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Theo's Obs And Gynae > Gynae Oncology > Flashcards

Gynae Oncology Flashcards

0
Q

What is cervical entropion?

A

More irregular redness resulting from minor lacerations during childbirth

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1
Q

What is cervical ectopy?

A

Are puberty, rising oestrogen levels cause the cervix to evert

Columnar tissue lining the cervical canal is everted on to the centre of the cervix

This appears as a red area around the os, and is a normal finding in younger women

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2
Q

What is cervical intraepithelial neoplasia (CIN)?

A

The presence of atypical cells within the squamous epithelium of the cervix

This is a histological diagnosis made only on biopsy

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3
Q

What are the different grades of CIN?

A

CIN1 - mild dysplasia- atypical cells are found only in the lower third of the epithelium

CIN2 - moderate dysplasia - atypical cells are found in the lower two thirds of the epithelium

CIN3 - severe dysplasia - atypical cells occupy the full thickness of the epithelium- this is carcinoma in situ

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4
Q

How is CIN managed?

A

Without treatment, a third of women will develop cervical cancer over the next 10 years- however it depends on the grade

If mild dysplasia (CIN1), may only require repeat colposcopy.

If more dysplasia, excision with LLETZ - large loop excision of the transformation zone - to depth of 8mm

If abnormality is not completely visible, do cone biopsy

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5
Q

What is CGIN?

A

Cervical glandular intraepithelial neoplasia

Rare
Arises within the cervical anal
Precursor to cervical adenocarcinoma

Definitely requires treatment

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6
Q

How common is cervical cancer, and in whom does it occur?

A

12th most common cancer in women

Most common between ages of 45 and 55 years

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7
Q

What are the risk factors for cervical cancer?

A 
Smoking
Unprotected sexual intercourse
Previous STI
HIV
On immunosuppressants
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8
Q

How does cervical cancer present?

A

Post coital bleeding, Intermenstrual bleeding, post menopausal bleeding
Persistent, offensive, blood stained discharge
Pain in late disease
Swollen leg- thrombosis in the pelvis

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9
Q

How is cervical cancer investigated?

A

Speculum
BE
PR

Colposcopy
Cervical biopsy
FBC UandEs LFTs
MRI pelvis
Ct abdomen and chest
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10
Q

How is cervical cancer staged?

A

0 - carcinoma in situ
1 - confined to cervix
2 - disease beyond cervix but not to pelvic wall or lower 1/3 of vagina
3 - disease to pelvic wall or lower 1/3 vagina
4 - invades bladder, rectum, or metastasis

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11
Q

How does cervical cancer spread?

A

Direct or local to vagina, bladder, parametrium, bowel
Lymphatic- para metrial nodes, internal, external, common iliac etc
Blood borne- lungs and liver

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12
Q

What are the treatment options for cervical cancer?

A

LLETZ
Hysterectomy
Radical hysterectomy
Fertility sparing - trachelotomy - removal of cervix, and stitch placed to give support in the case of future pregnancy
Radiotherapy/chemotherapy if later stages - platinum based chemo

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13
Q

What is the histological type of cervical cancer?

A

SCC in 70%
Adenocarcinoma in 25%
Small cell or TCC

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14
Q

What is the five year survival of cervical cancer?

A

67%

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15
Q

How common is ovarian cancer and what age does it typically affect?

A

Fifth most common cause of cancer in women

6000 new cases a year in the uk

Effects women usually between the age of 60 and 70

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16
Q

What are risk factors for ovarian cancer?

A

Anything that prolongs time spent ovulating

Multiparty
Late menopause
Early menarche
HRT
Endometriosis
Difficulties conceiving - IVF 
BRCA1/2
Turners syndrome
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17
Q

How does ovarian cancer typically present?

A 
Abdominal pain
Pressure effects on the bladder or rectum
Dyspnoea
GI upset and anorexia
Abnormal vaginal bleeding
Asymptomatic

On examination:
Adnexal mass
Shifting dullness
Irregular abdominal mass - omental cake

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18
Q

How is ovarian cancer staged?

A

Stage 1 - limited to one or both ovaries
Stage 2 - pelvic extension or implants
Stage 3 - microscopic peritoneal implants outside of the pelvis, or limited to the pelvis with extension to the small bowel or omentum
Stage 4 - distant mets

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19
Q

How does ovarian cancer spread?

A

Direct spread- omental cake, invasion to bowel/bladder

Haematogenous - liver and spleen

Lymphatic - para-aortics to diaphragmatic lymph nodes

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20
Q

What investigations are indicated in ovarian cancer?

A 
Pelvic USS
Ca125 in 80%
Ca19.9 for mets from pancreas
CEA for mets from bowel
AFP, hcg, LDH 
CXR 
FBC, UandEs, LFTs 
Ct 
Paracentesis of ascites
21
Q

What is the management of ovarian cancer?

A

TAH and BSO, with omentectomy, lymph node sampling, peritoneal biopsies with peritoneal washings or ascitic fluid for cytology

Adjuvant chemotherapy with platinum

22
Q

What is the five year survival of ovarian cancer?

A

Typically presents late

75% of cases of ovarian cancer presents as stage 3/4 disease

1- 75-90%
2- 45-60%
3- 30-40%
4- less than 20%

23
Q

What is the histology of ovarian cancer?

