Gynae oncology

Question 1

What symptoms might someone present with?

Answer 1

Post coital bleeding
Itra-menstrual bleeding
Post menopausal bleeding
Late disease: pain, DVT (pelvic thrombosis)

Question 2

What investigations check for gynae cancers?

Answer 2

Colposcopy
Cervical biopsy
FBC, U&E, LFTs
MRI pelvis
CT abdo and chest if indicated to check for lymphatic spread

Question 3

Where do gynae cancers spread too?

Answer 3

Direct/ local = vagina, bladder, parametrium, bowel

Haemotagoenous = liver and lungs (poor prognosis)

Question 4

Where are atypical cells in CIN 1?

Answer 4

Lower 1/3rd of the epithelium

Question 5

Where are atypical cells in CIN 2?

Answer 5

Atypical cells in lower 2/3rds of epithelium

Question 6

Where are atypical cells in CIN 3?

Answer 6

Full thickness of the epithelium - only malignancy if invade through basement membrane

Question 7

What % of women with CIN 2/3 will develop cancer within 10 years if disease untreated?

Answer 7

1/3rd (33%)

Question 8

How much does smoking + HPV increase the rate of cervical cancer by?

Answer 8

20 x

Question 9

Does CIN cause symptoms?

Answer 9

No - no symptoms and not visible on the cervix

Question 10

From what ages do women get 3 year smears?

Answer 10

25 - 49

Question 11

What ages do women get a smear every 5 year?

Answer 11

50 - 64 yrs

Question 12

What do you do if someone has mild dyskarosis and is HPV negative what would you do?

Answer 12

Refer back to normal smear programme

Question 13

What histological type are most cervical cancers?

Answer 13

• 90%

- 10% are adenocarcinomas originating from columnar epithelium

Question 14

What virus is in ALL cervical cancers?

Answer 14

HPV

Question 15

What is the treatment options for cervical cancer 2b and above?

Answer 15

Chemo-radiotherapy alone

Question 16

What are indications for chemo-radiotherpy for cervical cancer?

Answer 16

• Stage 2b disease and above
• lymph node positive MRI or after lymphadenectomy
• Alternative to hysterectomy in lymph node negative disease
• surgical resection margins are not clear
• palliation for bone pain or haemmorhage (radiotherapy)

Question 17

what is the overall 5 year survival for cervical cancer?

Answer 17

65%

Question 18

What is the histological type of 90% of endometrial cancers?

Answer 18

Adenocarcinoma of columnar endometrial gland cells

Question 19

What is the main aetiology to endometrial cancer?

Answer 19

Unopposed oestrogen

- higher ratio of oestrogen to progestogen

Question 20

What are common presentations of endometrial cancer?

Answer 20

• postmenopausal bleeding (10%)
• Premenopausal patients with irregular or intermenstraul bleed , or recent onset menorrhagia
• Cervical smear may contain abnormal columnar cells (cervical glandular intra-epithelial neoplasia)

Question 21

What vaginal condition co-exists with endometrial cancer?

Answer 21

Atrophic vaginitis

Question 22

What investigations are done in possible endometrial cancer?

Answer 22

• USS scan/ endometrial biopsy with pipelle or hysteroscopy (dependent on age, menopausal status and symptoms i.e. likelihood of it being cancer)
• endometrial biopsy is required to make the diagnosis
• MRI where spread is suspected due to symptoms or histology
• CXR to exclude rare pulmonary spread
• to assess patient’s fitness; FBC, U&E, glucose, ECG

Question 23

What are the treatment options for endometrial cancer?

Answer 23

• hysterectomy or bilateral salpinoophrectomy
• staging is surgo-pathological i.e. used for staging
• routie lymphadenectomy is not beneficial in early stage disease and there not routine
• Radiotherapy

Question 24

What are indications for radiotherapy in endometrial cancer?

Answer 24

• used after hysterectomy in patients for high risk lymph node involvement
• for pelvic reccurence (confined to pelvis) - beneficial if not previousl used

Question 25

Describe the risk factors for lymph node involvement in endometrial cancer

Answer 25

• deep myometrial spread (the myometrium normally acts as a barrier)
• poor tumour histology or grade
• cervical stromal involvement

Question 26

Do progestegens or chemo have a place in endometrical Ca treatment?

Answer 26

Yes

• progestogens are rarely used but can treat distant mets
• chemo may have a role in high risk early stage and advanced disease, but the response may be modest

Question 27

What is the overall 5 year survival rates in endometrial cancer?

Answer 27

75%

Question 28

what are risk factors in ovarian cancer related to?

Answer 28

the number of ovulations i.e. early menarche, late menopause, nulliparity

Question 29

What is protective against ovarian cancer?

Answer 29

pregnancy, lactation, used of the pill (that stops ovulation)

Question 30

What % of ovarian cancer is familial?

Answer 30

5%

• BRCA1 = 50% lifetime risk
• BRCA2 = 25% lifetime risk

Question 31

What screening is offered for women with BRCA1/2 mutations? (for ovarian cancer)

Answer 31

Yearly transvaginal USS and Ca125 screening or prophlyactic salpino-oophrectomy

Question 32

What stage of ovarian Ca do most women present with?

Answer 32

Stage 3-4, often absent or vague symptoms

Question 33

What are symptoms of ovarian cancer?

Answer 33

• persistant abdominal distension
• early satiety
• loss of appetite
• pelvic/ abdo pain
• increased urinary urgency/ frequency

Question 34

What would a malignant ovarian mass be like?

Answer 34

• rapid growth of >5cm
• ascites
• advanced age
• bilateral massess
• solid or septate nature on USS
• increased vasculatiry

Question 35

Describe the stages 1-4 of ovarian cancer?

Answer 35

1 - confined to ovaries
2- beyond ovaries but confined to pelvis
3 - beyond the pelvis but confined to the abdomen
4 - beyond the abdomen e.g. in the lungs or liver parenchyma