gynae cancers

Question 1

who is most likely to be affected by cervical cancer?

Answer 1

Affects younger women within reproductive ages

Question 2

who is most likely to be effected by endometrial cancers?

Answer 2

Postmenopausal mainly

Question 3

what infection is cervical cancer linked to?

Answer 3

HPV

Question 4

when is the HPV vaccination done?

Answer 4

children aged 12-13 are vaccinated against before sexual activity)

Question 5

what makes up 80% of cervical cancer?

Answer 5

80% are squamous cell carcinomas

Question 6

what makes up 80% of endometrial cancer?

Answer 6

80% are adenocarcinoma and oestrogen dependent cancer

Question 7

what is pre-cancerous for endometrial cancer?

Answer 7

Endometrial hyperplasia is precancerous – thickening of endometrium  5% develop into cancer

Question 8

what stimulates endometrial cancer?

Answer 8

Oestrogen stimulates growth

Question 9

what increases risk of cervical cancer?

Answer 9

Increased risk of catching HPV
Later detection of cancer – not attending smear tests
Smoking
HIV
COCP (more than 5yrs use)
Increased number of full-term pregnancies
Exposure to diethylstibestrol during foetal development (used before 70s to prevent miscarriages)

Question 10

what can increase risk of HPV infection?

Answer 10

early sexual activity, more sexual partners, sexual partners who had more partners, not using barrier contraception

Question 11

what are RF for endometrial cancers?

Answer 11

Increased age
Earlier onset of menstruation
Late menopause
Oestrogen only HRT
No/ fewer pregnancies
Obesity  adipose tissue is key source of oestrogen in postmenopausal women
PCOS
Tamoxifen
T2DM
HNPCC, lynch syndrome

Question 12

how does cervical cancer present?

Answer 12

May be asymptomatic  picked up in smear
Abnormal bleeding (IMB, post-coital, post0menopausal)
Vaginal discharge
Pelvic pain
Dyspareunia
Abnormal cervix

Question 13

how should suspected cervical cancer be referred?

Answer 13

2ww

Question 14

how would endometrial cancer present?

Answer 14

Abnormal bleeding: post-coital, IMB, unusually heavy
Abnormal discharge
Haematuria
Anaemia
Raised platelets

Question 15

what diagnostics can be done for cervical cancer?

Answer 15

colposcopy
histology
biopsy

Question 16

what would indicate cervical cancer on colposcopy?

Answer 16

ulceration, inflammation, bleeding, visible tumour indicative

Question 17

on cervical histology, what would acetic acid show?

Answer 17

abnormal cells

Question 18

what diagnostics can be done for endometrial cancer?

Answer 18

Needs transvaginal US in women 55+ with unexplained vaginal discharge/ visible haematuria
Pipelle biopsy – highly sensitive
hysteroscopy

Question 19

how do you manage Cervical intraepithelial neoplasia + early stage 1a cervical cancer?

Answer 19

large loop excision/ cone biopsy

Question 20

how do you manage stage 1 and 2 endometrial cancer?

Answer 20

total abdo hysterectomy with bilateral salpingo-ooporectomy

Question 21

what is a salpingo-ooporectomy?

Answer 21

removing uterus, cervix and adnexa)

Question 22

how do you manage more advanced stages of endometrial cancer?

Answer 22

Radical hysterectomy and removing pelvic lymph nodes
Radiotherapy
Chemotherapy
Progesterone – can slow progression

Question 23

how do you stage 2b -4a cervical cancer?

Answer 23

chemo and radiotherapy

Question 24

how do you manage stage 4B cervical cancer?

Answer 24

combination of surgery, radio, chemo + palliative

Question 25

what is the prognosis of cervical cancer?

Answer 25

5yr survival drops in advances Stage 1a: 98% Stage 4: 15% survival

Question 26

what is the point of cervical screening?

Answer 26

Have cervical screening: smear tests to screen precancerous/ cancerous/ cancerous changes to cells - Allows early detection

Question 27

what is the current HPV NHS vaccine?

