • A = upper two thirds of vagina
  • B = parametrial involvement
54
Q

FIGO stage 3 cervical cancer

A
  • Extension of tumour beyond the cervix and to the pelvic wall
  • A = lower third of vagina
  • B = pelvic side wall

Any tumour causing hydronephrosis or a non functioning kidney = considered stage III

55
Q

FIGO stage 4 cervical cancer

A
  • Extension of tumour beyond the pelvis or involvement of bladder or rectum
  • A = involvement of bladder or rectum
  • B = involvement of distant sites outside the pelvis
56
Q

Management of IA cervical cancer

A
  • Gold standard = hysterectomy +/- lymph node clearance
  • If maintaining fertility = cone biopsy with negative margins
57
Q

Management of stage IB cervical tumours

A
  • 1B1 : radiotherapy with concurrent chemotherapy is advised
  • 1B2 : radical hysterectomy with pelvic lymph node dissection
58
Q

Management of stage II and III cervical tumours

A

Radiation with concurrent chemotherapy

59
Q

Management of stage IV cervical tumours

A
  • Radiation and/or chemotherapy is the treatment of choice
  • Palliative chemotherapy may be best option for stage IVB
60
Q

Indication for hysteroscopy with endometrial biopsy

A

persistent intermenstraul bleeding or heavy menstrual bleeding in women >=45 with failure of nomral treatment

61
Q

what is the most common cause of postmenopausal bleeding

A

Vaginal atrophy

62
Q

What type of ovarian tumours are associated with the development of endometrial hyperplasia

A

Granulosa cell tumours

63
Q

apart from : infection and bleeding give 3 risks of TAH and BSO for endometrial cancer

A
  • Damage to urethra, uterus and bowel
  • Stress incontinence
  • VTE
64
Q

Complications of vaginal hysterectomy with antero-posterior repair

A

Vaginal vault prolapse

65
Q
A

Finals (92 decks)

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