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Obs Gynae > Gynae Oncology > Flashcards

Gynae Oncology Flashcards

1
Q

Most common types of cervical cancer?

A

SCC (80%)
adenocarcinoma (20%)

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2
Q

RFs for cervical cancer?

A

HPV !!!!!! (16,18,31)
incr. risk of exposure to HPV (young age at sexual intercourse, UPSI, incr. no. of sexual partners)
non-engagement with cervical screening programme
smoking
HIV, immunocompromised
COCP
multiparity
FHx
diethylstilbestrol exposure

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3
Q

Presentation of cervical ca?

A

asymptomatic (picked up through cervical screening)
abnormal vaginal bleeding (PMB, PCB, IMB)
vaginal discharge
pelvic pain
dyspareunia
ulceration, inflammation, bleeding, visible tumour on speculum exam

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4
Q

If suspected cervical ca on speculum exam, what to do?

A

urgent referral to colposcopy
do not take smear test

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5
Q

Colposcopy procedure?

A

colposcope used to visualise cervix
stains can be used
acetic acid (abnormal cells turn white ‘acetowhite’_
iodine (abnormal cells don’t stain)
can perform punch biopsy or LLETZ for tissue sample

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6
Q

When is LLETZ indicated?

A

Large Loop Excision of Transition Zone
CIN II and III
‘see and treat’ during colposcopy

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7
Q

Complications post-LLETZ?

A

bleeding
discharge
infection
if repeated or large biopsy -> incr. risk of cervical incompetence -> incr. risk of pregnancy loss or pre-term labour

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8
Q

Indications for Cone Biopsy?

A

CIN
Cervical Ca Stage 1A

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9
Q

Complications of Cone Biopsy?

A

pain
bleeding
infection
stenosis of cervix (scarring)
incr. risk of miscarriage and pre-term labour

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10
Q

Staging of Cervical Ca?

A

FIGO staging
Stage 1 - cervix
1A - microscopic
1B - gross lesion
Stage 2 - uterus or upper 2/3 of vagina
2A - no parametrial involvement
2B - obvious parametrial involvement
Stage 3 - pelvic sidewall or lower 1/3 of vagina
3A - no extension to sidewall
3B - extension to sidewall +/- hydronephrosis
Stage 4 - extension
4A - bladder or rectum
4B - distant mets

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11
Q

Management of Stage 1A cervical ca?

A

gold standard is hysterectomy +/- LN clearance
fertility-preserving -> cone biopsy with close follow up

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12
Q

Management of Stage 1B/2A cervical ca?

A

radical hysterectomy + LN clearance
chemo (cisplatin)
radiation (brachytherapy or external beam)

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13
Q

Management of stage 2b and 3 cervical ca?

A

chemo (cisplatin)
radiation (brachytherapy or external beam)

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14
Q

Management of stage 4 cervical ca?

A

palliative chemorads
Sx -> anterior/posterior/total pelvic exenteration

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15
Q

5yr survival rate of cervical cancer?

A

Stage 1 - 96%
Stage 2 - 54%
Stage 3 - 38%
Stage 4 - 5%

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16
Q

Post-menopausal bleeding is….?

A

endometrial cancer until proven otherwise

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17
Q

What type of cancer is endometrial ca?

A

80% adenocarcinoma
oestrogen-dependent cancer (unopposed oestrogen stimulates growth)

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18
Q

Risk Factors for endometrial ca?

A

exposure to unopposed oestrogen:
incr. age
early menarche
late menopause
oestrogen only HRT
nulliparity
obesity
PCOS
tamoxifen

T2DM
HNPCC

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19
Q

Protective factors against endometrial ca?

A

COCP
Mirena
incr. pregnancies
smoking

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20
Q

Endometrial protection in PCOS?

A

COCP
Mirena
Cyclical progesterones to induce withdrawal bleed

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21
Q

Presentation of endometrial ca?

A

PMB!!!!!!!!
PCB
IMB
unusually heavy menstrual bleeding
abnormal vaginal discharge
haematuria
anaemia
raised platelet count

22
Q

When to refer for endometrial ca?

A

‘2 week wait’ in all postmenopausal bleeding
TVUS in > 55yrs with visible haematuria or unexplained vaginal discharge

23
Q

Investigations for endometrial ca?

A

TVUS (endometrial thickness >4mm)
Pipelle biopsy (highly sensitive, useful for exclusion)
Hysteroscopy with endometrial biopsy

24
Q

Staging of endometrial ca?

