Gynae Onc Flashcards

1
Q

Endometrial ca - Incidence

A

2.5% lifetime risk

Most common gynae malignancy in developed countries (second to cervix in developing countries)

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

Endometrial cancer - Risk factors (Type I)

A

Endometrioid (80%)

  • Obesity
  • Increased oestrogen exposure
  • Tamoxifen
  • HNPCC
  • PCOS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Endometrial cancer - Risk factors (Type II)

A

Serous/clear cell/mucinous (20%)

  • Age
  • Tumour mutations and aneuploidy
  • Possibly obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Endometrial cancer - Symptoms

A

90% PMB (10% of PMB is ca)
Pelvic pressure secondary to enlarging uterus
Haematometra/pyometra
Asymptomatic <5% - pap smear, conincidental imaging finding, hysterectomy for other cause

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

Endometrial cancer - Survival

A

Overall 75%

75% are stage 1

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

Endometrial cancer - Role of screening

A

No role in women without HNPCC
Most women have symptoms at an early stage
With HNPCC - ~50% lifetime risk endo ca (and 10% ov), so yearly TV USS and endo sampling from 30 or 5y younger than youngest affected relative

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

Endometrial hyperplasia and progression to malignancy

A
Simple 1%
Complex 3%
Simple w atypia 8%
Complex w atypia 30%
- if ca coexistent risk coexistent ov ca (5%PM, 25% preteen)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Endometrial cancer types

A
Endometrioid 80%
Mucinous 5%
Clear cell 5%
Papp serous 3%
Squamous Rare
Simulatenous w ovary 1-3% (most well differentiated with good prognosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

FIGO Staging Endometrial Ca

A

1a 50% myometrial invasion

2 cx stroma but not beyond uterus

30% 5y
3a/b local spread
3c nodal spread (pelvic or paraaortic)

10% 5y
4a bladder/bowel
4b distant mets or inguinal LN

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

Endometrial cancer - Prognostic factors

A

Good prognosis:

  • Young age
  • Endometrioid type
  • Low grade
  • Small size
  • ER/PR +
  • Diploid
  • No myometrial invasion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Difference complete vs partial molar pregnancy

A

COMPLETE:
- Usually diploid (usually all paternal 46XX)
- 25% chance persistent trophoblastic disease
- usually no foetal parts
PARTIAL:
- Usually triploid (69XXY, 69XXX)
- May have foetal parts
- 1-2% risk persistent trophoblastic disease

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

Types of persistent trophoblastic disease

A

Choreocarcinoma = malignant transformtation of molar tissue or de novo after normal pregnancy
Palcental site tumour = increasedhumal placental lactogen
Epithelioid trophoblastic tumour

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

Vulval cancer

  • Incidence
  • Age group
  • Type
A

2/100 000
Bimodal distribution - older w LS, younger w HPV
Types: (90% are primary, 10% mets)
- 90% Squamous
- 5% Melanoma
- 3% adenocarcinoma (Bart’s and Bechet’s)
- Other BCC and sarcoma

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

Vulval cancer - Risk factors

A
Age
Lichen sclerosis
Smoking
HPV
Previous gynaecological malignancy
VIN
Paget’s disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Vulvar cancer - metastatic pattern

A

30 % metastatic at the time of diagnosis
Nodes: inguinofemoral > pelvic
Local
Haematogenous

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

Vulval cancer - Rx

A

Individualised
1mm depth of invasion then LN assessment (if 4cm groin dissection)
2cm rule:
- cut a 2cm margin
- if >2cm then consider bilateral nodes
- with within 2cm of the midline consider bilateral nodes

17
Q

VIN - Types

A
  1. Usual type
    - HPV related
    - <30y
    - 95%
    - warty/basaloid
  2. Differentiated type
    - LS
    - 5%
    - High rate of progression to ca (?100%)
    - older women
18
Q

Vulval melanoma

A
Staged with Clark levels and Breslow thickness
Most > 50y
Worse prognosis than other types
No role for CTx
? role of interferon
19
Q

Vulval adenocarcinoma

A
Majority arise in Bartholin’s gland 
Homan’s criteria for diagnosis
- Correct anatomical location
- deep to labia major
- overlying skin is intact
- Recognisable residual gland
Rx:
- Radical excision and LN (inguinofemoral)
- primary RTx if fixed to underlying structure