A

Epithelial - derived from mullerian epithelium - 85%

Sex cord or stromal

Germ cell

24
Q

How are the BRCA genes implicated in ovarian cancer?

A

BRCA1 - 39% will get ovarian ca by 70

BRCA2 - 11-16% get ovarian ca by 70

25
Q

What are the risk factors for endometrial cancer?

A 
Obesity - increased oestrogen
Diabetes
PCOS - Anovulatory cycles
Age - peak 65-75
Early menarche
Late menopause
Nulliparity
Unnopposed oestrogen therapy
FH of breast, ovary, colon cancer
Tamoxifen
Prior pelvic irradiation
Sex cord stromal tumour of the ovary
26
Q

What are protective factors for endometrial cancer?

A

Pregnancy
Diet and exercise
IUS
Reduced menstrual history eg early menopause of COCP

27
Q

How does endometrial cancer spread?

A

Direct - through cavity to cervix, Fallopian tubes to ovaries

Lymphatic - pelvic to para aortic nodes

Haematogenous - rare to liver, lungs

28
Q

What investigations are required in endometrial cancer?

A 
Speculum and bimanual exam
Biopsy with or without hysteroscopy
USS to assess endometrial thickness 
MRI - invasion
Ct
29
Q

What are the treatment options in endometrial cancer?

A

Hysterectomy with oophorectomy
Laparoscopy best for obese women

Radiotherapy/chemo - high grade, high stage tumours

High dose progestogens- can reverse the premalignant phase of hyperplasia. Also for palliative

30
Q

What is the staging of endometrial cancer?

A

1- limited to body of uterus
2- limited to body if uterus and cervix
3- extension to uterine serosa, peritoneal cavity or lymph nodes
4- extension to adjacent organs or beyond true pelvis

31
Q

What is the premalignant stage of endometrial cancer?

A

Hyperplasia with atypia - excessive proliferation of endometrial glands and stroma

Comes with atypia had much higher risk of progression to cancer

32
Q

What are the different histological types of endometrial cancer?

A

Endometrioid adenocarcinoma - 80-85%
Papillary serous 10%
Clear cell 4%

33
Q

What is the average age of diagnosis of invasive and noninvasive vulval cancer?

A

Invasive - 70

Non-invasive - 50

34
Q

What are the risk factors for vulval cancer?

A 
Age - 50% over 70
HPV
Smoking
Immunodeficiency 
Lichen sclerosis
Melanoma- personal or family history
35
Q

What is the premalignant form of vulval cancer?

A

Vulgar intraepithelial neoplasia - abnormal cells found only in the surface later of vulval cancer

The higher the grade, the greater the chance of invasive carcinoma

36
Q

How does vulval cancer present?

A

Asymptomatic
Itching
Pain
Bleeding (PMB)

On examination:
Skin often thicker and lighter than skin around it
Raised mass- red, pink, white
Ulcerated mass
Warty mass
37
Q

How do vulval cancers spread?

A

Local invasion of adjacent structures

Lymph nodes - inguinal, inguinofemoral

38
Q

What investigations are indicated for vulval cancer?

A

Examination to assess direct spread - PR, PV, inguinal lymphadenopathy

Biopsy

MRI to assess spread

39
Q

What is the management of vulval cancer?

A 
Wide local excision if suspicious area
Vulvectomy
Lymphadenectomy
Radiotherapy
Chemotherapy
40
Q

What is the average age of diagnosis of invasive and noninvasive vulval cancer?

A

Invasive - 70

Non-invasive - 50

41
Q

What are the risk factors for vulval cancer?

A 
Age - 50% over 70
HPV
Smoking
Immunodeficiency 
Lichen sclerosis
Melanoma- personal or family history
42
Q

What is the premalignant form of vulval cancer?

A

Vulgar intraepithelial neoplasia - abnormal cells found only in the surface later of vulval cancer

The higher the grade, the greater the chance of invasive carcinoma

43
Q

How does vulval cancer present?

A

Asymptomatic
Itching
Pain
Bleeding (PMB)

On examination:
Skin often thicker and lighter than skin around it
Raised mass- red, pink, white
Ulcerated mass
Warty mass
44
Q

How do vulval cancers spread?

A

Local invasion of adjacent structures

Lymph nodes - inguinal, inguinofemoral

45
Q

What investigations are indicated for vulval cancer?

A

Examination to assess direct spread - PR, PV, inguinal lymphadenopathy

Biopsy

MRI to assess spread

46
Q

What is the management of vulval cancer?

A 
Wide local excision if suspicious area
Vulvectomy
Lymphadenectomy
Radiotherapy
Chemotherapy
47
Q

What is the five year survival rate of vulval cancer?

A

Local - 86%
Regional - 54%
Distant - 16%

48
Q

How common is endometrial cancer?

A

Most common genital tract cancer

4th most common cancer in women

49
Q

How common is vulval carcinoma?

A

Accounts for 5% of genital tract cancers

50
Q

What is the management of abnormal smear tests? Mild, moderate and severe dysplasia

A 
Normal - repeat in three years
Mild dysplasia - repeat in 4-6 months
Mild on two occasions - colposcopy
Moderate - colposcopy
Severe/CIN - colposcopy
GLandular IN - urgent colpsocopy/hysterectomy

Mild/moderate must be tested for HPV first, if positive refer for colposcopy

Annual screening in immunosuppressed patients!

Theo's Obs And Gynae (22 decks)

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