A

FIGO Staging
Stage 1 - confined to uterus
Stage 2- invades cervix
Stage 3 - invades ovaries, fallopian tubes, vagina or LNs
Stage 4 - invades bladder, rectum or beyond pelvis

25
Q

What is endometrial hyperplasia?

A

precancerous condition involving thickening of the endometrium

hyperplasia with atypia
hyperplasia without atypia

26
Q

Mx of endometrial hyperplasia?

A

without atypia -> manage with progesterones (Mirena IUS) and surveillance

with atypia -> treat as cancerous, TAHBSO

27
Q

Mx of endometrial ca?

A

Stage 1 - TAHBSO
Stage 2 - Radical hysterectomy + LN assessment
Stage 3 + 4 - maximal de-bulking sx + chemorads

28
Q

Prognosis of endometrial ca?

A

usually good
75% present with Stage 1
Stage 1 has 90% 5yr survival rate

29
Q

Types of ovarian ca?

A

epithelial cell tumours
germ cell tumours
sex cord stromal tumours
metastasis (Kruckenburg tumour -> from GI ca)

30
Q

Types of epithelial cell tumours?

A

serous tumours (most common)
endometrioid carcinomas
clear cell tumours
mucinous tumours
undifferntiated

31
Q

Types of germ cell tumours?

A

teratomas/dermoid cysts

associated with ovarian torsion
raised AFP and hCG

32
Q

Types of sex cord stromal tumours?

A

Sertoli-Leydig cell tumours
granulosa cell tumours

33
Q

What is a Kruckenburg tumour?

A

ovarian mets from GI tract ca
‘signet-ring’ cells on histology

34
Q

Risk Factors for ovarian ca?

A

age (peak 60)
BRCA1 and BRCA2
incr. no. of ovulations (early menarche, late menopause, nulliparity)
obesity
smoking
recurrent use of clomifene

35
Q

Protective factors for ovarian ca?

A

pregnancy
breast-feeding
COCP

36
Q

Presentation of ovarian ca?

A

non-specific -> often late presentation
abdominal bloating
early satiety
anorexia
pelvic pain
urinary symptoms
weight loss
ascites
abdo or pelvic pain

37
Q

When to refer for suspected ovarian ca?

A

2 week wait if:
ascites
pelvic mass
abdo mass

CA125 if > 50 with:
new IBS
abdo bloating
early satiety
pelvic pain
urinary frequency
weight loss

38
Q

Risk of Malignancy Index includes?

A

Menopausal Status
US findings
Ca 125

multiply 3, RMI > 250 requires referral to gynae

39
Q

Red flag US findings for ovarian ca?

A

multilocular cyst
solid area
mets
bilateral lesions
ascites

40
Q

Investigations for ovarian ca?

A

RMI (CA125, pelvic US)
CT (staging)
histology
paracentesis

women <40 with complex ovarian mass:
AFP
HCG

41
Q

Causes of raised CA125?

A

ovarian ca
endometriosis
fibroids
adenomyosis
pelvic infection
liver disease
pregnancy

42
Q

Staging of ovarian ca?

A

Stage 1 - confined to ovary
Stage 2 - spread past the ovary, but inside the pelvis
Stage 3 - spread past the pelvis, but inside the abdomen
Stage 4 - spread past the abdomen

43
Q

Mx of ovarian ca?

A

de-bulking sx and chemotherapy

44
Q

Types of vulval ca?

A

90% are SCC
malignant melanomas

45
Q

RFs for vulval ca?

A

advanced age (>75yrs)
immunosuppression
HPV infection
lichen sclerosus
VIN

46
Q

How many women with lichen sclerosus get vulval ca?

A

about 5%

47
Q

Presentation of vulval ca?

A

incidental finding
lump
fungating lesion
ulceration
bleeding
pain
itching
lymphadenopathy in groin

48
Q

Investigations of vulval ca?

A

refer suspected vulval ca under 2wk wait pathway
biopsy of lesion
sentinel node biopsy
CT for staging

49
Q

Mx of vulval ca?

A

WLE, partial or radical vulvectomy
groin LN dissection
chemorads depending on staging

50
Q

Staging of vulval ca?

A

FIGO staging
Stage 1 - confined to vulva
Stage 2 - extending to lower 1/3 of vagina, urethra or anus
Stage 3 - upper 2/3 of vagina or urethra, bladder, rectum or LNs
Stage 4 - ulcerated LNs, pelvic bone or distant mets

Obs Gynae (4 decks)

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