Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Obs & Gynae > Gynae Malignancy > Flashcards

Gynae Malignancy Flashcards

1
Q

Most common gynae malignancy

A

Endometrial cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

THE major risk factor for endometrial cancer

A

UNOPPOSED OESTROGEN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk factors/causes of unopposed oestrogen

A

High BMI
Anovulation - PCOS or perimenopause.
Granulosa cell tumours - secrete oestrogen.
Oestrogen replacement - Tamoxifen.
Nulliparity
DM
Hereditary non-polyposis colorectal cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Clinical features of endometrial cancer

A

Postmenopausal bleeding.
Irregular PV bleeding.
Menorrhagia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Investigating endometrial cancer

A

TVUS - primary care Ix, measure thickness of endometrium.
Endometrial biopsy for histology examination.
Diagnostic hysteroscopy if unable to obtain biopsy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Classification of endometrial cancer

A

Most are adenocarcinomas.

FIGO staging 1-4.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

FIGO stage 3 endometrial cancer

A

Over all = local/regional spread and invasion.
3A = spread to ovary.
3B = Spread to vaginal
3C = Spread to para-aortic lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management of endometrial cancer

A

Total hysterectomy + bilateral salpingo-oophorectomy + lymphadenectomy
Adjuvant radiotherapy/pallative chemotherapy e.g. carboplatin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Prognosis of endometrial cancer

A

Five year survival is close to 80%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cervical cancer common age presentations

A

in 30s and in 80s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Major risk factors for cervical cancer

A

Highly related to sexual activity and HPV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Risk factors for cervical cancer

A

Early age of sexual intercourse (less than 16yrs)
Multiple sexual partners.
STI
Multiparity
COCP use
History of cervical intra-epithelial neoplasia
Cigarrettes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CIN pathophysiology, staging and treatment

A

This is a pre-malignant stage where cervical cells are changing, most likely due to HPV.
Unable to see with naked eye. Picked up on smears and then colposcopy.
CIN 1 = confined to lower 1/3 of epithelium.
CIN2 = 1/3 to 2/3 thickness of epithelium.
CIN3 = covers more than 2/3 of epithelium.

CIN 1 Rx = re-assess in 1 year as can regress to normal.
CIN2 and 3 Rx = ablation or excision (LEEP).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clinical symptoms of cervical cancer

A

POST COITAL BLEEDING
Inter-menstrual bleeding.
Vaginal discharge (offensive) and vaginal pain.
In later stages can get urinary symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Classification of cervical cancer

A

Most are squamous cells.

FIGO stages 1-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

FIGO stage 3 cervical cancer

A

Carcinoma reached pelvis wall or lower third of vagina. Causes hydronephrosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Investigations for cervical cancer

A

Cervical biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management of cervical cancer

A

Stage 1ai= cone biopsy
Stages 1b-2b= hysterectomy and consider lymph nodes.
Stage 2b plus = chemo-radiotherapy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Most oncogenic HPV and oncoprotein they affect

A

16, 18 and 33 HPV and E6 and E7 oncoprotein.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is HPV transmitted

A

Sexually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When is the HPV vaccine offered

A

Girls, before first sexual intercourse as only effective if no present HPV, around 12yrs of age.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Screening timetable for HPV

A 
25-49yrs - every 3 years
50-64yrs - every 5 years
Continue in 65+ if Hx of abnormal tests.
HIV +ve - annual.
Transgender males still qualify for screening if they retain their cervix.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does the screening test look for

A

Historically - dyskaryosis of cervical epithelial (i.e. CIN)

From 2019 - Presence of HPV.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Results of cervical screen smear

A

No changes/normal = continue screening programme.
Low-grade dyskaryosis/borderline changes = test for HPV. If this is +ve –> Colposcopy. If this is -ve –>continue with screening programme.
High-grade dyskaryosis = Colposcopy.

HPV testing = triage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Colposcopy procedure

A

Apply chemical - acetic acid which is taken up by neoplastic cells and turn them white or iodine solution which stains normal tissues brown.
Take punch biopsy to confirm diagnosis.

26
Q

What strains does the HPV vaccine cover

A

6, 11, 16, and 18

27
Q

Ovarian cancer prognosis and why

A

Leading cause of death from gynae cancer, mostly asymptomatic so presents late.

28
Q

Main age of diagnosis of ovarian cancer

A

75-85years

29
Q

Clinical features of ovarian cancer

A

Asymptomatic? Abdo pain and bloating, abnormal PV bleeding, weight loss, loss of appetite, early satiety, fatigue. Can have palpable mass, urinary and bowel symptoms.

