Gynae Malignancy

Question 1

most common type of cervical cancer

Answer 1

squamous cell (80%)
adenocarcinoma (20%)

Question 2

what virus is linked to cervical cancer

Answer 2

HPV 16, 18, 33

Question 3

Risk factors for cervical cancer

Answer 3

HPV
Smoking
combined contraceptive pill
early sexual activity with many partners

Question 4

age group affected by cervical cancer

Answer 4

25-29 highest incidence

majority of cases women <45 years

Question 5

symptoms of cervical cancer

Answer 5

abnormal bleeding - intermenstrual / post coital
vaginal discharge
pelvic pain
increased urinary frequency / dysuria

Question 6

what is cervical intraepithelial neoplasia (CIN)

Answer 6

premalignant cervical changes at transformation zone of cervix (squamo-columnar junction)
- glandular epithelium changes to squamous epithelium

Question 7

stages of CIN

Answer 7

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

Question 8

treatment of CIN 2 + CIN 3

Answer 8

large loop excision of transitional zone

Question 9

screening for cervical cancer

Answer 9

smear test

• every 3 years 25-49 year olds
• every 5 years 50-64 year olds

Question 10

next step if 1st smear result inadequate

Answer 10

repeat smear

Question 11

next steps if persistent (>3) inadequate smear results

Answer 11

assess by routine colposcopy

Question 12

next steps if smear shows mild dyskaryosis

Answer 12

Test for HPV

• if negative she goes back to routine call
• if positive refer for routine colposcopy

Question 13

next steps if smear shows moderate dyskaryosis

Answer 13

urgent colposcopy – within 2 weeks

Question 14

next steps if smear shows severe dyskaryosis

Answer 14

urgent colposcopy – within 2 weeks

Question 15

stages of cervical cancer

Answer 15

stage 1: confined to cervix
stage 2: Invades uterus / upper vagina
stage 3: invades pelvic wall / lower vagina
stage 4: invades bladder / rectum

Question 16

treatment of cervical cancer beyond stage 2 if

• tumour < 4cm
• tumour > 4cm

Answer 16

<4cm = radical hysterectomy

> 4cm = chemotherapy + radiotherapy

Question 17

most common symptom of endometrial cancer

Answer 17

post menopausal bleeding

Question 18

most common type of endometrial cancer

Answer 18

adenocarcinoma (95%)

Question 19

risk factors for endometrial cancer

Answer 19

increasing age
obesity
oestrogen exposure (nulliparity, early menarche, late menopause, HRT)
tamoxifen

Question 20

what things are protective against endometrial cancer

Answer 20

smoking

combined contraceptive pill

Question 21

1st line investigation for suspected endometrial cancer

Answer 21

transvaginal USS for endometrial thickness

normal thickness <4mm

Question 22

diagnostic for endometrial cancer

Answer 22

hysteroscopy with biopsy

Question 23

treatment of endometrial cancer confined to uterus

Answer 23

totat hysterectomy (TAH) + bilateral salpingoopherectomy (BSO)

Question 24

Treatment of endometrial cancer that has spread outwith the uterus

Answer 24

TAH + BSO + radiotherapy

Question 25

peak age of presentation in ovarian cancer

Answer 25

60

Question 26

most common ovarian cancer

Answer 26

serous carcinoma (epithelial adenocarcinomas)

Question 27

symptoms of ovarian cancer

Answer 27

vague presentation:

• abdo bloating
• pelvic pain
• urinary symptoms
• weight loss

Question 28

risk factors for ovarian cancer

Answer 28

BRCA genes
obesity 
smoking 
early menarche, late menopause, nulliparity
HRT

Question 29

What marker can be raised in ovarian cancer

Answer 29

CA 125

Question 30

what else can raise CA 125 apart from ovarian cancer

Answer 30

endometriosis
menstruation
benign cysts
fibroids

Question 31

investigations of ovarian cancer

Answer 31

CA 125 blood test

USS

Question 32

diagnostic investigation for ovarian cancer

Answer 32

laparoscopy