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Gynae > Gynae-Oncology > Flashcards

Gynae-Oncology Flashcards

1
Q

RFs for cervical cancer

A

HPV 16 and 18
Smoking
HIV
Multiple sexual partners

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2
Q

What are the majority of cervical cell cancers?

A

The majority of cervical cancers are squamous cell carcinomas

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3
Q

Cervical cancer screening programme

A

Offered every 3 years from 25 to 49 years
Offered every 5 years from 50 to 64 years

Outcomes
Positive for HPV 16 and/or 18 AND abnormal morphology on cytological analysis –> Invite for Colposcopy
Positive for HPV 16 and/or 18 AND normal morphology on cytological analysis –> Repeat Smear in 1 Year
Negative for HPV 16 and/or 18 –> Routine Screening

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4
Q

Presentation of cervical cancer

A

Abnormal vaginal bleeding (often post-coital bleeding)
Abnormal vaginal discharge

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5
Q

What type of bleeding is often associated with cervical cancer?

A

post coital

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6
Q

When is cervical cancer usually identified?

A

Usually identified in the pre-cancerous stages (cervical intraepithelial neoplasia) during screening

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7
Q

Investigations for cervical cancer

A

Bedside
Speculum Examination

Imaging & Other
Colposcopy
Cervical Biopsy
CT or MRI (for staging)

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8
Q

What is used for staging of cevical cancer?

A

CT/MRI

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9
Q

How is cervical cancer staged?

A

Stage 1: Confined to cervix
Stage 2: Beyond the cervix but not to the pelvic wall or lower 1/3 of the vagina
Stage 3: Invading the pelvic wall or lower 1/3 of the vagina
Stage 4: Invading the bladder or rectum, or distant metastases present

NOTE: Think rule of 1/4rds

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10
Q

Management of stage 1A cervical cancer (preclinical lesion)

A

Can be excised with a clear margin

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11
Q

Management of stage 1B cervical cancer (clinically invasive cervical cancer)

A

Usually requires radical hysterectomy and bilateral pelvic node dissection (Wertheim’s hysterectomy)
If fertility-sparing surgery is required, a radical trachelectomy with pelvic node dissection may be considered

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12
Q

What may be done if fertility sparing surgery is requied in cervical cancer?

A

If fertility-sparing surgery is required, a radical trachelectomy with pelvic node dissection may be considered

NOTE: Done in stage 1B cervical cancer

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13
Q

Stage 1 cervical cancer

A

confined to cervix

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14
Q

stage 2 cervical cancer

A

Beyond the cervix but not to the pelvic wall or lower 1/3 of the vagina

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15
Q

stage 3 cervical cancer

A

Invading the pelvic wall or lower 1/3 of the vagina

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16
Q

stage 4 cervical cancer

A

Invading the bladder or rectum, or distant metastases present

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17
Q

When is radiotherapy used in cervical cancer?

A

If tumour has extended beyond the cervix (>stage 1, e.g. stage 2/3/4)

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18
Q

What is the mainstay of treatment if tumour has extended beyond the cervix?

A

radiotherapy

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19
Q

Two forms of radiotherapy used in cervical cancer

A

External Beam Radiotherapy
Usually given over 4 weeks
Internal Radiotherapy (Brachytherapy)
Involves the insertion of radioactive rods into the affected area

NOTE: Used if tumour has extended beyond the cervix (>stage 1, e.g. stage 2/3/4)

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20
Q

What are the majority of endometrial cancers?

A

adenocarcinomas

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21
Q

What are endometrial cancers assocaited with?

A

states in which oestrogen exposure is increased:

Hormone replacement therapy
Obesity
Polycystic ovarian syndrome
Nulliparity

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22
Q

Types of endometrial cancers

A

Type 1 (85%)
Subtypes: Secretory, Endometrioid, and Mucinous Adenocarcinoma
Tends to affect younger patients and is often oestrogen-dependent
Associated with better prognosis
Usually preceded by atypical hyperplasia

Type 2 (15%)
Subtypes: Papillary, Clear Cell and Serous
Tends to affect older patients and is less oestrogen-dependent
Associated with poorer prognosis as the tumours tend to be higher grade with deeper invasion

NOTE: “Sarah Eats Meat, Paul Can’t Stand it”

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23
Q

Mnemonic to remember types of endometrial cancer

A

“Sarah Eats Meat, Paul Can’t Stand it”

Type 1 (85%)
Subtypes: Secretory, Endometrioid, and Mucinous Adenocarcinoma

Type 2 (15%)
Subtypes: Papillary, Clear Cell and Serous

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24
Q

Who does type 1 endometrial cancer tend to affect?

