Gynae Cancers Flashcards
Endometrial Cancer
Adenocarcinoma of columnar endometrial gland cell (90%)
Rest: adenosquamous carcinoma –> poorer prognosis
Presentation
Post-menopausal bleeding (10% of PMB –>carcinoma)
Irregular or IMB in premenopausal
Recent-onset menorrhagia
Cervical smear may contain abnormal columnar cells
Associated with atrophic vaginitis
Inx
Pelvic examination normal
USS
Endomentrial biopsy (Pipelle or hysteroscopy)
MRI if suspected spread from histology/symptoms
Assess fitness: FBC, renal function, GTT, ECG
Tx
Surgical
75% present with stage I disease
TAH + BSO (laparoscopic or abdo)
Routine lymphadenectomy not benefical in early-stage disease
Radiotherapy
External beam
Following hysterectomy in high risk or lymph node involvement
Vaginal vault therapy
Reduces local recurrence
Does not improve survival
Other
Chemotherapy
high-risk early stage disease
Or end stage disease
Risk Factors (unopposed oestrogen) Exogenous oestrogen Obesity PCOS Nulliparity Late menopause Ovarian granulosa tumours --> secrete oestrogen Tamoxifen Lynch Type II syndrome HTN and DM associated
Protective: Pregnancy and COCP
Staging of Endometrial Cancer
Premalignant Disease
Oestrogen –> cystic hyperplasia of endometrium
Further stimulation leads to atypical hyperplasia = pre-malignant
May cause IBM or PMB
Atypical hyperplasia coexists with uterine carcinoma (40%)
If recognized and want to preserve fertility: monitor and give progestogens
FIGO Staging + Histologival Grading G1-3 (G1 =well-differentiated)
Stage 1: Lesion confined to uterus
a: <1/2 myometrium
b: >1/2 myometrium
Stage 2: As above but cervix is involved
Stage 3: Tumour invades through uterus
a: invades serosa or adenexae
b: vaginal and or paramterial
ci: pelvis node
3cii: para-aortic node
Stage 4: Further spread
a: in bowel/bladder
b: distant met
Uterine Sarcoma
Three categories
Malignant fibroids (leiomyosarcomas,): rapid painful enlargement of fibroid
Endometrial stromal tumours (vary from benign nodule to highly malignant sarcoma)
Mixed mullerian tumours (more common in old age)
Present with IBM or PMB
Tx: hysterectomy
Then
Radiotherapy and chemotherapy
Survival: poor 320% 5 year
Premalignant Vulval Disease
VIN
Can be: Usual Type (nearly all) HPV 16 Smoker Immunosupression Types: Warty, Basaloid, Mixed Malignancy: Warty or basaloid squamous cell carcinoma
Differentiated Type (following lichen sclerosis, older women) Keratinising squamous cell carcinoma
Tx:
Local surgical excision
Confirm histology and exclude invasive disease
Emollients/steroids may help
Carcinoma of Vulva
95% squamous cell carcinoma
Others: Melanoma, BCC, adenocarcinoma,
Often de novo but associated with: Lichen sclerosis Immunosupression Smoking Paget's disease of the vulva
Symptoms
Pruritus, bleeding and discharge
Mass
Spreads locally: Superficial inguinal –> Deep inguinal –> femoral –> external iliac
Ix
Biopsy
Tx
1a: wide local excision
Other stages Wide excision \+ groin lymphadenectomy Triple incision radical vulvectomy If not near midline --> unilateral excision only
Can use radiotherapy to shrink tumours post sugrery or if LN +
Carcinoma of the Vagina
Secondary Vaginal Carcinoma
Common
After local infiltration from cervical, endometrial or vulva carcinoma
Can be metastatic spread from endometrium or GI carcinoma
Primary Vaginal Carcinoma
Affects older women
Usually squamous cell
Discharge, bleeding, mass or ulcer
Tx
Vaginal radiotherapy
Radical surgery
Clear cell carcinoma: complication of maternal DES
present in teenagers
Radical surgery and radiotherapy –> good survival
Staging of Vulva Cancer
Stage 1: tumour confined to vulva/perineum
a: <2cm in size with stromal invasion <1mm
b: >2cm in size with stromal invasion >1mm
Negative nodes
Stage 2: tumour or any size with adjacent spread (lower urethra, vagina or anus)
Negative nodes
Stage 3: Tumour of any size with positive inguinofemoral nodes
Stage 4: Tumour invades upper urethra/vagina, rectum, bladder, bone (4a) or distant metastases (4b)
