Gynae malignancy Flashcards by Ellen Thomas

How does cancer metastasise?

Cells invade tumour border
The invade the circulatory system or the lymphatic system
They’re transported by blood or lymph vessels
They arrive at a different organ/location
They invade organ tissue and multiply causing a tumour

How well did you know this?

Not at all

Perfectly

What is:

proliferation
senescence
apoptosis?

Proliferation: increase in number of cells, cell replication

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

Apoptosis: programmed cell death

How well did you know this?

Not at all

Perfectly

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

How is this different in cancer cells?

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

How well did you know this?

Not at all

Perfectly

Describe the cell cycle?

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

How well did you know this?

Not at all

Perfectly

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

Give an example.

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

How well did you know this?

Not at all

Perfectly

What are oncogenes? How do they cause cancer?

Give an example?

Mutated genes whose presence stimulates the development of cancer

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

HER-2

How well did you know this?

Not at all

Perfectly

List the gynaecological cancers.

Uterine (includes endometrial)
Ovary
Cervix
Vulva

How well did you know this?

Not at all

Perfectly

What’s the endometrium?

The lining of the uterus

How well did you know this?

Not at all

Perfectly

What are the risk factors for endometrial cancer?

Unopposed oestrogen is the main risk factor

Endogenous:

nulliparity
early menarche and late menopause
obesity
PCOS

Exogenous:

HRT
Tamoxifen

Others:
- Diabetes

How well did you know this?

Not at all

Perfectly

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

Adenocarcinoma, oestrogen sensitive, less aggressive

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

How well did you know this?

Not at all

Perfectly

All endometrial tumours are oestrogen sensitive. True or false?

False, most are but not all.

How well did you know this?

Not at all

Perfectly

In what age group is endometrial cancer most prevalent?

Over 60

Post-menopausal women

How well did you know this?

Not at all

Perfectly

What are the clinical features of endometrial cancer?

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

How well did you know this?

Not at all

Perfectly

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

What’s the management?

Endometrial hyperplasia with atypia

Oestrogen acting unopposed or erratically

Close monitoring
Hysterectomy

How well did you know this?

Not at all

Perfectly

How is endometrial cancer staged?

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.)

How well did you know this?

Not at all

Perfectly

Investigations of suspected endometrial cancer?

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

How well did you know this?

Not at all

Perfectly

Management of endometrial cancer?

Hysterectomy + salpingo-oophorectomy

Adjuvant therapy if later stage or for palliation

radiotherapy
chemo

How well did you know this?

Not at all

Perfectly

What is a salpingo-oophorectomy?

Removal of fallopian tube and ovary

How well did you know this?

Not at all

Perfectly

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

Cervical intraepithelial neoplasia

How well did you know this?

Not at all

Perfectly

How is cervical intraepithelial neoplasia picked up?

From the cervical smear

How well did you know this?

Not at all

Perfectly

What types of cervical intraepithelial neoplasia are there?

1 - 3

Mild
Moderate
Severe

How well did you know this?

Not at all

Perfectly

Management of cervical intraepithelial neoplasia?

If 1 (mild), close observation

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

How well did you know this?

Not at all

Perfectly

What is cervical intraepithelial neoplasia?

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

Caused by dysplasia

Cells are dyskaryotic (abnormal, with large nuclei)

Which age group is prevalence of cervical cancer most common?

Between 25-49

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

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

What are the causes of cervical cancer?

HPV infection Smoking COCP Immunosupression

What are the risk factors for getting an HPV infection?

Multiple sexual contacts Unprotected sex Not having the vaccine

What does HPV stand for? How does HPV lead to cervical cancer?

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

What are the clinical features of cervical intraepithelial neoplasia?

None

What are the clinical features of cervical cancer?

Sometimes none Intermenstrual bleeding Offensive discharge

When is the HPV vaccination jab given?

Ages 12-13

How is cervical cancer staged?

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

Investigation of suspected cervical cancer?

Biopsy Examination under anaesthetic to assess for mets MRI

Management of cervical cancer?

Depends on stage Stage 1: cone biopsy (cone shaped area removed from entrance to cervix) Later: - hysterectomy - lymph node removal - chemo - radiotherapy

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

Vulval intraepithelial neoplasia

What is the vulva?

The area where the female external genitalia are From mons pubis anteriorly to perineum posteriorly to labia majora laterally

What causes vulval intraepithelial neoplasia (VIN)?

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)

What is lichen sclerosus? Symptoms, investigation and management)

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

Causes of vulval cancer?

Vulval intraepithelial neoplasia HPV Lichen sclerosus

How is vulval cancer staged?

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

Investigation and management of vulval cancer?

Ix: biopsy, sentinel lymph node biopsy Tx: - wide local excision - lymph node excision - radiotherapy if lymph involvement

What are the risk factors for ovarian cancer? What are protective factors?

More ovulations = higher risk So risk: - Nulliparity - Early menarche - Late menopause - Also family history Protective: - Pregnancy - Lactation - OCP

Presentation of ovarian cancer?

No symptoms in early stages, so often women present in later stages ``` Bloating Dyspepsia Change in bowel habit Abdo pain Urinary frequency Abnormal bleeding ```

In what age group is ovarian cancer most prevalent?

Older women, around age 60

Which genes are linked with ovarian cancer?

BRCA1 and 2

Investigations of ovarian cancer?

USS Ca125 CT

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

Germ cell tumours Secondary metastases

How is ovarian cancer staged?

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

Management of ovarian cancer?

Bilateral salpingo-oophorectomy Total abdominal hysterectomy Lymph node removal Chemo, if later stage

Which gynae malignancy has the worst prognosis? Which is most common?

Ovarian, because patients present late due to having no symptoms in early stages Endometrial is most common

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

They should be tested for HPV

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

Colposcopy clinic

What is done in colposcopy clinic?

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

What would you see on USS of ovarian malignancy?

Solid Multi-lobular Ascites (lots of fluid around) At least 4 papillary structures High colour content on Doppler?

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

Serous tumour: epithelial cells Dysgerminoma: germ cells Granulosa cell tumours: connective tissue cells

Common places for mets in ovarian cancer?

Peri-aortic and pelvic lymph nodes | Lungs