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Y4 reproductive health > Gynae oncology > Flashcards

Gynae oncology Flashcards

1
Q

Endometrial cancer aetiology & pathophysiology

A

Most common form - adenocarcinoma

  • caused by unopposed oestrogen

Progesterone is produced by the corpus luteum after ovulation → where women have experienced a longer period of anovulation → predisposed to malignancy

Unopposed oestrogen → endometrial hyperplasia → can predispose to atypia, a precancerous state

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2
Q

Endometrial cancer risk factors

A

Anovulation

  • early menarche and/or late menopause
  • low parity
  • PCOS
  • HRT with oestrogen alone
  • tamoxifen use

Age - between 65 and 75 years old

Obesity

Hereditary - lynch syndrome

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3
Q

Endometrial cancer clinical features

A

Postmenopausal bleeding

Clear/white vaginal discharge

Abnormal cervical smears

Abdominal pain/weight loss

O/E - abdominal/pelvic masses, vulval/vaginal atrophy, cervical lesions, assess size & axis of the uterus prior to endometrial sampling

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4
Q

Endometrial cancer ix

A

Transvaginal USS

  • endometrial thickness > 4mm → endometrial biopsy (pipelle biopsy)
  • high risk → hysteroscopy with biopsy

MRI/CT for staging

Baseline bloods prior to intervention

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5
Q

Endometrial cancer FIGO staging

A

Stage I - carcinoma confined to within uterine body

Stage II - carcinoma may extend to cervix but is not beyond the uterus

Stage III - carcinoma extends beyond uterus but is confined to the pelvis

Stage IV - carcinoma involves bladder or bowel, or has metastasised to distant sites

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6
Q

Endometrial hyperplasia mx

A

Hyperplasia without atypia - can be treated with progestogens; surveillance biopsies should be performed to identify any progression

Atypical hyperplasia - TAH & BSO

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7
Q

Endometrial carcinoma mx

A

Stage I - TAH & BSO

Stage II - radical hysterectomy & assessment and removal of pelvic lymph nodes

Stage III - maximal de-bulking surgery

Stage IV - maximal de-bulking surgery; palliative approach may be preferred

Frequent follow up required up to 5 years post-op due to recurrence

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8
Q

Ovarian cancer pathophysiology

A

Believed to be derived from surface epithelial irritation during ovulation

More ovulations that take place, the increased risk of developing malignancy

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9
Q

Ovarian cancer risk factors

A

Nulliparity

Early menarche

Late menopause

HRT containing oestrogen only

Smoking

Obesity

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10
Q

Ovarian cancer protective factors

A

Multiparity

Combined contraceptive methods

Breastfeeding

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11
Q

Ovarian cancer genetic mutations

A

BRCA1&2 - mutations increase the risk of breast & ovarian cancers; prophylactic BSO can be performed, but does not completely eradicate risk of developing malignancy

Hereditary nonpolyposis colorectal cancer (lynch II syndrome)

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12
Q

Ovarian cancer risk of malignancy index

A

Tool used in practice to determine the likelihood that ovarian masses are malignant

CA125, menopausal status & ultrasound score

Patients with a RMI >250 should be referred to a specialist gynaecologist

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13
Q

Ovarian cancer clinical features

A

Incidental & asymptomatic

Chronic pain

PV bleeding

Bloating

Change in bowel habit & urinary frequency

Weight loss

IBS

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14
Q

Ovarian cancer ix

A

Basic bloods - FBC, U&Es, LFT & albumin

CA125

Abdominal & pelvic USS

Confirmed cancer → staging CAP

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15
Q

Ovarian cancer mx

A

Surgery - staging laparotomy for those with a high RMI with attempt to debulk the tumour

Adjuvant chemotherapy

Follow-up for 5 years

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16
Q

Cervical cancer aetiology & pathophysiology

A

Majority are SCCs

Usually develop as a progression from CIN, occurs over the course of 10-20 years

Invasive cervical cancer occurs when the basement membrane has been breached; most common sites of metastasis are lung, liver, bone & bowel

Vast majority are caused by persistent HPV - high risk serotypes are 16 & 18

17
Q

Cervical cancer risk factors

A

HPV

Smoking

Other STIs

Long term (> 8 years) COCP use

Immunodeficiency

18
Q

Cervical cancer clinical features

A

Abnormal vaginal bleeding

Vaginal discharge (blood-stained, foul-smelling)

Dyspareunia

Pelvic pain

Weight loss

Often asymptomatic

Advanced disease - loin pain, rectal bleeding, radiculopathy, haematuria

O/E - bleeding, discharge, ulceration, pelvic masses, hydronephrosis, hepatomegaly, rectal bleeding, mass on PR

19
Q

Cervical cancer ix

A

Pre-menopausal - test for chlamydia trachomatis infection

  • if negative → colposcopy and biopsy performed

Post-menopausal - urgent colposcopy and biopsy

Confirmed diagnosis:

  • basic blood tests - FBC, LFTs, U&Es
  • CT CAP
  • further staging scans - MRI pelvis, PET
  • +/- examination under anaesthesia with further biopsies
20
Q

Cervical cancer mx

A

MDT input

Surgery:

  • stage 1a - radical trachelectomy if fertility-preservation priority otherwise hysterectomy with pelvic lymphadenectomy
  • stage 1b/2a - radical hysterectomy
  • stage 4a/recurrent disease - anterior/posterior/total pelvic extenteration

Radiotherapy:

  • stage 1b to 3 - conjunction with chemo (chemoradiation gold standard)

Chemotherapy: often cisplatin-based, neoadjuvant or adjuvant, also mainstay of palliative care

Follow-up: every 4 months for first 2 years & every 6-12 months for subsequent 3 years

21
Q

Vulval cancer clinical features

A

Pruritis

Burning

Soreness

Bleeding

Pain

Lump

Most are SCCs & occur on the labia majora, other sites include the clitoris and perineum

22
Q

Vulval cancer diagnosis

A

Keye’s punch biopsy

Performed under local anaesthetic

23
Q

Vulval cancer mx

A

Surgery gold standard treatment

Early disease - complete resection of primary tumour & appropriate groin lymphadenectomy

Advanced disease - radical vulvectomy with resection of bilateral inguinofemoral lymph nodes

24
Q

Cervical screening age range

A

Available to women and people with a cervix aged 25-64

25-49 years: 3 yearly screening

50-64 years: 5 yearly screening

25
Q

Cervical screening process

A

Speculum inserted & brush is rotated against the transformation zone of the cervix

Brush head is sent off to the lab for testing:

  • HPV screening: testing for HPV first is more sensitive & accurate
  • LBC: looks for dyskaryosis
26
Q

Cervical screening results

A

hrHPV negative → routine screening

hrHPV positive & normal smear → repeat smear in 12 months

hrHPV positive & abnormal smear → colposcopy

Inadequate smear → repeat smear within 3 months → if remains inadequate → colposcopy

Y4 reproductive health (11 decks)

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