30
Q

Blood test in primary care for ovarian cancer

A

CA125, raised in 80% of cancers. Over 35 IU/ml arrange an ultrasound scan of the abdomen and pelvis.

31
Q

Investigations for ovarian cancer

A

CA125.
TVUS to image ovaries.
Diagnosis via biopsy.

32
Q

Risk factors for ovarian cancer

A

BRCA 1 and 2 genes (tumour suppressor genes)
FHx of ovarian or other cancers.
Increase in the number of ovulatory cycles = nulliparity, early menarche, late menopause.
IVF
HRT
Endometriosis
Cigarettes, obesity, exposure to asbestos.

33
Q

Factors which REDUCE the risk of ovarian cancer

A

Multiparity
Breastfeeding
Use of COCP
Early menopause.

34
Q

RMI

A

risk of malignancy index = U x M x CA125
U = ultrasound score (multilocality, solid area, metastasis, ascites, bilateral lesions)
M = menopausal status (pre =1 or post =3)
CA125 level
Low risk = under 25
Medium risk = 25-250
High risk = over 250

35
Q

Other causes of a raised CA125

A 
Peritoneal trauma
Endometriosis
PID
Ovarian cyst torsion
Pregnancy
HF
Other cancers e.g. lung, pancreatic.
36
Q

Management of ovarian cancer

A 
Surgical = hysterectomy plus bilateral sapling-oophorectomy. Lymph nodes if appropriate.
Chemotherapy = platinum agents
37
Q

Age group most commonly affected by vulval cancer

A

over 50s, mostly 70-80yr olds

38
Q

Most common type of vulva carcinoma

A

Squamous.

39
Q

Aetiology of vulva carcinoma

A

HPV
Vulval intra-epithelial neoplasia.
Lichen sclerosus.
Paget’s disease.

40
Q

Presentation of vulva carcinoma

A

Squamous cell carcinomas are rarely itchy (unlike VIN and lichen sclerosis)
Most present as lump or ulceration.

Vulval irriation or pain
Lump
Bleeding or discharge PV due to ulceration.
Dysuria.
Enlarged groin lymph nodes.
41
Q

Diagnosis of vulva carcinoma

A

Biopsy

42
Q

Lymph nodes for vulva carcinoma

A

Inguinal nodes

43
Q

Treatment of vulva carcinoma

A

Surgerical - local excision, lymph node removal, vulvectomy,
Radiotherapy +/- chemotherapy - shrink tumours pre-op.

44
Q

Lichen Sclerosus pathophys

A

Auto-immune. Inflammatory dermatitis. Elastic tissue turns to collagen. Pre-malignant.

45
Q

Signs and symptoms of lichen sclerosus

A

Itchy, sore.
Pale white atrophic area
Purpura
Changes occur in figure of 8/hour-glass shape around vulva.

46
Q

Investigations for lichen sclerosus

A

Clinical appearance diagnosis.
Biopsy if uncertain on diagnosis.
Skin swab.

47
Q

Management of lichen sclerosus

A

Topical steroids - Clobetasol propionate.

Review annually due to risk of malignancy.

48
Q

Vulval intra-epithelial neoplasia pathophys

A

Pre-malignant, pre-invasive neoplasia.

49
Q

Most common cause of VIN and risk factors.

A

HPV mostly HPV16. Smoking and immunocompromised.

50
Q

Clinical features of VIN

A 
Itching and burning.
Lumps/warts.
Itch and irritation
Pain
Asymptomatic
White or erythematous lesions on examination
51
Q

Diagnosis of VIN

A

Biopsy most show loss of squamous cell epithelium organisation.

52
Q

Management of VIN

A 
Can regress and resolve on its own.
Local excision.
Imiquimod cream
Vulvectomy (not recommended)
Follow up closely due to pre-malignancy.
53
Q

Risks and protective cancers and the COCP

A

Increased risk of breast and cervical cancer

Protective against ovarian and endometrial cancer

54
Q

3 inadequate smears in a row?

A

refer for colposcopy!

55
Q

Treatment for low grade CIN

A

LLETZ - large loop excision of transformed zone

56
Q

Sister Mary Joseph Nodule

A

Ovarian cancer metastasis to umbilicus

57
Q

Endometrial cancer TVUS

A

Refer for biopsy and hysteroscopy if thickness greater than 20mm pre-menopause and 4mm if post-menopause.

58
Q

Smearing during pregnancy

A

do it 12 weeks after birth.

59
Q

Level for a high CA125

A

Greater or equal to 35units/ml

60
Q

What cancer does PCOS increase the risk of?

A

Endometrial

61
Q

Sign seen in low-grade HPV cervical squamous cell carcinomas

A

Koilocytosis - ‘halo’ in cell.

Obs & Gynae (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions