Gynae Oncology Flashcards
What is the cervical screening program?
SMEAR INVITATION Every 3 years between the ages of 25-49
then every 5 years between the ages of 50 and 64
How does the physiological transformation zone form and when does it become pathological?
During puberty oestrogen makes the cervix evert slightly exposing columnar epithelium to the acidic conditions of the vagina and turning it into SQUAMOUS cell - this is the transformation zone Oncogenic factors (most often HPV) act on this zone and cause cervical intraepithelial neoplasia
Which HPV strains confer the highest risk?
HPV 16 and 18 (cause 70% cervical cancers)
What are the results of cervical screening and what should the next stage of treatment be?
MILD dyskaryosis - samples should be tested for high risk HPV strains
MODERATE or above should be sent for coloposcopy (2 week wait referral)
How might cervical cancer present symptomatically?
PCB, PMB and IMB
Persistent, offensive, blood-stained discharge
Pain (late disease)
Swollen leg (due to thrombosis in the pelvis)
Where is cervical cancer most likely to metastasise to?
Vagina, bladder and bowel
Nodes: parametrical, iliac, obturator and pre-sacral
Blood: liver and lungs
What are some risk factors for cervical cancer?
HPV +++
Smoking
High parity
Herpes
What are some risk factors for endometrial cancer?
OBESITY - aromatase leads to increased levels of oestrogen Early menarche Nulliparity Late menopause COCP HRT Diabetes Anovulatory amenorrhoea (PCOS) Tamoxifen FH of bowel, breast or endometrial cancer
Smoking appears to REDUCE the risk
What are the most common types of endometrial cancer?
ADENOCARCINOMA - 90%
Serous papillary
Clear cell
Sarcoma
What is the most common way for endometrial cancers to present?
POST-MENOPAUSAL BLEEDING - this should be at leats 1 year after stopping periods
(Pre-menopausal women might have irregular bleeding, heavy bleeding or IMB)
What examinations should be done in a woman with suspected endometrial cancer?
Speculum to look or vaginal or cervical sources of the bleeding
Then do a bimanual examination - a fixed bulky and retroverted uterus might suggest endometrial Ca (only in advanced disease)
What investigations should be ordered in a woman with suspected endometrial cancer?
TV USS - to look for endometrial thickening (should be <11mm)
Fine need biopsy / PIPELLE should be taken and sent for histology - can be done in clinic
MRI should be considered to assess depth of invasion of malignancy
CT abdo and chest to assess for malignancy spread
What are the treatment options for endometrial cancer?
assess if the woman wants further children
- RADICAL HYSTERECTOMY and BSO possibly with lymph node resection
- EXTERNAL and INTERNAL radiotherapy are used sometimes
- CHEMOTHERAPY
- HORMONES - anastrozole
What are some risk factors for ovarian cancer?
Nulliparity - ? ovulation more traumatic to ovary
HRT
Endometriosis
BRCA1 and BRCA2
PROTECTIVE: parity, breastfeeding and COCP
How do we calculate how likely a woman is to have an ovarian malignancy?
RISK OF MALIGNANCY INDEX (RMI) … it takes into account three factors:
- Ca125
- Whether or not they have been through the menopause
- Findings on USS
What are the three most common types of ovarian cancer?
Epithelial (most common)
Germ cells (actual ovum producing cells)
Sex cord stromal tumours
What is another name for sex-cord stromal tumours of the ovary?
Sertoli-Leydig tumours
How does ovarian cancer present?
Abdominal pain Bloating Back pain Pressure on bladder or bowel causing urinary or bowel symptoms Dyspnoea Anorexia and weight loss
***always consider ovarian cancer in a woman presenting with IBS-like symptoms but at an older age
What might you find on examination in a patient with ovarian cancer?
Might find an ADNEXAL MASS
Might also find evidence of shifting dullness (the ovarian cancer causes oedematous change)
What investigations should be done in a patient with suspected ovarian cancer?
Pelvic USS
CA-125 (marker produced when peritoneum is irritated so can be associated with endometriosis and pregnancy or just normal menstruation)
CA19.9 - only produced by mucinous types of cancer
CEA - might also be detected in blood but again it is not specific
AFP, hCG and LDH
CXR
FBC, U&E and LFTCT abdo and pelvis
Paracentesis of ascitic fluid
How is ovarian cancer managed?
Image guided biopsy
TAH and BSO +/- lymph node resection
Peritoneal washes
Chemotherapy with PLATINUM compounds
How common are vulval cancers and how do they present?
They are very uncommon and only make up 4% of the gynaecological malingnacies (nearly exclusively in post-menopausal women)
just present as a lump or skin change on the vulva
What type of malignancy are vulval cancers usually?
They are nearly always squamous cell carcinomas of the vulval skin
How should vulval malignancy be treated?
WLE
Sentinel node biopsy
Chemoradiotherapy
