Gynae cancers

Question 1

Cervical cancer:

• Definition
• Symptoms and signs
• Risk factors
• Complications
• What is CIN + types
• Investigations
• Management

Answer 1

Cervical cancer:

• Definition: scc
• Symptoms and signs : pelvic pain, unusual bleeding, discharge bloody
• Risk factors: no screening, age, hpv16/18, smoking, hiv
• Complications: vte, anaemia
• What is CIN + type: dysplasia. if CIN2/3 needs excisional ablation via loop excision of transformation zone
• Investigations: preg test, sti swabs, fbc/crp, colposcopy
  Screening 25-50 every 3 years, 50-64 every 5 years
• Management: hysterectomy (cone biopsy if wants children) +/- chemo

Question 2

Endometrial cancer:

• Definition
• Met locations
• Causes: endogenous + exogenous
• Risk factors
• Protective factors
• Symptoms + signs
• Investigations
• Management
• Complications

Answer 2

Endometrial cancer:

• Definition: adenocarc
• Met locations : intraperitoneal, lung, bone, brain
• Causes: endogenous + exogenous
• Risk factors: obesity, nullparity, early menarche, late menopause, t2dm, pcos, hnpcc, tamoxifen/hrt
• Protective factors: smoking, multiple, cocp
• Symptoms + signs: post menopausal bleeding, discharge, pain, enlarged uterus
• Investigations: transvag uss + biopsy (>4mm post menopausal, >12 mm pre)
• Management: TAH + bilat salpingoorphrectomy, + radio if high risk. Progesterone if palliative
• Complications: hysterectomy (enterocoele, vag prolapse, urin retention)

Question 3

Ovarian cancer:

• Definition + types
• Risk factors
• Protective factors
• Symptoms + signs
• Investigations
• Management

Answer 3

Ovarian cancer:

• Definition + types: epithelial cell (serous most common), sex, gc (benign). Most commonly spreads to paraaortic which drains to ovaries/fallopian tubes.
• Risk factors: age, fx, brca1/2, breast cancer, ovarian cysts, early menarche/late menop
• Protective factors : breast feeding, multiple, hysterectomy
• Symptoms + signs: early satiety, abdo pain, diarrhoea, urin symptoms, pelvic pain, pelvic mass, ascites, fixed immobile uterus
• Investigations : ca125 (also inc in endomet/fibrosis/infection/preg) and if high urgent abdo uss, transvag uss, explorative laprotomy diagnostic
• Management : surgery, chemo

Question 4

Vulval cancer:

• Definition
• Risk factors
• Symptoms
• What is VIN
• Investigations
• Management

Answer 4

Vulval cancer:

• Definition : scc
• Risk factors : lichen sclerosis, immunosupp, hpv16/18, >75, VIN, smoking
• Symptoms : lump, inguinal lymphadenopathy
• What is VIN: needs WLE, imiquimod, laser ablation. Risk f: hpv16/18, smoking, hsv1/2, lichen sclerosis
• Investigations
• Management: punch biopsy, wle, vulvectomy, groin lymph node dissection

Question 5

Post menopausal bleeding causes
- ix

Answer 5

• causes: atrophic vaginitis, endomet hyperplasia, endomet ca, cervical ca, ovarian cancer, vaginal ca, trauma, hrt, bleeding disorders
• ix >55 + post meno 2ww uss