Gynae Malignancy Flashcards
most common type of cervical cancer
squamous cell (80%) adenocarcinoma (20%)
what virus is linked to cervical cancer
HPV 16, 18, 33
Risk factors for cervical cancer
HPV
Smoking
combined contraceptive pill
early sexual activity with many partners
age group affected by cervical cancer
25-29 highest incidence
majority of cases women <45 years
symptoms of cervical cancer
abnormal bleeding - intermenstrual / post coital
vaginal discharge
pelvic pain
increased urinary frequency / dysuria
what is cervical intraepithelial neoplasia (CIN)
premalignant cervical changes at transformation zone of cervix (squamo-columnar junction)
- glandular epithelium changes to squamous epithelium
stages of CIN
CIN 1: mild dysplasia, no treatment
CIN 2: moderate dysplasia, likely to progress to cancer without treatment
CIN 3: severe dysplasia, will progress to cancer without treatment
treatment of CIN 2 + CIN 3
large loop excision of transitional zone
screening for cervical cancer
smear test
- every 3 years 25-49 year olds
- every 5 years 50-64 year olds
next step if 1st smear result inadequate
repeat smear
next steps if persistent (>3) inadequate smear results
assess by routine colposcopy
next steps if smear shows mild dyskaryosis
Test for HPV
- if negative she goes back to routine call
- if positive refer for routine colposcopy
next steps if smear shows moderate dyskaryosis
urgent colposcopy – within 2 weeks
next steps if smear shows severe dyskaryosis
urgent colposcopy – within 2 weeks
stages of cervical cancer
stage 1: confined to cervix
stage 2: Invades uterus / upper vagina
stage 3: invades pelvic wall / lower vagina
stage 4: invades bladder / rectum
treatment of cervical cancer beyond stage 2 if
- tumour < 4cm
- tumour > 4cm
<4cm = radical hysterectomy
> 4cm = chemotherapy + radiotherapy
most common symptom of endometrial cancer
post menopausal bleeding
most common type of endometrial cancer
adenocarcinoma (95%)
risk factors for endometrial cancer
increasing age
obesity
oestrogen exposure (nulliparity, early menarche, late menopause, HRT)
tamoxifen
what things are protective against endometrial cancer
smoking
combined contraceptive pill
1st line investigation for suspected endometrial cancer
transvaginal USS for endometrial thickness
normal thickness <4mm
diagnostic for endometrial cancer
hysteroscopy with biopsy
treatment of endometrial cancer confined to uterus
totat hysterectomy (TAH) + bilateral salpingoopherectomy (BSO)
Treatment of endometrial cancer that has spread outwith the uterus
TAH + BSO + radiotherapy
peak age of presentation in ovarian cancer
60
most common ovarian cancer
serous carcinoma (epithelial adenocarcinomas)
symptoms of ovarian cancer
vague presentation:
- abdo bloating
- pelvic pain
- urinary symptoms
- weight loss
risk factors for ovarian cancer
BRCA genes obesity smoking early menarche, late menopause, nulliparity HRT
What marker can be raised in ovarian cancer
CA 125
what else can raise CA 125 apart from ovarian cancer
endometriosis
menstruation
benign cysts
fibroids
investigations of ovarian cancer
CA 125 blood test
USS
diagnostic investigation for ovarian cancer
laparoscopy
