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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
How do you treat cervical intra-epithelial neoplasia?
large loop excision via colposcopy
26
What is the red flag for cervical cancer?
post-coital bleeding | can also get offensive discharge and inter-menstrual bleeding
27
Which types of HPV most likely to cause cervical cancer?
16 & 18
28
Name four risk factors for cervical cancer (they are all to do with catching HPV)
early intercourse lots of sexual contacts immunocompromised (e.g. HIV)
29
Why is there a link between HIV and cervical cancer?
more likely to catch HPV
30
As well as CIN, HPV can cause VIN. What does this stand for and what is it pre-malignant for?
Vulvar intra-epithelial neoplasia | Vulval cancer
31
What kind of carcinoma is cervical?
squamous cell carcinoma
32
Which investigation is diagnostic for cervical cancer? | What examinations are done to help stage cervical cancer?
biopsy = diagnostic vaginal and rectal Ex. help to stage
33
If cervical cancer is stage 1a, what is the treatment?
remove the cells with CONE BIOPSY
34
If cervical cancer has gone beyond stage 1a, what is the treatment?
radical hysterectomy | or chemo-radio therapy
35
If she wants to get pregnant, what is the treatment for fibroids that are causing subfertility?
myomectomy
36
Post-menopausal woman comes to GP complaining of vaginal dryness. On US there is a "5cm complex ovarian cyst". What do you do now?
urgent referral to gynae! any ovarian mass in post-menopausal woman needs to be investigated
37
On transvaginal US, what will it show if endometrial cancer?
thickness >5mm
38
On 2 week wait gynae referral for suspected endometrial Ca, what investigations?
transvaginal US endometrial biopsy HYSTEROSCOPY
39
Chronic inflammatory anogenital skin condition, caused by genetics or autoimmune. What's this?
lichensclerosis
40
what is lichen sclerosis?
chronic inflamatory anogenital skin condition | caused by genetics or autoimmune
41
two peaks of lichen sclerosis incidence?
pre-pubertal | post-menopausal
42
white atrophic patches on anogenital skin, ITCHING and dyspareunia. What do you suspect?
lichen sclerosis
43
what are the symptoms of lichen sclerosis?
white atrophic patches on anogenital skin itching dyspareunia
44
two complications of lichen sclerosis?
scarring / adhesion of labia | squamous cell vulval carcinoma
45
differentials for lichen sclerosis
lichen simplex (itchy dermatitis) thrush vulval Ca/ VIN
46
what is the treatment for lichen sclerosis?
topical steroid cream lube / dilators for dyspareunia follow up from vulval Ca
47
first get called for cervical smear at age 25. how often from then?
25-49 every 3 yrs | 50-64 every 5 yrs
48
smear results are reported as which three options?
normal inadequate abnormal
49
if a smear is reported as abnormal, this can be in what 5 varying degrees?
``` borderline mild dyskaryosis moderate dyskaryosis severe dyskaryosis neoplasia! ```
50
if 100 women have a smear, how many will be normal ? inadequate? abnormal?
normal - 93 inadequate - 2 abnormal - 6
51
if smear is borderline/mild dyskaryosis what happens?
test for HPV if pos - colp if neg - back to routine recall
52
if smear is abnormal moderate / severe, what happens?
colposcopy
53
smear is HPV positive with cell changes?
colposcopy
54
a 57 yr old. how often is she being called for smears?
every 5 yrs
55
a 30 yr old. how often is she being called for smears?
every 3 yrs
56
a 75 yr old. how often is she being called for smears?
no

Gynaecology (8 decks)

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