Gynae cancers Flashcards
Risk factors for Endometrial cancer?
Unopposed oestrogen:
- Early menarche
- Late menopause
- Nulliparity
- PCOS
- Obesity
- Tamoxifen
- Oestrogen-only HRT
Also
- T2DM
- Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome
An obese 65-year-old woman presents to her GP with PMB. Her menarche was aged 10 and she has no children. She says she went through the change 9 years ago. Diagnosis?
Endometrial cancer
2ww
Protective factors against endometrial cancer?
COCP
Mirena Coil
More pregnancies
Smoking
Investigations for 2ww PMB?
Transvaginal US
Pipelle biopsy
Hysteroscopy
Management for endometrial cancer?
Total abdominal hysterectomy with bilateral salpingo-oophrerectomy
A large 64 yr old lady with hirsutism, an adopted child complains of sporadic bleeding despite her last period being 8 years ago. She also complains of bleeding after sex. What are you concerned about?
Endometrial cancer
What is the precancerous condition for endometrial cancer?
Endometrial hyperplasia
Can be typical or atypical
How do you treat endometrial hyperplasia?
With progesterones
- Mirena coil or oral progesterone e.g. medroxyprogesterone or levongestrel
Most common type of cervical cancer?
Squamous cell carcinoma- 80%
Most common cause of cervical cancer
HPV - esp type 16 and 18
Public health prevention of cervical cancer?
Smear screening programme
Risk factors for cervical cancer?
- Early sexual activity, unprotected sex, lots of partners (catch HPV)
- Not getting smears
- Smoking
- HIV
- COCP >5 yrs
- High parity
- Family history
- Low socioeconomic status
A 32-year-old woman who has never had a smear before, smokes and has lots of sex with lots of people, has been on the pill since she was 14 and hates condoms presents to her GP complaining of pain during sex and bleeding after. What are you concerned about?
Cervical cancer
Examine cervix with speculum
What is the first thing they test for with a smear sample?
High risk HPV
What age and how often do women get called for smears?
3 years 25-49
5 years 50-64
How often do women with HIV get smears?
Annually
What does the liquid based cytology look for in the smear results?
Dyskaryosis
Can be low or high grade or have borderline changes
A woman’s smear is hrHPV positive but her cytology is normal- whats next?
Smear in 12 months
A woman’s smear is hrHPV positive and cytology is abnormal- whats next?
Referred for colposcopy
A woman’s smear is deemed inadequate- whats next?
Repeat smear in 3 months
If inadequate again- colposcopy
What stains are used in colposcopy to visualise abnormal cells?
Acetic acid and iodine stain
How is dysplasia graded and what level should you treat?
CIN and treat II and III
Risk factors for ovarian cancer?
Age- peak at 60
BRCA1 and BRCA2 gene
Increased number of ovulations: early menarche, late period, nulliparity.
Obesity
Smoking
Clomifene- fertility drug
Protective against ovarian cancer?
COCP pill
Breastfeeding and pregnancy (stops ovulation)
