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Obs&Gynae > gynae cancers > Flashcards

gynae cancers Flashcards

1
Q

who is most likely to be affected by cervical cancer?

A

Affects younger women within reproductive ages

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2
Q

who is most likely to be effected by endometrial cancers?

A

Postmenopausal mainly

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3
Q

what infection is cervical cancer linked to?

A

HPV

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4
Q

when is the HPV vaccination done?

A

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

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5
Q

what makes up 80% of cervical cancer?

A

80% are squamous cell carcinomas

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6
Q

what makes up 80% of endometrial cancer?

A

80% are adenocarcinoma and oestrogen dependent cancer

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7
Q

what is pre-cancerous for endometrial cancer?

A

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

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8
Q

what stimulates endometrial cancer?

A

Oestrogen stimulates growth

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9
Q

what increases risk of cervical cancer?

A

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)

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10
Q

what can increase risk of HPV infection?

A

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

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11
Q

what are RF for endometrial cancers?

A

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

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12
Q

how does cervical cancer present?

A

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

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13
Q

how should suspected cervical cancer be referred?

A

2ww

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14
Q

how would endometrial cancer present?

A

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

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15
Q

what diagnostics can be done for cervical cancer?

A

colposcopy
histology
biopsy

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16
Q

what would indicate cervical cancer on colposcopy?

A

ulceration, inflammation, bleeding, visible tumour indicative

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17
Q

on cervical histology, what would acetic acid show?

A

abnormal cells

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18
Q

what diagnostics can be done for endometrial cancer?

A

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

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19
Q

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

A

large loop excision/ cone biopsy

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20
Q

how do you manage stage 1 and 2 endometrial cancer?

A

total abdo hysterectomy with bilateral salpingo-ooporectomy

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21
Q

what is a salpingo-ooporectomy?

A

removing uterus, cervix and adnexa)

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22
Q

how do you manage more advanced stages of endometrial cancer?

A

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

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23
Q

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

A

chemo and radiotherapy

24
Q

how do you manage stage 4B cervical cancer?

A

combination of surgery, radio, chemo + palliative

25
Q

what is the prognosis of cervical cancer?

A

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

26
Q

what is the point of cervical screening?

A

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

27
Q

what is the current HPV NHS vaccine?

A

gardasil

28
Q

what does gardasil protect against?

A

many strains of HPV
protecting against genital warts and cervical cancer

29
Q

how can you treat endometrial hyperplasia?

A

Can treat endometrial hyperplasia with mirena coil, continues progesterones

30
Q

what are protective factors against endometrial cancers?

A

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

31
Q

when does ovarian cancer present?

A

Presents late due to non-specific symptoms

32
Q

when does vulval cancer present?

A

old age

33
Q

what is the aetiology of ovarian cancer?

A

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

34
Q

what are dermoid cysts/ germ cell?

A

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

35
Q

what makes up 90% of vulval cancers?

A

90% are squamous cell carcinomas
Less common – malignant melanomas

36
Q

what is the premaligant vulval cancer state?

A

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

37
Q

what are the RF for ovarian cancers?

A

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

38
Q

what are thr RF for vulval cancers?

A

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

39
Q

how does ovarian cancer present?

A

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

40
Q

how does vulval cancer present?

A

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

41
Q

how do you diagnose ovarian cancer?

A

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

42
Q

what is stage 1 ovarian cancer?

A

confined to ovary

43
Q

what is stage 2 ovarian cancer?

A

spread past ovary but within pelvis

44
Q

what is stage 3 ovarian cancer?

A

outside pelvis but within abdo

45
Q

what is stage 4 ovarian cancer?

A

outside abdo - distant mets

46
Q

how do you diagnose vulval cancer?

A

Biopsy
Sentinel node biopsy: demonstrate lymph node spread
2WW

47
Q

how do you manage ovarian cancer?

A

Specialist gynae oncology MDT
Surgery/ chemo

48
Q

how do you manage vulval cancer?

A

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

49
Q

what is ovarian cancer prognosis?

A

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

50
Q

what is the vulval cancer prognosis?

A

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

51
Q

what is krukenberg tumour?

A

mets of ovaries usually from GI cancer

52
Q

what do krukenberg tumours have on histology?

A

classic signet - ring cells

53
Q

what are protective factors against ovarian cancer?

A

Protective factors: COCP, breastfeeding, pregnancy

54
Q

what can cause raised Ca125?

A

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

55
Q
A

Obs&Gynae (17 decks)

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