Gynae cancers

Question 1

76 yo woman with pain in pelvic area, persistant bloating, change in toilet habit, back pain. No vag discharge or bleeding.
History of HRT, endometriosis and BRCA gene.
USS - mass left ovary
Most likely diag?

Answer 1

Ovarian cx - 75 % post menopausal

Question 2

28 yo woman with abnormal vag bleeding and discharge, last smear was 5 yrs ago, history of chlamydia

Answer 2

Cervical - STD indicate opportunity to have picked up Human Papilloma Virus - 90% of cerv cx related to HPV16/18
Most common cx in <35yo

Question 3

70 yo woman with itching, bleeding lump on vulva. History of Lichen sclerosus and Lichen planus

Answer 3

Vulval cancer

Question 4

90% of cervical cancer is caused by which 2 strains of HPV

Answer 4

HPV16 and HPV18

Question 5

This cancer is bimodal, with peaks in incidence at <30yo and 70-80yo

Answer 5

Cervical cx

Question 6

Commonest cancer in women in the UK

Answer 6

Breast - 30% of fem canx

Question 7

Commonest gynae cancer in UK

Answer 7

Uterus

Question 8

Commonest gynae cancer in world

Answer 8

Cervical - poor screening

Question 9

FIGO staging 1-4 what are the stages

Answer 9

1 Confined to local area
2 Local spread
3 Lymph node spread
4 Metastatic spread

Question 10

Screening available for 2 gynae cancers - which ones?

Answer 10

Cervical (HPV smear)

Ovarian - CA 125 tumour marker and transvaginal USS

Question 11

MRI scan indicated in local staging for which 2 cx

Answer 11

Cervical

Vulval

Question 12

Recently NICE has approved molecular therapy (Bevacizumab) for what cancer

Answer 12

Ovarian cancer - One caveat, though, is that by using the Anti-VEGF, you will minimise the ability of any wounds to revascularise too which may impact on overall healing.

Question 13

Endometrial cancer is mostly what type of tumour

Answer 13

Adenocarcinoma (95%)

Question 14

Risk factors for endometrial cx (5)

Answer 14

Tamoxifen (breast cx treatment)
Oestrogen only HRT
HTN
Diabetes
Obesity

Question 15

Type of cancer - vulval

Answer 15

SCC

Question 16

Risk factors for Vulval cx

Answer 16

Lichen sclerosus / Lichen planus
HPV
Pagets disease
Old age
Fam. history