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Women's Health > Gynae malignancy > Flashcards

Gynae malignancy Flashcards

1
Q

How does cancer metastasise?

A
  1. Cells invade tumour border
  2. The invade the circulatory system or the lymphatic system
  3. They’re transported by blood or lymph vessels
  4. They arrive at a different organ/location
  5. They invade organ tissue and multiply causing a tumour
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2
Q

What is:

  • proliferation
  • senescence
  • apoptosis?
A

Proliferation: increase in number of cells, cell replication

Senescence: when cells permanently stop replicating and growing without undergoing apoptosis

Apoptosis: programmed cell death

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3
Q

Cells only divide for a certain amount of time and then go into senescence. Why is this?

How is this different in cancer cells?

A

Normal cells have telomeres, which are repetitive DNA sequences at the end of each chromosome.

The telomere shortens during every cell replication, so after time it has shortened so much the cell no longer replicates (senescence)

Cancer cells lengthen their telomeres so they can keep replicating for longer

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4
Q

Describe the cell cycle?

A

G1: cellular organelles are replicated

S: chromosomes are replicated

G2: cell double checks and repairs any errors in chromosomes

Mitosis: cell splits into two identical cells

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5
Q

What are tumour suppressor genes? How do they cause cancer?

Give an example.

A

They code for proteins that regulate cell division

They’re like brakes that slow down or stop the cell cycle before S phase (when chromosomes are replicated)

When they’re mutated and not working there’s nothing to regulate cell division, so there’s too much cell division

p53

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6
Q

What are oncogenes? How do they cause cancer?

Give an example?

A

Mutated genes whose presence stimulates the development of cancer

They instruct cells to make proteins that stimulate excessive growth and division

HER-2

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7
Q

List the gynaecological cancers.

A

Uterine (includes endometrial)
Ovary
Cervix
Vulva

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8
Q

What’s the endometrium?

A

The lining of the uterus

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9
Q

What are the risk factors for endometrial cancer?

A

Unopposed oestrogen is the main risk factor

Endogenous:

  • nulliparity
  • early menarche and late menopause
  • obesity
  • PCOS

Exogenous:

  • HRT
  • Tamoxifen

Others:
- Diabetes

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10
Q

What are the features of the two main types of endometrial tumour?

A
  1. Adenocarcinoma, oestrogen sensitive, less aggressive

2. Serous or carcinosarcome, not oestrogen sensitive, more aggressive

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11
Q

All endometrial tumours are oestrogen sensitive. True or false?

A

False, most are but not all.

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12
Q

In what age group is endometrial cancer most prevalent?

A

Over 60

Post-menopausal women

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13
Q

What are the clinical features of endometrial cancer?

A

Post-menopausal bleeding is the main symptom, if a woman has this she has a 10% chance of having e. cancer

If they’re premenopausal then change in menstruation (irregular, heavier)

Abdo pain
Pain during sex

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14
Q

What is the name for the premalignant disease that precedes endometrial cancer? What causes it?

What’s the management?

A

Endometrial hyperplasia with atypia

Oestrogen acting unopposed or erratically

Close monitoring
Hysterectomy

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15
Q

How is endometrial cancer staged?

A

Stage 1: lesions in uterus only

Stage 2: in uterus and cervix

Stage 3: into local lymph nodes

Stage 4: further spread (bladder, bowel etc.)

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16
Q

Investigations of suspected endometrial cancer?

A

USS (more than 4mm is suspicious)

Endometrial biopsy is diagnostic.
Done via hysteroscopy or pipelle (tube up into uterus and grab a bit)

MRI to assess myometrial invasion

CXR to look for mets

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17
Q

Management of endometrial cancer?

A

Hysterectomy + salpingo-oophorectomy

Adjuvant therapy if later stage or for palliation

  • radiotherapy
  • chemo
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18
Q

What is a salpingo-oophorectomy?

A

Removal of fallopian tube and ovary

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19
Q

What’s the name of the pre-malignant condition that precedes cervical cancer?

A

Cervical intraepithelial neoplasia

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20
Q

How is cervical intraepithelial neoplasia picked up?

A

From the cervical smear

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21
Q

What types of cervical intraepithelial neoplasia are there?

A

1 - 3

  1. Mild
  2. Moderate
  3. Severe
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22
Q

Management of cervical intraepithelial neoplasia?

A

If 1 (mild), close observation

If 2-3 large loop excision of transformation zone (by ablation or laser)

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23
Q

What is cervical intraepithelial neoplasia?

A

Presence of atypical cells in the normal, squamous epithelium of the cervix

Caused by dysplasia

Cells are dyskaryotic (abnormal, with large nuclei)

24
Q

Which age group is prevalence of cervical cancer most common?

A

Between 25-49

25
Q

What type of cancer is cervical cancer usually? (i.e adenocarcinoma, squamous)

What about

  • endometrial cancer
  • vulval cancer
  • ovarian cancer
  • vaginal cancer
  • f. tube cancer
A

Cervical: squamous cell carcinoma

Endometrial is adenocarcinoma usually.

Vulval is squamous cell usually

Ovarian is often adenocarcinoma

Vaginal is squamous cell or adenocarcinoma

F. tube is serous cell

26
Q

What are the causes of cervical cancer?

