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MFSRH part 2 > Gynae Oncology > Flashcards

Gynae Oncology Flashcards

1
Q

Treatment of Persistent GTN with FIGO score >6

A

Combined chemotherapy

Continue for 6 weeks after HCG levels are normal

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2
Q

Overall 5 year survival of breast cancer

A

57-66%

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3
Q

What is the false positive rate of mamographic screening

A

10% in younger women

5% in older women

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4
Q 
Cervical screening guidelines for 
England
Wales
Scotland
N. Ireland
A

England - 25-49 yo 3 yearly
50-64 yo 5 yearly

Wales and N. Ireland - as England

Scotland - 20-60 yo 3 yearly

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5
Q

Presentation of Paget’s disease of the vulva

A

Burning

Raised erythematous lesion

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6
Q

Treatment of choice for Paget’s disease of the vulva

A

Surgery

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7
Q

Recurrence rate after surgical treatment of Paget’s disease of the vulva

A

30%

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8
Q

What proportion of cervical invasive cancers are squamous carinomas?

A

90% squamous

10% adenocarcinoma

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9
Q

What is the commonest type of vaginal cancer

A

90% squamous

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10
Q

Usual management of invasive vaginal cancer

A

Radiotherapy

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11
Q

Management of squamous or adenocarcinoma of the cervix

A

Both managed the same

Best treated with surgery +/- radiotherapy

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12
Q

Does methotrexate have any impact on adenocarcinoma of the cervix

A

Yes but not curative. Causes some regression

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13
Q

Presentation of adenocarcinoma of the endocervix

A

PV bleeding
Offensive PV discharge
Pain
Haematuria

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14
Q

Management of smear showing CIN 1 (mild dyskaryosis)

A

Check HPV status

If HR HPV +be refer to colposcopy

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15
Q

Management of smear showing CIN 2

A

Refer to colposcopy

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16
Q

Clinical presentation of androgen producing tumours

A

androgen producing tumours are usually adrenal or ovarian

rapid hair growth
virilization and clitoral enlargement
masculinization
androgenic symptoms

timeframe of 3 to 6 months

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17
Q

What hormone do Granulosa cell tumours produce?

What are the symptoms

A

Granulosa cell tumours produce oestrogen
can lead to vaginal bleeding and breast tenderness
General symptoms - bloating etc

may lead to endometrial hyperplasia, polyps or endometrial cancer.

ultrasound appearance vary from completely solid to cystic

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18
Q

Most common Type of Ovarian Cancer

A

Epithelial Cancers

90% of ovarian cancers

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19
Q

What proportion of ovarian cancers are Germ cell carcinomas?

And who do they affect

A

Germ cell carcinoma
5% of cases of ovarian cancers

Usually in women in their 20’s

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20
Q

Three main subtypes of ovarian Germ cell carcinoma

A

Three main subtypes:
teratoma
dysgerminomas
endodermal sinus tumors

Other subtypes are
Embryonal cancer
polyembryoma
choriocarcinoma 
mixed type
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21
Q

What proportion of ovarian cancers are Stromal carcinoma?

What are the 2 main types?

A

Stromal carcinoma
5% of cases of ovarian cancers

Two main types:
granulosa cell tumors
sertoli-leydig cell tumors

Granulosa cell tumours typically secrete oestrogen

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22
Q

What proportion of ovarian cancers are Small cell carcinoma?

Who do they usually affect?

A

Small cell carcinoma of the ovary

0.1% of cases of ovarian cancers (very rare)

Usually in women in their 20’s

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23
Q

Definitions Complete Molar pregnancy

A

Complete Molar: Abnormal diploid conceptus with absence of foetus (typically 46XX)

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24
Q

Define Partial Molar pregnancy

A

Partial molar

Abnormal triploid conceptus that may have fetal tissue typically 69XXY

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25
Q

Define Choriocarcinoma

A

Malignant tumour of trophoblast

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26
Q

What proportion of pregnancies are molar?

A

1 in 1000 pregnancies per year are molar

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27
Q

What proportion of pregnancies are effected by choriocarinoma

A

1 in 45,000 pregnancies effected by choriocarcinoma

70% of choriocarcinoma occurs after molar pregnancy
20% after TOP
10% after normal pregnancy

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28
Q

Classic Clinical Features of molar pregnancy

A

Irregular vaginal bleeding
Hyperemesis
Large for gestational age uterus
Early Miscarriage

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29
Q

Classic Biochemical Features of molar pregnancy

A

Excessive HCG production

In 3% of cases excess HCG sufficient to trigger hyperthyroidism

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30
Q

Diagnosis of molar pregnancy

A

Ultrasound assessment

Formal diagnosis is on histopathological assessment following evacuation

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31
Q

Advice regarding chemo for breast cancer and breastfeeding

A

should not breastfeed whilst taking tamoxifen, trastuzumab (herceptin®) or during chemotherapy.

Women on chemotherapy should wait at least 14 days from their last chemotherapy dose before breastfeeding

32
Q

What is the most common cancer in females?

A

Breast cancer

33
Q

How many pregnancies are affected by breast-cancer development?

A

Breast cancer in 1 in 3000 pregnancies

34
Q

Treatment of breast cancer during pregnancy

A

Surgical treatment can be considered in all trimesters

Systemic chemotherapy contraindicated in 1st trimester - high rate of fetal abnormality

Chemo Safe from the second trimester.

Radiotherapy contraindicated until after delivery - unless life saving/preserve function eg spinal cord compression

Tamoxifen and trastuzumab (herceptin®) contraindicated in pregnancy

35
Q

Why is breastfeeding while on chemotherapy not advised?

A

risk of neonatal leucopenia.

Breast feeding should be delayed until 14 days after last chemotherapy dose

36
Q

What is associated with Differentiated VIN?

A

Differentiated VIN is associated with lichen sclerosus

37
Q

What is Undifferentiated or usual/classical VIN associated with?

A

Undifferentiated or usual/classical VIN is associated with high risk HPV - 16 + 18

undifferentiated VIN is often seen in younger women and may be multifocal

38
Q

Predisposing conditions to vulval cancer

A

lichen sclerosus (may lead to differentiated VIN prior to carcinoma)

high-risk HPV i.e. 16 and 18 (may lead to undifferentiated or usual type VIN prior to carcinoma)

39
Q

What is the Risk of developing invasive vulval disease in women with lichen sclerosus?

A

4%

40
Q

5 yr survival of vulval cancer

A

No LN involvement >80%

Inguinal LN involvement <50%

Iliac and other Pelvic LNs 10-15%

41
Q

What is stage 1 vulval cancer

A

Confined to vulva

1A = Lesions ≤ 2cm with < 1mm stromal invasion

1B = Lesions > 2 cm in size OR with stromal invasion > 1 mm confined to the vulva or perineum

42
Q

What is stage 2 vulval cancer

A

Stage 2 vulval cancer

Tumour of any size

with extension to adjacent perineal structures 
   - lower 1/3 urethra
   - lower 1/3 vagina
    - anus
with negative nodes
43
Q

What is stage 3 vulval cancer

A

Stage 3 vulval cancer

Tumour of any size
with or without extension to adjacent perineal structures (lower 1/3 urethra; lower 1/3 vagina; anus)
with positive inguinofemoral nodes

3A (I) = 1 LN met (≥5 mm)
OR (II) 1 - 2 LN met (< 5 mm)

3B (I) = 2+ LN mets (≥5 mm)
OR (II) 3+ LN mets (< 5 mm)

3C = Positive nodes with extra capsular spread

44
Q

What is stage 4 vulval cancer

A

Tumour invades other regional (upper 2/3 urethra; 2/3 vagina) or distant structures

4A (I) = Upper urethral and/or vaginal mucosa; bladder mucosa; rectal mucosa or fixed to pelvic bone
OR (II) Fixed / ulcerated inguinofemoral LN

4B = Any distant mets including pelvic LN

45
Q

Bowel obstruction may occur in what percentage of women following radiotherapy for cervical carcinoma

A

10-15%

46
Q

Side effects from treatments of gynae malignancies with radiotherapy

A

of F treated for gynae malignancies:

Infertility

> 50% have GI SE - diarrhoea, rectal bleeding and fistula formation.
Bowel obstruction up to 14.5% following radiotherapy for cervical ca
Bowel fistulae up to 8% after tx of cervical ca.
Intraoperative ureteric injury in 1% of radical hysterectomy without prior radiotherapy
1% undergoing radiotherapy develop ureteric fibrosis + obstruction
Radiation cystitis - 26% who survive > 5 yr
Bladder atony common after radical hysterectomy. 2-3% requiring intermittent self-catheterisation.

