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GYNAE > Gynae cancers > Flashcards

Gynae cancers Flashcards

1
Q

What is the effect of COCP on ovarian cancer?

A

Protective/reduce the risk

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2
Q

What is the mean age of diagnosis of ovarian cancer

A

63

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3
Q

What are 6 risk factors of ovarian cancer?

A
  1. FH - BRCA 1 + 2, HPNCC
  2. Early menarche
  3. Late menopause
  4. Nulliparity
  5. Smoking/obeisity
  6. Unopposed oestrogen use/other oestrogen modulators eg. Tamoxifen
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4
Q

What are the protective factors against ovarian cancer?(3)

A
  1. pregnancy
  2. Lactation
  3. Tubal ligation
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5
Q

Is there a screening programme for ovarian cancer?

A

NO - presents late

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6
Q

What do you offer high risk women for ovarian cancer?

A

Prophylactic sapling-oophrectomy

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7
Q

Clinical features of ovarian cancer (6)

A
  1. Non specific symptoms, usually present in later stages
  2. Abdominal bloating/distension or mass pain
  3. Loss of appetite
  4. Pelvic pain
  5. Increased urinary frequency and urgency
  6. Breast and GI symptoms
  7. Weight Loss
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8
Q

What signs do you see on examination of ovarian cancer? (4)

A
  1. Cachexia
  2. Abdominal/pelvic mass
  3. Ascites
  4. Breast examination
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9
Q

How does ovarian cancer spread? (3)

A
  1. Direct in the pelvis and abdominal transcoelomic spread

2. Lymphatic and rarely blood borne

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10
Q

What is the most common cellular type of ovarian cancer?

A
  1. 95% are epithelial cell carcinomas of which 75% are serous, 10% are clear cell and 10% are endomatrioid and 10
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11
Q

What are the Stages of ovarian cancer?

A

Stage 1: macroscopically confined in ovaries

Stage 1a: one ovary is affected with an intact capsule

Stage 1b: both ovaries are affected with an intact capsule

Stage 1c: 1a/b with tumour on the surface, ruptured capsule, cytologically positive ascites or positive peritoneal washings

Stage 2: disease extending into the pelvis/uterus/fallopian tubes

Stage 3: abnormal disease/affected lymph nodes

Stage 4: disease is beyond the abdomen eg. Lung or liver parynchyma

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12
Q

List 6 features of malignant ovarian cancer

A
  1. Rapid growth >5 cm
  2. Ascites
  3. Advanced age
  4. Bilateral masses
  5. Solid or septate nature on ultrasound scan
  6. Increased vascularity
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13
Q

How do you investigate ovarian cancer?

A

Bloods and CA125 –should be done in women above 50 with abdominal symptoms

If ca125 >35 IU/ml –needs urgent ultrasound pelvis and abdomen

<40years – AFP and HCG to rule out germ cell tumours

RMI (Risk of Malignancy Index)-

RMI >250 are referred to MDT

CT thorax abdopelvis

Further staging performed at surgery

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14
Q

What raises CA125

A
  1. Epithelial ovarian cancers
  2. Endometriosis
  3. Pregnancy
  4. PID
  5. Menstruation
  6. Other cancers like endometrial/fallopian tube
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15
Q

In which age group are Germ cell tumours common?

A

<30

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16
Q

How do we stage ovarian cancer?

A

surgical and histological

17
Q

What is the management for ovarian cancer?

A
  1. Midline laparotomy allows through assessment of pelvis/abdomen - staging
  2. Peritoneal washings for cytology
  3. TAH( Total Abdominal Hysterectomy)/BSO( Bilateral Salpingo oophorectomy)/Partial omentectomy With biopsies of peritoneal deposits
  4. Lymph node dissection if indicated
18
Q

When is Chemotherapy used in ovarian cancer?

A
  1. Stage 1a and Ib- not given
  2. Stage 1c- 6 cycles of carboplatin are given
  3. Stage 2 -4- carboplatin plus paclitaxel
19
Q

How do you treat Dysgerminomas?

A

Radiotherapy

20
Q

How do you treat borderline ovarian tumours?

A

preserve fertility by removing affected ovary and tube and meticulous follow up

21
Q

How do you follow up a patient with ovarian cancer?

A
  1. CA-125

2. CT scan to detect relapse

22
Q

What are poor prognostic signs of ovarian cancer?

A
  1. Advanced stage
  2. Poor cell differentiation
  3. Clear cell tumours
  4. Slow response to chemotherapy/radiotherapy
23
Q

How do you manage a patient with ovarian caner palliatively?

A
  1. Pain- analgesic ladder
    NSAIDS-low dose Codeine-high dose codeine-morphine
  2. Nausea and vomiting-antiemetics – anticholinergics/antihistaminic/ondansetron
  3. Heavy vaginal bleeding –high dose progesterone/radiotherapy
  4. Ascites may have to be drained
  5. Intestinal obstruction- stool softeners/enemas/cyclizine/ondansetron
24
Q

Which lymph node does ovarian cancer metastasise to?

A

Pelvic and Para-aortic

Inguinal

25
Q

What is the peak incidence of cervical cancer?

A

30’s and 80’s

26
Q

What are the two main cell types of cervical cancer and percentage?

A
  1. Adenocarcinoma -10%

2. Squamous cell - 90%

27
Q

Which type of cervical cancer has the worse prognoses?

A

Adenocarcinoma

28
Q

Name 5 causes of cervical cancer

A
  1. Non-familial
  2. CIN (cervical intraepithelial neoplasia) is a preinvasive stage
  3. HPV (16+18) associated
  4. Smoking associated
  5. Immunosuppression (HIV/steroids) accelerate process of CIN invasion
29
Q

List 4 clinical features of cervical cancer

A
  1. Post coital + intermenstrual bleeding
  2. Offensive vaginal discharge
  3. Pain is NOT an early feature
  4. Later stages: uremia, haematuria, rectal bleeding and pain

GYNAE (1 decks)

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