Answer 27

gardasil

Question 28

what does gardasil protect against?

Answer 28

many strains of HPV protecting against genital warts and cervical cancer

Question 29

how can you treat endometrial hyperplasia?

Answer 29

Can treat endometrial hyperplasia with mirena coil, continues progesterones

Question 30

what are protective factors against endometrial cancers?

Answer 30

Protective factors: COCP, mirena coil, more pregnancies, cigarette smoking

Question 31

when does ovarian cancer present?

Answer 31

Presents late due to non-specific symptoms

Question 32

when does vulval cancer present?

Answer 32

old age

Question 33

what is the aetiology of ovarian cancer?

Answer 33

Epithelial: most common dermoid cysts/ germ cell sex cord stromal

Question 34

what are dermoid cysts/ germ cell?

Answer 34

Dermoid cysts/ germ cell: teratomas (containing skin, teeth, hair and bone), may causes raised AFP and HCG

Question 35

what makes up 90% of vulval cancers?

Answer 35

90% are squamous cell carcinomas Less common – malignant melanomas

Question 36

what is the premaligant vulval cancer state?

Answer 36

Vulval intraepithelial neoplasia: premalignant condition affecting squamous epithelium High grade squamous intraepithelial lesion: HPV infection typically within younger

Question 37

what are the RF for ovarian cancers?

Answer 37

Age – peaks at 60 BRAC1 and BRAC2 Increased numbers of ovulations Obesity Smoking Recurrent use of clomifene

Question 38

what are thr RF for vulval cancers?

Answer 38

Advanced age – over 75 Immunosuppression HPV infection Lichen sclerosus -5% develop vulval cancer

Question 39

how does ovarian cancer present?

Answer 39

Non specific Abdo bloatinf Early satiety Loss of appetite Pelvic pain Urinary symptoms (frequency/ urgency) Weight loss Abdo/ pelvic mass Ascites

Question 40

how does vulval cancer present?

Answer 40

Incidental finding in older women eg during catheterisation in pt with dementia Vulval lump Ulceration Bleeding Pain Itching Lymphadenopathy in groin Usually in labia majora: irregular mass, fungating lesion, ulceration, bleeding

Question 41

how do you diagnose ovarian cancer?

Answer 41

2WW: if exam shows ascites, pelvic mass, abdo mass Ca125 blood test  check this in every women 50+ with those symptoms Pelvic US CT scan: diagnosis and staging Histology Paracentesis: test ascitic fluid for cancer cells <40 with complex ovarian mass: AFP, HCG

Question 42

what is stage 1 ovarian cancer?

Answer 42

confined to ovary

Question 43

what is stage 2 ovarian cancer?

Answer 43

spread past ovary but within pelvis

Question 44

what is stage 3 ovarian cancer?

Answer 44

outside pelvis but within abdo

Question 45

what is stage 4 ovarian cancer?

Answer 45

outside abdo - distant mets

Question 46

how do you diagnose vulval cancer?

Answer 46

Biopsy Sentinel node biopsy: demonstrate lymph node spread 2WW

Question 47

how do you manage ovarian cancer?

Answer 47

Specialist gynae oncology MDT Surgery/ chemo

Question 48

how do you manage vulval cancer?

Answer 48

Wide local excision to remove cancer Groin lymph node dissection Chemo Radiotherapy

Question 49

what is ovarian cancer prognosis?

Answer 49

poor More than 70% of pts present after it has spread beyond pelvis

Question 50

what is the vulval cancer prognosis?

Answer 50

Early staging – 5yr is 86% Late staging: 5yr is 54%

Question 51

what is krukenberg tumour?

Answer 51

mets of ovaries usually from GI cancer

Question 52

what do krukenberg tumours have on histology?

Answer 52

classic signet - ring cells

Question 53

what are protective factors against ovarian cancer?

Answer 53

Protective factors: COCP, breastfeeding, pregnancy

Question 54

what can cause raised Ca125?

Answer 54

endometriosis, fibroids, adenomyosis, pelvic infection, liver disease, pregnancy