Gynae - cancers

Question 1

What are 3 reasons to recall someone after a mammogram?

Answer 1

mass, microcalcification, parenchymal deformity/distortion, asymmetrical density, enlarged lymph nodes

Question 2

What age are people eligible for NHSBSP?

Answer 2

50-71

Can continue after this but they need to request it

Question 3

What are first line breast investigations for different ages of women?

Answer 3

<35 - exam and US
>/= 35 - exam, US and mammomogram
>40 - mammogram

Question 4

What are the 4 stages of NHSBSP?

Answer 4

1. Invitation
2. Screening mammography
3. Assessment - 5% recalled
4. Surgery & treatment

Question 5

How would you screen for breast cancer in women < 40?

Answer 5

Do MRI in younger women as the breast tissue is denser

Question 6

What are some risk factors of breast cancer?

Answer 6

Increased estrogen exposure - COCP, HRT, obesity post-menopause, early menarche
Less breastfeeding and pregnancy - these make breast tissue more stable so means less mutations
Alcohol - hormone made in the breakdown is carcinogenic

Question 7

What is the difference between grade and stage?

Answer 7

Grade - what it looks like histologically

Stage - anatomically (TNM)

Question 8

What are the two types of surgical treatments for breast cancer and indications for them?

Answer 8

Lumpectomy - small tumour (<25% total breast tissue), no previous radiotherapy, pre-operative chemo, patient choice
Mastectomy - large tumour relative to breast size, more than one tumour, if they want reconstruction, patient choice

Question 9

What are some adjunvant therapies for breast cancer?

Answer 9

Endocrine - tamoxifen if pre-menopausal (inhibits oestrogen receptor on breast cancer cells), aromatase if post-menopausal
radiotherapy - for anyone with lumpectomy and masectomy if it was aggressive
Chemo- for aggressive diseases
Trastuzumab - monoclonal antibody
Bisphosphonate - reduce chance of bone metastases

Question 10

What is the difference between BRCA 1 and 2?

Answer 10

1 - chromosome 17 - higher breast and ovarian risk

2 - chromosome 13

Question 11

What are the risk factors of endometrial cancer?

Answer 11

It is increasing in the UK as more overweight people in the UK = fat cells secrete oestrogen post-menopause

Question 12

What is the biggest symptom of endometrial cancer?

Answer 12

post menopausal bleeding

Question 13

What are the tests for endometrial cancer?

Answer 13

transvaginal US - first line

Hysteroscopy - endometrial biopsy

Question 14

How do you treat endometrial cancer?

Answer 14

Hysterectomy +/- pelvic lymph nodes

Radiotherapy and progesterone therapy

Question 15

What is the biggest risk factor for ovarian cancer?

Answer 15

More ovulation

Women in the UK are having earlier menarche, having less children

Question 16

When are cervical smears done?

Answer 16

women aged 25-49 every 3 years

Question 17

What are the symptoms of ovarian cancer?

Answer 17

Bloating/IBS symptoms
Abdominal pain and discomfort
ascites (increased protein)
change in bowel habit 
urinary frequency 
bowel obstruction
decreased appetite

decreased renal function, anaemia

Question 18

How would you test for ovarian cancer?

Answer 18

CA125
US of abdo and pelvis
risk of malignancy index - CA125, US and pre or post menopause

Question 19

What are the risk factors for cervical cancer?

Answer 19

HPV infection - especially a prolonged infection

early intercourse, multiple partners, lack of vaccination, lack of screening

Question 20

What is the risk factor for vulval cancer?

Answer 20

Lichen sclerosis - patches of skin that is easily damaged

Question 21

What are some symptoms of vulval cancer?

Answer 21

vulval itching or soreness
persistent lump
bleeding
pain on passing urine

Question 22

Name 3 breast canccer risk factors

Answer 22

genetics
smoking
obesity
oestrogen exposure - intrinsic or extrinsic

Question 23

How would you screen for breast cancer?

the buzzword

Answer 23

Triple assessment

• clinical examination
• radiological assessment
• histological assessment

Question 24

Which two views are taken for a mammogram?

Answer 24

CC - cranial-caudal

MLO - medio-lateral oblique

Question 25

What endocrine treatment would you give to pre-menopausal women?

Answer 25

Tamoxifen - inhibits oestrogen receptors in the breast cancer cells

Question 26

What endocrine treatment would you give to post-menopausal women?

Answer 26

aromatase inhibitors - inhibit aromatase enzyme which is responsible for the conversion of androgens to oestrogens

Question 27

What cells are attacked by chemotherapy?

Answer 27

Cells in the S phase of replication

- when each of the 46 chromosomes are replicated by the cell

Question 28

What are the 3 ways cancer cells can spread around the body?

Answer 28

lymphatic system
vascular system
direct

Question 29

How does a fibroadenoma typically present?

Answer 29

mobile, smooth, non-tender lump

about 10-40mm

Question 30

How would you treat a fibroadenoma?

Answer 30

Leave it alone unless

• rapidly growing
• symptomatic
• 3cm or more
• patient choice

Question 31

How would a breast cyst appear on US?

Answer 31

Very circular
Dark black
White underneath

Question 32

When can women get breast cysts?

Answer 32

Before the menopause or if they are on HRT

Question 33

What is a galactocele?

Answer 33

retention cyst containing milk

Question 34

What is a lipoma?

Answer 34

benign tumour of fat tissue

Question 35

What are symptoms of cervical cancer?

Answer 35

ectropian bleeding - abnormal bleeding
vaginal discharge and discomfort
urinary symptoms

Question 36

What is Meigs syndrome?

Answer 36

benign ovarian tumour with ascites and pleural effusion - resolves after tumour resection