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Gynaecology > Gynae cancers > Flashcards

Gynae cancers Flashcards

1
Q

Which cancer is caused by high oestrogen unopposed by progesterone?

A

endometrial cancer

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2
Q

more ovulation = higher risk of which cancer?

A

ovarian cancer

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3
Q

what kind of cancer is vulval cancer

A

squamous cell carcinoma

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4
Q

How do you calculate the Risk of Malignancy Index for ovarian cancer? What do you do if the score is >250?

A

CA125 x US x menopausal status = >250? gynae referral

score 3 for post menopausal and 1 for pre

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5
Q

If ovarian cancer if pre-menopausal, what type of cancer is it more likely to be?

A

germ cell carcinoma (as opposed to epithelial cell)

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6
Q

If an ovarian cancer is pre-menopausal, it is more likely to be germ cell carcinoma, so what investigations would be relevant?

A

bHCG, AFP, HDL

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7
Q

What are the two key investigations for ovarian cancer?

A 
CA125 
ultrasound (TV or abdo)

(if they have abdo mass, refer urgently to gynae before waiting for these results)

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8
Q

Why is ovarian cancer dubbed the “silent killer”?

A

It presents late

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9
Q

Ovarian cancer is more likely if you’ve had more ovulation! With that in mind give me three risk factors

A

nulliparity
early menarche
late menopause

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10
Q

Ovarian cancer is more likely if you’ve had more ovulation! With that in mind give me three protective factors

A

COCP
pregnancy
lactation

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11
Q

Ovarian cancer can often be mets. Where do these tend to come from?

A

breast

gut (krukenberg)

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12
Q

What is the treatment for ovarian cancer?

A

Debulking chemo, then…

Hysterectomy + Bilateral Salpingo-Oophorectomy

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13
Q

What is the treatment for endometrial cancer?

A

Hysterectomy + Bilateral Salpingo-Oophorectomy

plus, adjuvant radio

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14
Q

What staging is used for endometrial cancer?

A

FIGO staging 1-4

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15
Q

What is the red flag for endometrial cancer?

A

post-menopausal bleeding

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16
Q

What kind of cancer is endometrial cancer usually?

A

adenocarcinoma

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17
Q

What are the investigations for endometrial cancer?

A

Transvaginal US
Endometrial biopsy
Hysteroscopy

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18
Q

Give me two examples of drugs which cause high oestrogen unopposed by progesterone in the uterus (increasing risk of endometrial cancer)?

A

oestrogen-only HRT
Tamoxifen

(tamoxifen decreases oestr in breast but increases oestr in uterus)

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19
Q

Why don’t you put a woman with a uterus on oestrogen-only HRT?

A

risk of endometrial cancer (oestrogen unopposed by progesterone)

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20
Q

Endometrial cancer is risked when high oestrogen unopposed by progesterone. With this in mind, give me some RFs (not including drugs)?

A

nulliparity, late menopause, obesity, PCOS

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21
Q

Give me three key risk factors for vulval cancer

A

> 60yrs
lichen sclerosis
VIN

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22
Q

80 yr old lady with vulval pruritis, bleeding and discharge. On examination you find a mass in the labia majora. What investigation do you do?

A

biopsy

suspect vulval cancer

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23
Q

What is the treatment for vulval cancer?

A

wide local excision OR radical vulvectomy

24
Q

What is the pre-malignant for cervical cancer?

A

CIN (cervical intraepithelial neoplasia)

25
Q

How do you treat cervical intra-epithelial neoplasia?

A

large loop excision via colposcopy

26
Q

What is the red flag for cervical cancer?

A

post-coital bleeding

can also get offensive discharge and inter-menstrual bleeding

27
Q

Which types of HPV most likely to cause cervical cancer?

A

16 & 18

28
Q

Name four risk factors for cervical cancer (they are all to do with catching HPV)

A

early intercourse
lots of sexual contacts
immunocompromised (e.g. HIV)

29
Q

Why is there a link between HIV and cervical cancer?

A

more likely to catch HPV

30
Q

As well as CIN, HPV can cause VIN. What does this stand for and what is it pre-malignant for?

A

Vulvar intra-epithelial neoplasia

Vulval cancer

31
Q

What kind of carcinoma is cervical?

A

squamous cell carcinoma

32
Q

Which investigation is diagnostic for cervical cancer?

What examinations are done to help stage cervical cancer?

A

biopsy = diagnostic

vaginal and rectal Ex. help to stage

33
Q

If cervical cancer is stage 1a, what is the treatment?

A

remove the cells with CONE BIOPSY

34
Q

If cervical cancer has gone beyond stage 1a, what is the treatment?

A

radical hysterectomy

or chemo-radio therapy

35
Q

If she wants to get pregnant, what is the treatment for fibroids that are causing subfertility?

A

myomectomy

36
Q

Post-menopausal woman comes to GP complaining of vaginal dryness. On US there is a “5cm complex ovarian cyst”. What do you do now?

A

urgent referral to gynae!

any ovarian mass in post-menopausal woman needs to be investigated

37
Q

On transvaginal US, what will it show if endometrial cancer?

A

thickness >5mm

38
Q

On 2 week wait gynae referral for suspected endometrial Ca, what investigations?

A

transvaginal US
endometrial biopsy
HYSTEROSCOPY

39
Q

Chronic inflammatory anogenital skin condition, caused by genetics or autoimmune. What’s this?

A

lichensclerosis

40
Q

what is lichen sclerosis?

A

chronic inflamatory anogenital skin condition

caused by genetics or autoimmune

41
Q

two peaks of lichen sclerosis incidence?

A

pre-pubertal

post-menopausal

42
Q

white atrophic patches on anogenital skin, ITCHING and dyspareunia. What do you suspect?

A

lichen sclerosis

43
Q

what are the symptoms of lichen sclerosis?

A

white atrophic patches on anogenital skin
itching
dyspareunia

44
Q

two complications of lichen sclerosis?

A

scarring / adhesion of labia

squamous cell vulval carcinoma

45
Q

differentials for lichen sclerosis

A

lichen simplex (itchy dermatitis)
thrush
vulval Ca/ VIN

46
Q

what is the treatment for lichen sclerosis?

A

topical steroid cream
lube / dilators for dyspareunia

follow up from vulval Ca

47
Q

first get called for cervical smear at age 25. how often from then?

A

25-49 every 3 yrs

50-64 every 5 yrs

48
Q

smear results are reported as which three options?

A

normal
inadequate
abnormal

49
Q

if a smear is reported as abnormal, this can be in what 5 varying degrees?

A 
borderline
mild dyskaryosis
moderate dyskaryosis
severe dyskaryosis
neoplasia!
50
Q

if 100 women have a smear, how many will be normal ? inadequate? abnormal?

A

normal - 93
inadequate - 2
abnormal - 6

51
Q

if smear is borderline/mild dyskaryosis what happens?

A

test for HPV
if pos - colp
if neg - back to routine recall

52
Q

if smear is abnormal moderate / severe, what happens?

A

colposcopy

53
Q

smear is HPV positive with cell changes?

A

colposcopy

54
Q

a 57 yr old. how often is she being called for smears?

A

every 5 yrs

55
Q

a 30 yr old. how often is she being called for smears?

A

every 3 yrs

56
Q

a 75 yr old. how often is she being called for smears?

A

no

Gynaecology (8 decks)

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