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CP2 OBGYN > Gynae Oncology > Flashcards

Gynae Oncology Flashcards

1
Q

What is an ovarian cyst?

A

Fl filled sac in ovary

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2
Q

What are physiological cysts?

A

Cysts that predominate through menstrual cycle

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3
Q

What are the 2 general rules with ovarian cysts?

A

Do not raise concern unless symptomatic

Resolution should be confirmed by scanning 12 weeks later

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4
Q

What is the RMI

A

Risk Malignancy Index

Tool used to determine likelihood of a mass related to malignancy

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5
Q

What is a simple ovarian cyst?

A

One that contains fl only

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6
Q

What is a complex ovarian cyst?

A

Can be irregular and can contain solid material, blood or have septations or vascularity

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7
Q

Functional non-neoplastic ovarian cysts (2)

A

Follicular

Corpus Luteal cysts

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8
Q

How big is a ovarian follicular cyst

A

<3cm

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9
Q

What does an ovarian follicular cyst represent?

A

Developing follicle in 1st 1/2 menstrual cycle

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10
Q

How big is a corpus luteal cyst?

A

<5cm

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11
Q

When does a corpus luteal cyst occur?

A

In luteal phase of menstrual cycle after formation of corpus luteum

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12
Q

What are pathological ovarian cysts? (3)

A

Endometrioma
Polycystic ovaries
Theca lutein cyst

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13
Q

Another name for endometrioma

A

Chocolate cysts

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14
Q

Who gets endometriomas

A

Those with endometriosis

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15
Q

What is an endometrioma?

A

Bleeding into cyst

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16
Q

What are theca lutein cysts a consequence of?

A

raised hCG

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17
Q

When should theca lutein cysts resolve?

A

Upon resolution hCG levels

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18
Q

E.g.s of epithelial ovarian tumours (3)

A

Serous cystadenoma
Mucinous cystadenoma
Brenner tumour

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19
Q

Which is the most common type of malignant ovarian tumour?

A

Serous cystadenoma

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20
Q

What % serous cystadenoma are bilateral?

A

30%

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21
Q

Are mucinous cystadenomas usually unilateral or bilateral?

A

unilateral

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22
Q

Are mucinous cystadenomas usually unilocular or multiloculated?

A

Multiloculated

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23
Q

Are Brenner tumours usually uni or bilateral?

A

Unilateral

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24
Q

Brenner tumour - appearance

A

Solid grey/yellow

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25
Q

Which ovarian tumours contain teeth, hair, skin and bone?

A

Mature cystic teratoma (dermoid cysts)

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26
Q

Who do dermoid cysts occur in?

A

young pregnant women

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27
Q

What percentage dermoid cysts are bilateral?

A

10%

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28
Q

What is the most common type of ovarian stromal tumours?

A

Sex-cord tumours/fibromas

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29
Q

What are sex-cord tumours associated with?

A

Ascites/pleural effusion

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30
Q

How to investigate and manage pre-menopausal women (<40) for ovarian cysts

A

If simple cyst on USS - No CA125
LDH, aFP, hCG
Rescan in 6w
If persistent or >5cm - consider laparoscopic cystectomy or oophorectomy

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31
Q

Managing ovarian cysts in post-menopausal women - low RMI

A

Follow up in 1yr w/ USS + CA125 if <5cm

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32
Q

Managing ovarian cysts in post-menopausal women - moderate RMI

A

Bilateral oophorectomy

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33
Q

Managing ovarian cysts in post-menopausal women - High RMI

A

Refer for staging laparotomy

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34
Q

What type of ovarian cancer do post-menopausal women get?

A

Epithelial cell carcinoma

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35
Q

What type of ovarian cancer do pre-menopausal women get?

A

Germ cell tumours

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36
Q

Risk factors ovarian cancers

A

Incr ovulations: early menarche, late menpause, nulliparity

Familial - BRCA1/2, HNPCC

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37
Q

Protective factors against ovarian cancer (2)

A

Pregnancy + lactation

OCP

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38
Q

Is there a screening program for ovarian cancer in the UK?

