Gynae malignancy Flashcards
what is the mc gynae cancer world-wide ?
endometrial
85% survival rate 5y at stage 1
All gynae malignancies have what staging?
imaging?
FIGO 1-4 Staging
imaging for staging = PET, CT AP, MRI
What is the most common type of endometrial cancer?
% and type of cell?
80% ADENOCARCINOMA (Glandular epithelium)
type 1 and type 2 endometrial cancer:
prognosis?
cause?
Type 1 - MC, Better prognosis, high oestrogen related
type 2 - Poor prognosis, atrophic, may resemble ovarian tumours, p53 Mutation (clear cell carcinoma, serous carcinoma)
RF for endometrial cancer?
unopposed oestrogen
genetic
what causes unopposed oestrogen causing endometrial cancer?
nulliparous, early menarche, late menopause, oestrogen only HRT, PCOS, Tamoxifen (breast cancer med), T2DM
What are protective factors?
COCP, IUS, Multiparty and breast feeding
What are some of the genetic factors causing endometrial cancer?
HNPCC (MLH/MSH Mutation auto dom)
KRAS
p53
PTEN
Sx of endometrial cancer?
typical PX?
ANY 50+ post menopausal women coming with unexplained post menopausal bleeding
+dysparanunia, pelvic mass, dysuria
what happens if this Px comes in?
2 WW cancer pathway referral
Dx for endometrial cancer?
bimanual exam = large and irregular uterus
1st = TV USS
GS = hysteroscopy and biopsy
what would be seen on TV USS?
How thick in the endometrium normally and abnormally?
> 5mm thick = worry
8mm if on HRT/Tamoxifen
if myometrium involved, may see subendometrial halo
what is the staging for endometrial cancer 1-4 and spread?
1 = uterus only
2 = + cervix
3 = + pelvis + lymph nodes
4 = + extra pelvic eg. mets to bladder, lungs, liver
Tx for stages 1,2,3+4?
1+2 = hysterectomy + bilateral salp
3+4 = debunking + adjuvant chemo
what is the survival rate for stage 1 making it 5 years for ovarian cancer?
25%
what are the 3 types of ovarian cancer and %?
epithelial 70%
germ cell 20%
sex cord 10%
+ 2^ from GIT (KRUKENBURN TUMOUR (signet ring adenocarcinoma) + 2^ from breast
epithelial + germ + sex cord - what types of cells?
MC serous, mucinous (large, rupture = pseudomyxoma peritones)
teratoma (hair and teeth), dysgerminoma
theca - granulosa (coffee bean nuclei on histopathology), sertoli-leydig, fibroma (meg syndrome)
RF for ovarian cancer?
unstopped oestrogen (as endometrial)
BRCA 1+2 Genes
Sx of ovarian cancer?
typical Px?
50+ post menopausal female with first Time IBS-like or GI Sx
bloating, constipation, indigestion, abdo pain vague, dysuria/retention
+/- mets (eg. jaundice)
Dx of ovarian cancer?
1st = TV USS (Complex cysts - multilocular bilateral free fluid heterogeneous)
+ CA 125
GS = Pipelle biopsy
when do you do TV USS?
only do it then CA 125 IS 35 IU/L or greater
Other causes for raised CA 125?
Menstruation
benign cysts
PID
What would you consider testing for in germ cell?
AFP + BetahCG
What is RMI and how do we access it?
Risk of malignancy index
Menopause status + CA 125 + USS Findings
250+ = specialist assessment for biopsy
what is the staging for ovarian cancer and location of spread?
1 = ovaries
2 = + pelvis
3 = + peritoneum/LNs
4 = + distant mets (liver, brain, bowel)
Tx for each stage?
1 = hyst + b/l salp
2-4 = debunking + adjuvant chemo (cisplatin)
what are pre surgery bloods that are done?
FBC = Anemia
U+E = renal function
Crossmatch group and save = transfusion
clotting screen = DIC/Bleeding risk
what are 2 comps of ovarian cancer?
stroma ovarii
meig syndrome
What is stroma ovarii?
high t4 due to ovarian tumour (teratoma) - comprising ectopic thyroid tissue
what is meig syndrome ?
fibroma (benign) = ovarian fibroma + ascites + pleural effusion
Who does cervical cancer mostly affect?
age?
30-45 y sexually active females
what are the 2 types of cervical cancer and %?
squamous - 90%
adenocarcinoma - 10%
RF for cervical cancer?
high risk HPV strains
Unprotected sexual intercourse (non screening)
Non HPV vaccinated
COCP Use
HIV
Smoking
Immunosuppression
which strains of HPV Can cause cervical cancer?
16, 18, 31, 45 (inhibit p53 + tumour supressor genes)
what can HPV 6 + 11 Cause?
genital warts and oral ulcers
what is the 5 year survival rate for stage 1 and stage 2 cervical cancer?
stage 1 = 95%
stage 2 = 5%
SCREENING IS KEY
when is cervical screening done, at what ages and how often?
25 - 49 = every 3 years
50-65 = every 5 years
what 3 tests are conduced for cervical screening?
PAP smear, cytology biopsy, colposcopy
how often do people with HIV get cervical screening done?
annually
what happens if someone gets an inadequate sample?
what happens if this happens again?
inadequate sample
again in 3 months
happens again
3 months
AGAIN!!!
= colposcopy
what happens if a high risk HPV strain comes back positive but the cytology is normal?
what happens if this happens again?
12 months recall
same again
12 months
AGAIN!!!
colposcopy
when should a PAP smear be avoided?
menstruation
PID
<12 months Postpartum, TOP or miscarriage
what does CIN stand for?
cervical intraepithelial neoplasia
what are the 3 results it can come back as?
CIN 1 = not worrying
CIN 2 = Moderate dyskaryosib = risk of ca
CIN 3 = Major dyskaryosus - cervical cancer in situ
Sx:
early?
later?
early = aSx
later = cervicitis =
post coital/intermentrual bleeding,
abnormal discharge increased,
vaginal DISCOMFORT
Dx of cervical cancer?
Screening
exam = speculum = erosions, masses, ulcers
colposcopy + biopsy
what are the FIGO levels of spread for cervical cancer?
- Cervix (A=Microscopic, B=Visible)
- upper 2/3 vagina
- lower 1/3 vagina or pelvic wall
- bladder/rectum/extrapelvic
Tx for:
CIN?
1-2A?
2B-4A?
4B?
Large loop excision of the transformational zone (LLETZ)
Hysterectomy and chemo
Cisplatin chemo +/- radio
Cisplatin + bevacizumab (VEGF blocker - vascular endothelial GF)
=PALLIATIVE CHEMO
What are the 2 types of vulval cancers?
age it affects?
squamous - 90%
melanoma - 10%
(sunbed use)
35-55 y/o
RF for vulval cancers?
younger?
older?
younger = HPV associated, unprotected sex
older = lichen sclerosis (kravosis vulvae)
Sx of vulval cancer?
vulvadynia!!!! (pain)
superficial dysparanunia
ulcers
inguinal lymadenopathy
Dx for vulval cancer?
2 WW for biopsy
Tx for figo 1A and 1B+
1A = <2cm - wide local excision (+ LN removal)
1B+ = 2+ cm or 1+ cm deep
vulvectomy + B/L LN removal
