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Obstetrics & Gynaecology > Gynae Oncology > Flashcards

Gynae Oncology Flashcards

1
Q

Risk factors for endometrial cancer…

A
  • Increased endogenous and exogenous oestrogen exposure: early menarche, late menopause, oestrogen only HRT
  • Nulliparity - less amenorrhoea
  • Obesity
  • Diabetes
  • PCOS
  • Tamoxifen in breast cancer (oestrogen agonist)
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2
Q

Presentation of endometrial cancer…

A
  • Postmenopausal bleeding = sensitive sign

- Premenopausal women may have intermenstrual bleeding

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3
Q

Investigations for endometrial cancer…

A

1st line = TV USS:

  • > 4mm = endometrial biopsy
  • <4mm = discharge patient
  • <4mm and tamoxifen

Endometrial biopsy done using TV US guidance - used for diagnosis and staging

MRI can be done to look for metastases

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4
Q

Treatment for endometrial cancer…

A
  • Low risk= total laparoscopic hysterectomy with bilateral salpingoopherectomy
  • High risk i.e. lymph node involvement = external beam radiotherapy
  • Vaginal vault radiotherapy is done to reduce local reccurence but no benefit to survival
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5
Q

What HPV types are associated with cervical cancer?

A

HPV 16, 18, 31, 33

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6
Q

What is cervical intraepithelial neoplasia?

A

Presence of atypical cells in squamous epithelium - eventually become dyskaryotic.
*Premalignant phase where if left untreated, it may develop into a carcinoma

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7
Q

Histological subtypes of cervical intraepithelial neoplasia…

A

CIN 1 = mild dysplasia: atypical cells found in lower third of epithelium

CIN 2=moderate dysplasia: atypical cells found in lower 2/3 of epithelium

CIN 3= severe dysplasia: atypical cells found in full thickness of epithelium

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8
Q

What age groups are involved in Cervical Cancer screening programme?

A

Screening every 3 years between 25-49

Screening every 5 years between 50-64

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9
Q

Smear test results from cervical screening programme…

A
  • Normal histology = return to normal screening programme
  • Borderline = HPV test:
  • HPV negative- return to screening programme
  • HPV positive - colposcopy
  • High grade dyskariosis = colposcopy
  • Any grade of CIN also receives colposcopy
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10
Q

What happens in colposcopy ?

A

LLETZ = large loop excision of transformation zone

This is carried out by using diathermy under LA

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11
Q

Presentation of cervical cancer…

A
  • Post-coital bleeding
  • Offensive discharge
  • Irregular bleeding: intermenstrual and post-menopausal
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12
Q

Stages of cervical cancer…

A

Stage 1 = lesions confined to cervix
Stage 2= invasion into vagina
Stage 3= invasion into lower 1/3 of vagina
Stage 4 = invasion beyond bladder/ metastasis

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13
Q

Treatment of cervical cancer…

A

Stage 1 = cone biopsy if fertility is being preserved, or simple hysterectomy if family complete
Stage 2= Radical hysterectomy (may cause haemorrhage, bladder damage)
Stage 3/4 = Chemoradiotherapy and palliative radiotherapy

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14
Q

What are the main types of ovarian cancer?

A
  • Serous = most common (70%)
  • Clear-cell - has poor prognosis (10%)
  • Endometrioid - histologically similar to endometrial cancer (10%)
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15
Q

Risk factors for ovarian cancer…

A
  • Many ovulations : early menarche, late menopause, nulliparity
  • BRCA1/2 gene
  • Smoking
  • Obesity
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16
Q

Presentation of ovarian cancer…

A

Generally very vague sx:

  • Abdominal distension
  • Bloating
  • Urinary frequency
  • Weight loss
  • Fatigue

Signs:
- Abdominal/ pelvic mass

17
Q

Investigations for ovarian cancer…

A

CA-125 levels tested in all women >50 y/o with abdo/urinary sx
- CA-125> 35IUml - arrange for USS of pelvis and abdomen

USS: positive for ascites = urgent 2 week referral to secondary care required

18
Q

Stages of ovarian cancer…

A

Stage 1: limited to ovaries
Stage 2: limited to pelvis
Stage 3: limited to abdomen
Stage 4: metastases beyond abdominal cavity

19
Q

Management of ovarian cancer…

A

Total abdomnial hysterectomy, bilateral salpingoopherectomy and partial omentectomy (removal of omentum in abdominal cavity) + adjuvant chemotherapy

Neo-adjuvant chemotherapy used in advanced disease

20
Q

What are the two types of vulval intraepithelial neoplasia?

A
  1. Usual type = common in women aged 35-55

2. Differentiated type = seen in older women, associated with lichen sclerosis. Most likely to differentiate into cancer

21
Q

Presentation of vulval cancer…

A
  • Vulval pruritus
  • Bleeding
  • Vulval discharge
  • Lump/ ulcer on labia majora
22
Q

Management of vulval carcinoma…

A

Local disease = wide local excision without lymphadenectomy
Extensive disease = add lymphadenectomy

Plastic surgeons may be needed for reconstructive surgery

Obstetrics & Gynaecology (10 decks)

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