A

No

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39
Q

How does ovarian cancer present early on?

A

Asymptomatic

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40
Q

S+S ovarian cancer

A

persistent bloating
Early satiety +/- loss appetite
Pelvic + abdo pain
Others - incr urgency/freq, vaginal bleeding

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41
Q

What could you find in a woman with ovarian cancer on examination?

A

Cahexia
Abdo pelvic mass
Ascites
Br tenderness

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42
Q

What does an ovarian adenocarcinoma spread?

A 
Transcoloemic spread 
(directly into abdo + pelvis)
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43
Q

Stage 1a ovarian Ca

A

One ovary is affected, capsule intact

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44
Q

Stage 1b ovarian Ca

A

Both ovaries are affected, capsule is intact

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45
Q

Stage 1c ovarian Ca

A

One/both ovaries = affected, + capsule is not intact, or malignant cells in abdo cavity (ascites)

46
Q

Stage 2 ovarian Ca

A

Disease is beyond the ovaries but confined to pelvis

47
Q

Stage 3 ovarian Ca

A

Disease is beyond the pelvis but confined to the abdomen

48
Q

In stage 3 ovarian Ca, which 3 structures are frequently involved?

A

Omentum
Small bowel
Peritoneum

49
Q

Stage 4 ovarian Ca

A

Disease beyond abdomen

50
Q

Investigations from ovarian cancer in primary care

A

CA-125 levels

51
Q

Who in primary care gets their CA-125 levels tested?

A

Women >50y/o

Abdo Sx

52
Q

If a patients CA-125 levels are >35 - what is the next step?

A

USS abdo + pelvis

53
Q

How is RMI calculated?

A

U x M x CA125
U = USS score
M = Menopause index

54
Q

What is used for staging of ovarian cancer?

A

CT pelvis and abdo

55
Q

Ovarian Ca - if unfit for surgery, what Mx should be offered?

A

Palliative care

56
Q

What surgical technique should be used to assess the level of spread of ovarian cancer?

A

Midline laparotomy

57
Q

Surgical Management ovarian Ca

A

Total hysterectomy, bilateral oopherectomy + partial omentectomy

58
Q

Biopsy of peritoneum in ovarian cancer: Mx of stage 1

A

Retroperitoneal LN biopsy

59
Q

Biopsy of peritoneum in ovarian cancer: Mx of stage s+

A

Retroperitoneal LN removal

60
Q

Chemotherapy - stage 1a/b ovarian Ca

A

No chemo!

61
Q

Chemo - stage 1c ovarian Ca

A

6xyxles of carboplatin

62
Q

Chemo - stage 2-4 ovarian Ca

A

Carbplatin +/- paclitaxel

63
Q

Poor prognosis ovarian Ca (3)

A

Advanced stage
Poorly differentiated
Slow response to chemo

64
Q

Follow up ovarian Ca

A 
Continue to monitor CA125 
CT scanning (detect residual disease or relapse)
65
Q

Mx - heavy vaginal bleeding in ovarian Ca

A

High dose progestogens

Radiotherapy

66
Q

Mx - ascites ovarian Ca

A

Drainage + dexamethasone

67
Q

Mx - partial bowel obstruction ovarian Ca

A

Metoclopramide/enema

68
Q

Mx - complete bowel obstruction ovarian Ca

A

Cyclizine

69
Q

How should the last 24hours in ovarian cancer before death be Mx

A

Anxiolytics + analgesics

70
Q

Which HPV are associated with cervical cancer

A

16 + 18

71
Q

RF HPV/Cervical cancer (9)

A 
Starting sex @ younger age
Multiple sexual partners 
HIV
Herpes 
Smoking 
<20 y/o 
COCP 
Low SE 
Exposure to DES
72
Q

Timing smears <50 y/o

A

3 yearly

73
Q

Timing smears >50

A

5 yearly

74
Q

Where in the cervix does cancer tend to develop?

