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Obs and Gynae > Gynae-oncology > Flashcards

Gynae-oncology Flashcards

1
Q

Symptoms of ovarian cancer?

A

Often vague symptoms, misdiagnosed as IBS
75% present at stage III

Bloating 
Abdominal or pelvic pain
Vaginal bleeding
Palpable mass
Urinary symptoms - frequency or urgency
Change in bowel habit

Unexplained weight loss, loss of appetite, early satiety
Fatigue

Hip or groin pain (obturator nerve)

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2
Q

Investigations for ovarian cancer

A

FBC, U&E, LFTS
CA125 (raised in 80% of epithelial cancers) normal = <35

TVS
CXR
CT TAP

Ascites or pleural effusion can be sampled and sent to cytology

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3
Q

Worrying finding on USS

A

Cysts

- large, bilateral, appear “complex” (both have solid and cystic areas)

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4
Q

What is risk of malignancy index?

A

RMI = U x M x CA125 - High risk = >200

U (0-3) point for multilocular cysts, solid areas, metastases, ascites, bilateral lesions

M - 1=pre-menopausal 3=OST menopausal

CA125

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5
Q

Types of ovarian cancer

A

High grade serous (85%)
Endometrioid (15%)
Low grade, clear cell, mucinous (<1%)

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6
Q

When is chemo given?

A

Recommended for everyone following surgery, unless low grade or stage 1a or 1b

Platinum agents used - carboplatin with paclitaxel

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7
Q

Types of cervical cancer

A

80% squamous cell carcinoma

Adenocarcinoma next most common

(Small cell carcinoma)

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8
Q

What cancers is HPV associated with?

A

Primarily cervical

Also:
anal, vulval, vaginal, penis, mouth and throat

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9
Q

Which strains of HPV are asociated with cervical cancer?

A

Type 16 and 18

Responsible for 70% of cervical cancer

(6 and 11 cause genital warts)

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10
Q

How does HPV cause cervical cancer?

A

Inhibits tumour suppressor genes

E6 inhibits P53

E7 inhibits pRb

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11
Q

What are the RF for cervical cancers

A

Increased risk of catching HPV

Later detection of precancerous and cancerous changes (non-engagement with screening) - missing smears

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12
Q

Increased risk of catching HPV (4)

A

Early sexual activity

Increased number of sexual partners

Sexual partners who have had more partners

Not using condoms

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13
Q

Other risk factors for cervical cancer excluding HPV and screening?

A

Smoking

HIV (patients with HIV are offered yearly smear tests)

Combined contraceptive pill use for more than five years

Increased number of full-term pregnancies

Exposure to diethylstilbestrol during fetal development

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14
Q

How does cervical cancer present?

A

Cervical cancer may be detected during cervical smears in otherwise asymptomatic women

Bleeding (intermenstrual, postcoital or post-menopausal bleeding)

Discharge

Pelvic pain

Dyspareunia (pain or discomfort with sex)

Ulceration
Inflammation
Visible tumour

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15
Q

Cervical Intraepithelial Neoplasia

grading system for level of dysplasia

A

CIN I: mild dysplasia, affecting 1/3 the thickness of the epithelial layer,

CIN II: moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, likely to progress to cancer if untreated

CIN III: severe dysplasia, very likely to progress to cancer if untreated
CIN III is sometimes called cervical carcinoma in situ

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16
Q

Who is involved in the cervical screening programmes?

A

25 – 49 Every 3 years
50 – 64 Every 5 years

HIV - screened annually
65+ may request a smear if they have not had one since aged 50
Previous CIN may require additional tests (e.g. test of cure after treatment)
Immunocompromised women may have additional screening (e.g. women on dialysis, cytotoxic drugs or undergoing an organ transplant)
Pregnant women should wait until 12 weeks post-partum

17
Q

What is colposcopy?

A

Insertion of a speculum and using equipment (a colposcope) to magnify the cervix

Acetic acid causes abnormal cells to appear white

Schiller’s iodine test - turns healthy cells brown

18
Q

Management of cervical cancer

A

Stage 1B – 2A: Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy

Stage 2B – 4A: Chemotherapy and radiotherapy

Stage 4B: Combination of surgery, radiotherapy, chemotherapy and palliative care

19
Q

Types of endometrial cancer

A

80% adenocarcinoma

20
Q

Risk factors for endometrial cancer

A

Based on exposure to UNOPPOSED OESTROGEN:

Increased age
Earlier onset of menstruation
Late menopause
Oestrogen only hormone replacement therapy
No or fewer pregnancies
Obesity
Polycystic ovarian syndrome
Tamoxifen
21
Q

What do women with PCOS need to take for endometrial protection?

A

Should have one of:

The combined contraceptive pill

An intrauterine system (e.g. Mirena coil)

Cyclical progestogens to induce a withdrawal bleed

22
Q

Why is obesity a crucial risk factor in endometrial cancer?

A

Adipose tissue produces aromatase

Aromatase converts androgens into oestrogen

23
Q

Risk factors in endometrial cancer not relating to unopposed oestrogen

A

T2DM - increased prod. of insulin increases risk of hyperplasia

HNPCC (Lynch syndrome)

24
Q

What are protective factors for endometrial cancer?

A

Combined contraceptive pill

Mirena coil

Increased pregnancies

Cigarette smoking

25
Q

Presentation of endometrial cancer

A

POSTMENOPAUSAL BLEEDING

Postcoital bleeding
Intermenstrual bleeding
Unusually heavy menstrual bleeding
Abnormal vaginal discharge
Haematuria
Anaemia
Raised platelet count
26
Q

When to refer with endometrial cancer symptoms?

A

2ww: Postmenopausal bleeding (more than 12 months after the last menstrual period)

TVS in 55+ with:

Unexplained vaginal discharge
Visible haematuria plus raised platelets, anaemia or elevated glucose levels

27
Q

What investigations are done for endometrial cancer?

A

Transvaginal ultrasound for endometrial thickness

Pipelle biopsy (highly sensitive for endometrial cancer)

Hysteroscopy with endometrial biopsy

28
Q

Risk factors for ovarian cancer

A

Age (peaks age 60)
Obesity

Smoking

Increased number of ovulations (Early-onset of periods, late menopause, no pregnancies)

Recurrent use of clomifene (used in infertility)

FH
BRCA1 and BRCA2 genes (consider the family history)

29
Q

Protective factors against ovarian cancer

A

Combined contraceptive pill

Breastfeeding

Pregnancy

30
Q

When to refer with ovarian cancer symptoms?

A

2-week-wait referral if a physical examination reveals:

Ascites
Pelvic mass (unless clearly due to fibroids)
Abdominal mass
31
Q

Causes of raised CA125 (6)

A

Endometriosis

Fibroids

Adenomyosis

Pelvic infection

Liver disease

Pregnancy

32
Q

Investigations for women u40 with complex mass

A

Need to investigate for germ cell tumour:

Alpha-fetoprotein (α-FP)
Human chorionic gonadotropin (HCG)

Obs and Gynae (19 decks)

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