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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
is type 1 endometrial cancer oestrogen dependent?
Yes, type 2 is less oestrogen-dependent
26
Types of type 1 endometrial cancer
Secretory, Endometrioid, and Mucinous Adenocarcinoma
27
Which type of endometrial cancer has a better prognosis? Why?
Type 1, because type 2 tends to be higher grade with depper invasion
28
Which type of endometrial cancer tends to be higher grade
Type 2 --> Associated with poorer prognosis as the tumours tend to be higher grade with deeper invasion
29
Which type of endometrial cancer is preceded by atypical hyperplasia?
type 1
30
Presentaition of endometrial cancer
postmenopausal bleeding
31
postmenopausal bleeding
endometrial cancer
32
Investigations for endometrial cancer
Imaging & Other Ultrasound Scan (reveals thickened endometrium) Hysteroscopy and Endometrial Biopsy MRI Scan (assess degree of spread)
33
USS findings of endometrial cancer
reveals thickened endometrium
34
What is MRI scan used for in endometrial cancer?
assess degree of spread
35
Staging of endometrial cancer
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
Stage 1 endometrial cancer
Stage 1: Confined to body of uterus
37
stage 2 endometrial cancer
Stage 2: Involves cervical stroma but does not extend beyond the uterus
38
stage 3 endometrial cancer
Stage 3: Extends beyond the uterus
39
stage 4 endometrial cancer
Stage 4: Involves bladder or rectal mucosa or distant metastases
40
Which stage of endometrial cancer involves cervix?
2
41
Management of endometrial cancer
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
conservative management of endometrial cancer
Weight loss (if overweight) for patients with endometrial hyperplasia without atypia Regular surveillance
43
Surgical management for endometrial cnacer
Usually requires total hysterectomy with bilateral salpingo-oophorectomy A modified radical hysterectomy may be considered if there is any cervical involvement
44
What type of surgical procedure may be considered if there is cervical management in endometrial cancer (>stage 2)
A modified radical hysterectomy
45
What hormone treatment may be used for endometrial cancer? Who may this treatment be suitable for?
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
When to use hormone treatment in endometrial cancer?
May be suitable in women who are not fit for surgery or those who want to avoid surgery and preserve fertility
47
How are ovarian tumours classified?
Epithelial (MOST COMMON) Germ cell Sex cord
48
Most common type of ovarian cancer
epithelial
49
Types of epithelial ovarian cancer
Serous Clear Cell Endometrioid Mucinous Brenner Undifferentiated
50
Types of germ cell ovarian cancer
Dysgerminoma Endodermal Sinus (Yolk Sac) Teratoma Choriocarcinoma
51
Types of sex cord ovarian tumour
Granulosa Cell Sertoli-Leydig Cell Gynandroblastoma
52
How can epithelial ovarian cancers be subclassified?
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
What type of ovarian cancer occurs in the context of endometriosis?
Type 1 epithelial Low-grade, relatively indolent and arise from well-defined precursors and in the context of endometriosis
54
What does type 2 epithelial ovarian cancer mostly include?
serous adenocarcinomas
55
RFs for ovarian cancer
Nulliparity Early menarche Late menopause Endometriosis HRT Pelvic inflammatory disease Genetic predisposition (e.g. BRCA, Lynch syndrome)
56
What genetic factors can predispose to ovarian cancer?
BRCA, Lynch syndrome
57
Presentation of ovarian cancer
Abdominal bloating Constipation Early satiety Weight loss Urinary symptoms Leg swelling Irregular vaginal bleeding Palpable mass in the lower abdomen
58
Investigations for ovarian cancer
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
What is used for staging in ovarian cancer?
CT or MRI
59
What bloods need to be done for ovarian cancer?
CA125
60
What is the Risk of malignancy index? what is it used for?
Used for ovarian cancer as a risk tool
61
What does risk of malignancy index consist of? (ovarian cancer)
Risk tool based on menopausal status, ultrasound findings and CA125
62
Management of ovarian cancer
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
Surgical management of ovarian cancer
Total Abdominal Hysterectomy and Bilateral Salpingo-oophorectomy Often accompanied by platinum-based chemotherapy
64
1st line chemotherapy in ovarian cancer
1st Line: Often a combination of a platinum-based compound (e.g. carboplatin) and paclitaxel
65
Chemotherapy treatment in ovarian cancer
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
What are most types of vulval cancers>
squamous cell carcinomasWh
67
Who does vulval cancer primarily affect?
older women
68
What may vulval cancer progress from?
vulval intraepithelial neoplasia
69
Risk Factors for vulval cancer
HPV Infection Age Immunosuppression Lichen sclerosus Smoking
70
Presentation of vulval cancer
Lump or ulcer on the vulva May bleed or produce discharge
71
Investigations for vulval cancer
Imaging & Other Biopsy CT Scan (for staging)
72
What is done for staging of vulval cancer?
Ct scan
73
Management of vulval cancer
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
Surgical management of vulval cancer
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
If the sentinel node in vulval cancer is invaded with malignant cells what is indicated?
a full groin lymphadenectomy is indicated
76
When is radiotherapy used in vulval cancer?
Radical radiotherapy may be considered if the patient is unfit for surgery
77

Gynae (8 decks)

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