A

Squamocolumnar junction

75
Q

What are the 2 premalignant cells of cervical cancer

A

CIN - Cervical intraepithelial neoplasia

CGIN - cervical glandular intraepithelial neoplasia

76
Q

What does CIN transform into?

A

Squamous cell carcinoma

77
Q

What does CGIN transport into?

A

Adenocarcinoma

78
Q

Features of cervical dyskaryosis (4)

A

Disproportionate nuclear enlargement
Hyperchromasia
Mutlinucleation
Irregular chromatid distribution

79
Q

When performing a colposcopy, what features are you looking for in cervical cancer?

A

Mosaicism

Punctuations

80
Q

What is used to stain abnormal cells in colposcopy?

A

Acetic acid

81
Q

Sx cervical cancer (5)

A 
IMB 
Post-coital bleeding 
Pain 
Dysuria 
Abnormal smear
82
Q

Stage 1 Cervical cancer

A

Microscopic <4cm

83
Q

Stage 2 Cervical cancer

A

Parametrium - tissues outside uterus, around uterus

84
Q

Stage 3 Cervical cancer

A

Pelvic side walsl

85
Q

Stage 4 Cervical cancer

A

Distant Mets

86
Q

Ix Cervical cancer

A

Cone biopsy
CHX
IVU
Cystoscopy + sigmoidoscopy

87
Q

Tx stage 1 cerivcal cancer

A

LLETZ/radical hysterectomy

88
Q

Tx stage 2 cervical cancer

A

Radical hysterectomy/chemoradiotherapy

89
Q

Tx stage 3 cervical cancer

A

Chemoradiotherapy

90
Q

Tx stage 4 cervical cancer

A

Chemoradiotherapy

91
Q

5 year prognosis - stage 1 cervical cancer

A

80-93%

92
Q

5 year prognosis - stage 4 cervical cancer

A

5-16%

93
Q

Why has the incidence of endometrial cancer increased?

A

Increased obesity

94
Q

Peak incidence endometrial cancer

A

60-75 y/o

95
Q

What is the most common type of endometrial cancer?

A

Adenocarcinoma

96
Q

Why does endometrial cancer occur

A

Unopposed oestrogen

97
Q

What are the 4 stages of endometrial cancer

A

1 - Simple hyperplasia
2 - complex hyperplasia
3 - complex hyperplasia
4 - Adenocarcinoma

98
Q

4 stages of endometrial cancer

A

1) Simple hyperplasia
2) Complex hyperplasia
3) Complex hyperplasia w/ atypia
4) Adenocarcinoma

99
Q

RF Endometrial cancer (10)

A 
Early menarche/late menopause 
Low parity 
PCOS
HRT (O only) 
Tamoxifen use 
DM
Age
Obesity 
FHx HNPCC
HTN
100
Q

Features endometrial Ca (4)

A

PMB
Clear/white vaginal discharge
Abnorm cervical smears
Advanced? W loss/ abdo pain

101
Q

What is the grading system used for endometrial cancer?

A

FIGO

102
Q

Low FIGO endometrial cancer

A

I - endometrium only

103
Q

High FIGO endometrial cancer

A

II - Myometrium
III - Other pelvic structures
IV - Distant mets

104
Q

O/E endometrial Ca

A

Abdo/pelvic mass

Vulval/vag atrophy. cervical lesions

105
Q

DDx endometrial Ca (6)

A 
Vulval atrophy 
Vulval pre-malig/malig conditions 
Cervical polyps
Cervical Ca
Endometrial polyps 
Endometrial atrophy
106
Q

Ix Endometrial Ca (3)

A

Pippelle biopsy
Pelvic USS
Hysteroscopy

107
Q

Features of endometrial Ca on USS

A

> 4mm endometrial thickness

Endometrium = white glow

108
Q

Tx Simple endometrial hyperplasia

A

W+W

Lose some weight

109
Q

Tx Complex endometrial hyperplasia

A

W+W
Lose some weight
Mirena coil

110
Q

Tx Complex endometrial hyperplasia + atypia

A

TAH

111
Q

Tx endometrial adenocarcinoma

A

TAH

CP2 OBGYN (21 decks)

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