Shortening and stenosis of Vaginal epithelium common
Dyspareunia is 55%

47
Q

What follow up is advised for women treated for CIN 1-3

A

cervical screening at 6 months after treatment

48
Q

Women with one previous molar pregnancy have what chance of the subsequent pregnancy being molar

A

1 in 80

49
Q

Women with more than one previous molar pregnancy have what chance of the subsequent pregnancy being molar

A

1 in 10

50
Q

In PMB an endometrial thickness with TVS of ≤ 4mm means what probability of endometrial carcinoma

A

<1%

51
Q

Advice regarding timing of cervical smear for pregnant women

A

In pregnancy routine cervical screening should be deferred until at least 12 weeks postnatal.

If previous smear abnormal refer for specialist opinion re mid-trimester sampling

52
Q

High risk HPV types for cervical cancer

A

16 + 18

53
Q

HPV 16 + 18 account for what % of cervical cancer?

A

70%

54
Q

What types of HPV does gardasil cover?

A

16, 18 = cervical ca

6, 11 = warts

55
Q

What % of smear tests come back normal?

A

94%

56
Q

What proportion of women have cervical cancer cells on their smear test?

A

1 in 1000

57
Q

What proportion of smears on average are insufficient?

A

2%

58
Q

What % of women who have a smear are referred to colposcopy?

A

4%

59
Q

Management of an inadequate cervical smear

A

Repeat smear - not before 3m

If 3x inadequate smears refer to colposcopy - 6 weeks

60
Q

Management of a borderline or low Grade dyskaryosis smear?

A

Test for HR HPV
if HPV +be refer to colp within 6/52
If HPV -ve refurn to routine recall

61
Q

Management of moderate / severe smear (high grade dyskaryosis)

A

Refer to colposcopy - urgent 2 week wait

62
Q

Management of suspected cervical cancer or a glandular abnormality on smear test

A

Refer to colposcopy - 2 week wait

63
Q

Life time risk of endometrial cancer in a patient with lynch syndrome?

A

50%

64
Q

What cut of for the endometrium on tv Uss is used for excluding cancer in PMB patients

A

4mm

65
Q

When a 4mm cut of is used on uss for excluding cancer in PMB patients what % of women will have an endometrial cancer which is missed?

A

1%

66
Q

Bowel fistulae occur in what % of women having pelvic radiotherapy for cervical cancer?

A

5-10%

67
Q

GI side effects from pelvic radiotherapy

A

Diarrhoea
Rectal bleeding
Fistulae
Bowel obstruction

68
Q

Urinary side effects from pelvic cancer surgeries or radiotherapy

A

Intraoperative ureteric injury - 1%
Ureteric fibrosis
Radiation cystitis
Bladder atony

69
Q

Sexual function side effects from pelvic radiotherapy

A 
Vaginal shortening 
Vaginal stenosis
Dysparunia
Vaginal dryness
Psyhoclogical dysfunction
70
Q

Management of a patient with a RMI of >200

A

CT abdomen and pelvis

Refer to gynae onc MDT

71
Q

What groups of patients are at higher risk of developing a complete molar pregnancy

A

Girls <15yo
Women > 45 yo
Women with a previous molar pregnancy

72
Q

Breast cancer occurs in how many pregnancies

A

1 in 3000

73
Q

Advice re breastfeeding whilst on breast cancer treatment

A

Women should not breastfeed whilst taking tamoxifen, trastuzumab (herceptin®) or during chemotherapy.

Women on chemotherapy should wait at least 14 days from their last chemotherapy dose before breastfeeding.

74
Q

Advice regarding tamoxifen and timing of conception

A

If planning future pregnancies women should stop tamoxifen three months prior to trying to conceive.

75
Q

What % of endometrial cancers are genetic

A

2-5%

76
Q

5 year survival in vulval cancer without lymph node spread

A

vulval cancer without lymph node spread

5year survival is over 80%

MFSRH part 2 (24 decks)

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