Gynae cancers

Question 1

What are the screening guidelines for cervical cancer?

Answer 1

PAP test every 2 years from 18 to 20-70 or starting from 2 years after first having sexual intercourse, whichever is later
Ending at 70 yrs for women who have had 2 normal PAP tests within the last 5 years

Question 2

What are the risk factors for cervical cancer?

Answer 2

HPV
Multiple sexual partners
Smoking
Partner whose previous partner had cervical cancer

Question 3

Is there a vaccine for cervical cancer?

Answer 3

Yes, vaccine against oncogenic HPV types - 16, 18 (Gardasil)

Question 4

How might cervical cancer present?

Answer 4

Finding on PAP smear
Abnormal bleeding
Abnormal discharge
Acute renal failure (end stage)

Question 5

What are the Ix for cervical cancer?

Answer 5

Colposcopy 
Acetic acid - aceto-white epithelium 
CXR
CT/MRI
PET

Question 6

What is the management for HSIL?

Answer 6

Laser ablation
Loop excision
Cone biopsy
Follow up to exclude residual CIN and to detect recurrence

Question 7

What is the management for cervical cancer?

Answer 7

Surgery if early stage /chemotherapy: cone biopsy, radical hysterectomy and pelvic node dissection
Chemoradiation if stage IIa-IV: external beam radiation with carboplatin chemotherapy or brachytherapy
Follow up: 6-12 months colposcopy and smear, at 12 months HPV and cytology

Question 8

What are the Cx of cervical cancer?

Answer 8

Menopause from chemotherapy 
Toxicity of treatment
Fertility issues
Recurrent thrush
Deep dyspareunia
Persistent vaginal discharge

Question 9

What are the risk factors for vulval cancer?

Answer 9

HPV
Smoking
Chronic vulva/ irritation/ dystrophy 
VIN (precancer)
Paget's disease of vulva

Question 10

What are the Sx of vulval cancer?

Answer 10

Itch
Bleeding
Pain/ irritation 
Lump
Discharge
Asymptomatic

Question 11

What are the Ix for vulval cancer?

Answer 11

Incisional biopsy Pap smear

Colposcopy of cervix and vagina

Question 12

What are the risk factors for endometrial cancer?

Answer 12

Obesity
FHx
Unopposed oestrogen

Question 13

What are the Ix for endometrial cancer?

Answer 13

Transvaginal U/S - endometrial thickness
CA125
CXR
CT and MRI once dx is confirmed for staging

Question 14

How is endometrial cancer dx?

Answer 14

Pipelle endometrial sampling

Hysteroscopy D&C (gold standard)

Question 15

What is the management for endometrial cancer?

Answer 15

TAH/BSO + lymphadenectomy

If unfit for surgery/ fertility preservation if stage 1: radiotherapy, hormonal therapy

Question 16

What are some protective factors for ovarian cancer?

Answer 16

Multiparity
OCP
Breastfeeding 
Hysterectomy 
Tubal ligation

Question 17

What are the Sx of ovarian cancer?

Answer 17

Mostly asymptomatic until advanced
Abdominal swelling
Abdominal pain
Urinary Sx

Question 18

What are the Ix for for ovarian cancer?

Answer 18

Transvaginal U/S
CA125
Preoperative Ix: FBE, UECs, LFTs, CT, CEA, CXR

Question 19

What is the management for ovarian cancer?

Answer 19

Prophylactic surgery if mutation
Chemotherapy: carboplatinum, taxol
Surgery: TAH/BSO debulking surgery
Measure response via CA125, CT scanning and MRI

Question 20

What is gestational trophoblastic disease?

Answer 20

A group of rare tumours that involve abnormal growth of cells inside a woman’s uterus. These tumours start in the cells that would normally develop into the placenta during pregnancy.
Types of GTD include hydatidiform mole and choriocarcincoma.

Question 21

What are the features of a molar pregnancy (hydatidiform mole)?

Answer 21

Vaginal bleeding
Uterus larger than dates
bHCG >20000
Vesicular pattern on U/S

Question 22

What is the management for a molar pregnancy?

Answer 22

Surgical D&C
Serial bHCG
Anti D if Rh-ve
Notify mole registry 
Placenta for histopathology for subsequent pregnancies