A

Tends to affect younger patients, Type 2 Tends to affect older patients

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25
Q

is type 1 endometrial cancer oestrogen dependent?

A

Yes, type 2 is less oestrogen-dependent

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26
Q

Types of type 1 endometrial cancer

A

Secretory, Endometrioid, and Mucinous Adenocarcinoma

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27
Q

Which type of endometrial cancer has a better prognosis? Why?

A

Type 1, because type 2 tends to be higher grade with depper invasion

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28
Q

Which type of endometrial cancer tends to be higher grade

A

Type 2 –> Associated with poorer prognosis as the tumours tend to be higher grade with deeper invasion

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29
Q

Which type of endometrial cancer is preceded by atypical hyperplasia?

A

type 1

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30
Q

Presentaition of endometrial cancer

A

postmenopausal bleeding

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31
Q

postmenopausal bleeding

A

endometrial cancer

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32
Q

Investigations for endometrial cancer

A

Imaging & Other
Ultrasound Scan (reveals thickened endometrium)
Hysteroscopy and Endometrial Biopsy
MRI Scan (assess degree of spread)

33
Q

USS findings of endometrial cancer

A

reveals thickened endometrium

34
Q

What is MRI scan used for in endometrial cancer?

A

assess degree of spread

35
Q

Staging of endometrial cancer

A

Stage 1: Confined to body of uterus
Stage 2: Involves cervical stroma but does not extend beyond the uterus
Stage 3: Extends beyond the uterus
Stage 4: Involves bladder or rectal mucosa or distant metastases

36
Q

Stage 1 endometrial cancer

A

Stage 1: Confined to body of uterus

37
Q

stage 2 endometrial cancer

A

Stage 2: Involves cervical stroma but does not extend beyond the uterus

38
Q

stage 3 endometrial cancer

A

Stage 3: Extends beyond the uterus

39
Q

stage 4 endometrial cancer

A

Stage 4: Involves bladder or rectal mucosa or distant metastases

40
Q

Which stage of endometrial cancer involves cervix?

A

2

41
Q

Management of endometrial cancer

A

Conservative Management
Weight loss (if overweight) for patients with endometrial hyperplasia without atypia
Regular surveillance

Surgery
Usually requires total hysterectomy with bilateral salpingo-oophorectomy
A modified radical hysterectomy may be considered if there is any cervical involvement

Adjuvant Treatment
Some patients will receive radiotherapy or chemotherapy

Hormone Treatment
High-dose oral or intrauterine progestins can be used in patients with complex atypical hyperplasia or low-grade endometrial tumours
May be suitable in women who are not fit for surgery or those who want to avoid surgery and preserve fertility

42
Q

conservative management of endometrial cancer

A

Weight loss (if overweight) for patients with endometrial hyperplasia without atypia
Regular surveillance

43
Q

Surgical management for endometrial cnacer

A

Usually requires total hysterectomy with bilateral salpingo-oophorectomy
A modified radical hysterectomy may be considered if there is any cervical involvement

44
Q

What type of surgical procedure may be considered if there is cervical management in endometrial cancer (>stage 2)

A

A modified radical hysterectomy

45
Q

What hormone treatment may be used for endometrial cancer? Who may this treatment be suitable for?

A

High-dose oral or intrauterine progestins can be used in patients with complex atypical hyperplasia or low-grade endometrial tumours
May be suitable in women who are not fit for surgery or those who want to avoid surgery and preserve fertility W

46
Q

When to use hormone treatment in endometrial cancer?

A

May be suitable in women who are not fit for surgery or those who want to avoid surgery and preserve fertility

47
Q

How are ovarian tumours classified?

A

Epithelial (MOST COMMON)
Germ cell
Sex cord

48
Q

Most common type of ovarian cancer

A

epithelial

49
Q

Types of epithelial ovarian cancer

A

Serous
Clear Cell
Endometrioid
Mucinous
Brenner
Undifferentiated

50
Q

Types of germ cell ovarian cancer

A

Dysgerminoma
Endodermal Sinus (Yolk Sac)
Teratoma
Choriocarcinoma

51
Q

Types of sex cord ovarian tumour

A

Granulosa Cell
Sertoli-Leydig Cell
Gynandroblastoma

52
Q

How can epithelial ovarian cancers be subclassified?

A

Type 1
Low-grade, relatively indolent and arise from well-defined precursors and in the context of endometriosis
Includes: low-grade serous, endometriosis, mucinous, clear cell carcinoma

Type 2
High-grade and does not arise from precursor lesions
Includes: mostly serous

53
Q

What type of ovarian cancer occurs in the context of endometriosis?