A

HPV infection

Smoking
COCP
Immunosupression

27
Q

What are the risk factors for getting an HPV infection?

A

Multiple sexual contacts
Unprotected sex
Not having the vaccine

28
Q

What does HPV stand for?

How does HPV lead to cervical cancer?

A

Human Papilloma Virus

Some strains contain oncogenes which code for oncoproteins which transform genes of normal cells

Persistent infection with HPV is associated with cervical intraepithelial neoplasia

29
Q

What are the clinical features of cervical intraepithelial neoplasia?

A

None

30
Q

What are the clinical features of cervical cancer?

A

Sometimes none

Intermenstrual bleeding
Offensive discharge

31
Q

When is the HPV vaccination jab given?

A

Ages 12-13

32
Q

How is cervical cancer staged?

A

1-4

  1. cervix and uterus
  2. above + upper vagina
  3. above + lower vagina, pelvic wall, blocking ureter
  4. into bladder or rectum or beyond pelvis
33
Q

Investigation of suspected cervical cancer?

A

Biopsy

Examination under anaesthetic to assess for mets

MRI

34
Q

Management of cervical cancer?

A

Depends on stage

Stage 1: cone biopsy (cone shaped area removed from entrance to cervix)

Later:

  • hysterectomy
  • lymph node removal
  • chemo
  • radiotherapy
35
Q

What’s the name of the premalignant condition to vulval cancer?

A

Vulval intraepithelial neoplasia

36
Q

What is the vulva?

A

The area where the female external genitalia are

From mons pubis anteriorly to perineum posteriorly to labia majora laterally

37
Q

What causes vulval intraepithelial neoplasia (VIN)?

A

HPV and cervical intraepithelial neoplasia are associated

Also smoking, immune suppression

A more unusual type of VIN is associated with lichen sclerosus (thinning of vulval skin causing itching)

38
Q

What is lichen sclerosus? Symptoms, investigation and management)

A

Thinning of vulval skin due to loss of collagen

Causing severe pruritus, pink-white papules, parchment like skin, adhesions

Do a biopsy to rule out carcinoma

Treat with ultra-potent topical steroid

39
Q

Causes of vulval cancer?

A

Vulval intraepithelial neoplasia

HPV

Lichen sclerosus

40
Q

How is vulval cancer staged?

A

1-4

  1. confined to vulva, perineum
  2. local spread
  3. lymph node involvement
  4. into upper urethra, vagina, rectum, bone etc.
41
Q

Investigation and management of vulval cancer?

A

Ix: biopsy, sentinel lymph node biopsy

Tx:

  • wide local excision
  • lymph node excision
  • radiotherapy if lymph involvement
42
Q

What are the risk factors for ovarian cancer?

What are protective factors?

A

More ovulations = higher risk

So risk:

  • Nulliparity
  • Early menarche
  • Late menopause
  • Also family history

Protective:

  • Pregnancy
  • Lactation
  • OCP
43
Q

Presentation of ovarian cancer?

A

No symptoms in early stages, so often women present in later stages

Bloating
Dyspepsia
Change in bowel habit
Abdo pain
Urinary frequency
Abnormal bleeding
44
Q

In what age group is ovarian cancer most prevalent?

A

Older women, around age 60

45
Q

Which genes are linked with ovarian cancer?

A

BRCA1 and 2

46
Q

Investigations of ovarian cancer?

A

USS

Ca125

CT

47
Q

Aside from epithelial tumours (adenocarcinomas) what other type of ovarian cancer is seen?

A

Germ cell tumours

Secondary metastases

48
Q

How is ovarian cancer staged?

A

1-4

  1. Ovaries only
  2. Pelvis only
  3. Abdomen and pelvis
  4. Distant mets
49
Q

Management of ovarian cancer?

A

Bilateral salpingo-oophorectomy

Total abdominal hysterectomy

Lymph node removal

Chemo, if later stage

50
Q

Which gynae malignancy has the worst prognosis?

Which is most common?

A

Ovarian, because patients present late due to having no symptoms in early stages

Endometrial is most common

51
Q

What would happen next if a patient was found to have borderline changes on their cervical smear?

A

They should be tested for HPV

52
Q

What would happen if a patient was found to have borderline changes on their cervical smear and HPV positive?

A

Colposcopy clinic

53
Q

What is done in colposcopy clinic?

A

Acetic acid applied to cervix: abnormal cells have high keratin so they show up white

Schiller’s Iodine test: to detects glutamine, the abnormal cells have lower glutamine so they don’t go orangey-brown like the normal cells

54
Q

What would you see on USS of ovarian malignancy?

A

Solid

Multi-lobular

Ascites (lots of fluid around)

At least 4 papillary structures

High colour content on Doppler?

55
Q

What are the main types of ovarian cancer and what cells are thy made of?

A

Serous tumour: epithelial cells

Dysgerminoma: germ cells

Granulosa cell tumours: connective tissue cells

56
Q

Common places for mets in ovarian cancer?

A

Peri-aortic and pelvic lymph nodes

Lungs

Women's Health (23 decks)

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