Gynae oncology Flashcards
What symptoms might someone present with?
Post coital bleeding
Itra-menstrual bleeding
Post menopausal bleeding
Late disease: pain, DVT (pelvic thrombosis)
What investigations check for gynae cancers?
Colposcopy Cervical biopsy FBC, U&E, LFTs MRI pelvis CT abdo and chest if indicated to check for lymphatic spread
Where do gynae cancers spread too?
Direct/ local = vagina, bladder, parametrium, bowel
Haemotagoenous = liver and lungs (poor prognosis)
Where are atypical cells in CIN 1?
Lower 1/3rd of the epithelium
Where are atypical cells in CIN 2?
Atypical cells in lower 2/3rds of epithelium
Where are atypical cells in CIN 3?
Full thickness of the epithelium - only malignancy if invade through basement membrane
What % of women with CIN 2/3 will develop cancer within 10 years if disease untreated?
1/3rd (33%)
How much does smoking + HPV increase the rate of cervical cancer by?
20 x
Does CIN cause symptoms?
No - no symptoms and not visible on the cervix
From what ages do women get 3 year smears?
25 - 49
What ages do women get a smear every 5 year?
50 - 64 yrs
What do you do if someone has mild dyskarosis and is HPV negative what would you do?
Refer back to normal smear programme
What histological type are most cervical cancers?
- 90%
- 10% are adenocarcinomas originating from columnar epithelium
What virus is in ALL cervical cancers?
HPV
What is the treatment options for cervical cancer 2b and above?
Chemo-radiotherapy alone
What are indications for chemo-radiotherpy for cervical cancer?
- 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)
what is the overall 5 year survival for cervical cancer?
65%
What is the histological type of 90% of endometrial cancers?
Adenocarcinoma of columnar endometrial gland cells
What is the main aetiology to endometrial cancer?
Unopposed oestrogen
- higher ratio of oestrogen to progestogen
What are common presentations of endometrial cancer?
- 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)
What vaginal condition co-exists with endometrial cancer?
Atrophic vaginitis
What investigations are done in possible endometrial cancer?
- 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
What are the treatment options for endometrial cancer?
- 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
What are indications for radiotherapy in endometrial cancer?
- used after hysterectomy in patients for high risk lymph node involvement
- for pelvic reccurence (confined to pelvis) - beneficial if not previousl used
