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Phase 3A Medicine > Gynae cancers > Flashcards

Gynae cancers Flashcards

1
Q

Risk factors for Endometrial cancer?

A

Unopposed oestrogen:
- Early menarche
- Late menopause
- Nulliparity
- PCOS
- Obesity
- Tamoxifen
- Oestrogen-only HRT
Also
- T2DM
- Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome

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1
Q

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?

A

Endometrial cancer
2ww

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2
Q

Protective factors against endometrial cancer?

A

COCP
Mirena Coil
More pregnancies
Smoking

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3
Q

Investigations for 2ww PMB?

A

Transvaginal US
Pipelle biopsy
Hysteroscopy

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4
Q

Management for endometrial cancer?

A

Total abdominal hysterectomy with bilateral salpingo-oophrerectomy

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5
Q

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?

A

Endometrial cancer

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6
Q

What is the precancerous condition for endometrial cancer?

A

Endometrial hyperplasia
Can be typical or atypical

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7
Q

How do you treat endometrial hyperplasia?

A

With progesterones
- Mirena coil or oral progesterone e.g. medroxyprogesterone or levongestrel

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8
Q

Most common type of cervical cancer?

A

Squamous cell carcinoma- 80%

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9
Q

Most common cause of cervical cancer

A

HPV - esp type 16 and 18

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10
Q

Public health prevention of cervical cancer?

A

Smear screening programme

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11
Q

Risk factors for cervical cancer?

A
  • 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
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12
Q

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?

A

Cervical cancer
Examine cervix with speculum

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13
Q

What is the first thing they test for with a smear sample?

A

High risk HPV

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14
Q

What age and how often do women get called for smears?

A

3 years 25-49
5 years 50-64

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15
Q

How often do women with HIV get smears?

A

Annually

16
Q

What does the liquid based cytology look for in the smear results?

A

Dyskaryosis
Can be low or high grade or have borderline changes

17
Q

A woman’s smear is hrHPV positive but her cytology is normal- whats next?

A

Smear in 12 months

18
Q

A woman’s smear is hrHPV positive and cytology is abnormal- whats next?

A

Referred for colposcopy

19
Q

A woman’s smear is deemed inadequate- whats next?

A

Repeat smear in 3 months
If inadequate again- colposcopy

20
Q

What stains are used in colposcopy to visualise abnormal cells?

A

Acetic acid and iodine stain

21
Q

How is dysplasia graded and what level should you treat?

A

CIN and treat II and III

22
Q

Risk factors for ovarian cancer?

A

Age- peak at 60
BRCA1 and BRCA2 gene
Increased number of ovulations: early menarche, late period, nulliparity.
Obesity
Smoking
Clomifene- fertility drug

23
Q

Protective against ovarian cancer?

A

COCP pill
Breastfeeding and pregnancy (stops ovulation)

24
Q

A 61-year-old lady who started her period aged 10 and has no kids, presents with feeling bloated, full without eating much, and needing to urinate more often. What’s your concern?

A

Ovarian cancer

25
Q

What is the 2ww criteria for suspected ovarian ca.?

A

Ascites, pelvic mass, abdo mass.

26
Q

What investigations should you do before referral in suspected ovarian ca.?
e.g. new bloating, pelvic pain, urinary symps, weight loss

A

CA125 blood test (>35 IU/mL)
Pelvic US

27
Q

Causes of a raised CA125?

A

Endometriosis
Fibroids
Adenomyosis
Pelvic infection
Liver disease
Pregnancy

28
Q

Staging system used for most gynae cancers?

A

FIGO system
stage 0: carcinoma in situ (common in cervical, vaginal, and vulval cancer)
stage I: confined to the organ of origin
stage II: invasion of surrounding organs or tissue
stage III: spread to distant nodes or tissue within the pelvis
stage IV: distant metastasis(es)

29
Q

If 2nd repeat smear at 24 months at 24 months is still hrHPV +ve with abnormal cytology- what next?

A

Refer for colposcopy

30
Q
A

Phase 3A Medicine (5 decks)

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