A

Type 1 epithelial

Low-grade, relatively indolent and arise from well-defined precursors and in the context of endometriosis

54
Q

What does type 2 epithelial ovarian cancer mostly include?

A

serous adenocarcinomas

55
Q

RFs for ovarian cancer

A

Nulliparity
Early menarche
Late menopause
Endometriosis
HRT
Pelvic inflammatory disease
Genetic predisposition (e.g. BRCA, Lynch syndrome)

56
Q

What genetic factors can predispose to ovarian cancer?

A

BRCA, Lynch syndrome

57
Q

Presentation of ovarian cancer

A

Abdominal bloating
Constipation
Early satiety
Weight loss
Urinary symptoms
Leg swelling
Irregular vaginal bleeding
Palpable mass in the lower abdomen

58
Q

Investigations for ovarian cancer

A

Bloods
CA125

Imaging & Other
Transvaginal Ultrasound Scan
CT or MRI (for staging)
Risk of Malignancy Index
Risk tool based on menopausal status, ultrasound findings and CA125

59
Q

What is used for staging in ovarian cancer?

A

CT or MRI

59
Q

What bloods need to be done for ovarian cancer?

A

CA125

60
Q

What is the Risk of malignancy index? what is it used for?

A

Used for ovarian cancer as a risk tool

61
Q

What does risk of malignancy index consist of? (ovarian cancer)

A

Risk tool based on menopausal status, ultrasound findings and CA125

62
Q

Management of ovarian cancer

A

Surgery
Total Abdominal Hysterectomy and Bilateral Salpingo-oophorectomy
Often accompanied by platinum-based chemotherapy

Chemotherapy
1st Line: Often a combination of a platinum-based compound (e.g. carboplatin) and paclitaxel
Other options: bevacizumab
Patients will undergo a CT scan after completion of chemotherapy to assess their response to treatment
CA125 may also be monitored

63
Q

Surgical management of ovarian cancer

A

Total Abdominal Hysterectomy and Bilateral Salpingo-oophorectomy
Often accompanied by platinum-based chemotherapy

64
Q

1st line chemotherapy in ovarian cancer

A

1st Line: Often a combination of a platinum-based compound (e.g. carboplatin) and paclitaxel

65
Q

Chemotherapy treatment in ovarian cancer

A

1st Line: Often a combination of a platinum-based compound (e.g. carboplatin) and paclitaxel
Other options: bevacizumab
Patients will undergo a CT scan after completion of chemotherapy to assess their response to treatment
CA125 may also be monitored

66
Q

What are most types of vulval cancers>

A

squamous cell carcinomasWh

67
Q

Who does vulval cancer primarily affect?

A

older women

68
Q

What may vulval cancer progress from?

A

vulval intraepithelial neoplasia

69
Q

Risk Factors for vulval cancer

A

HPV Infection
Age
Immunosuppression
Lichen sclerosus
Smoking

70
Q

Presentation of vulval cancer

A

Lump or ulcer on the vulva
May bleed or produce discharge

71
Q

Investigations for vulval cancer

A

Imaging & Other
Biopsy
CT Scan (for staging)

72
Q

What is done for staging of vulval cancer?

A

Ct scan

73
Q

Management of vulval cancer

A

Vulval Excision
Aims for a clear margin of 10 mm
Can be difficult to perform if the tumour is close to the urethra or anus
May be accompanied by neoadjuvant radiotherapy or chemotherapy to shrink the tumour

Sentinel Lymph Node Biopsy
May require full inguinofemoral lymphadenectomy (for all tumours with a depth of invasion > 1 mm)
Full groin lymphadenectomy may be avoided by doing a sentinel lymph node biopsy
If the sentinel node (identified by tracking radioactive dye) contains malignant cells, a full groin lymphadenectomy is indicated

Radiotherapy
Radical radiotherapy may be considered if the patient is unfit for surgery

74
Q

Surgical management of vulval cancer

A

Vulval Excision
Aims for a clear margin of 10 mm
Can be difficult to perform if the tumour is close to the urethra or anus

Sentinel Lymph Node Biopsy
May require full inguinofemoral lymphadenectomy (for all tumours with a depth of invasion > 1 mm)

75
Q

If the sentinel node in vulval cancer is invaded with malignant cells what is indicated?

A

a full groin lymphadenectomy is indicated

76
Q

When is radiotherapy used in vulval cancer?

A

Radical radiotherapy may be considered if the patient is unfit for surgery

77
Q
A

Gynae (8 decks)

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