Gynae Oncology Flashcards
Risk factors for endometrial cancer…
- 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)
Presentation of endometrial cancer…
- Postmenopausal bleeding = sensitive sign
- Premenopausal women may have intermenstrual bleeding
Investigations for endometrial cancer…
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
Treatment for endometrial cancer…
- 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
What HPV types are associated with cervical cancer?
HPV 16, 18, 31, 33
What is cervical intraepithelial neoplasia?
Presence of atypical cells in squamous epithelium - eventually become dyskaryotic.
*Premalignant phase where if left untreated, it may develop into a carcinoma
Histological subtypes of cervical intraepithelial neoplasia…
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
What age groups are involved in Cervical Cancer screening programme?
Screening every 3 years between 25-49
Screening every 5 years between 50-64
Smear test results from cervical screening programme…
- 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
What happens in colposcopy ?
LLETZ = large loop excision of transformation zone
This is carried out by using diathermy under LA
Presentation of cervical cancer…
- Post-coital bleeding
- Offensive discharge
- Irregular bleeding: intermenstrual and post-menopausal
Stages of cervical cancer…
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
Treatment of cervical cancer…
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
What are the main types of ovarian cancer?
- Serous = most common (70%)
- Clear-cell - has poor prognosis (10%)
- Endometrioid - histologically similar to endometrial cancer (10%)
Risk factors for ovarian cancer…
- Many ovulations : early menarche, late menopause, nulliparity
- BRCA1/2 gene
- Smoking
- Obesity
Presentation of ovarian cancer…
Generally very vague sx:
- Abdominal distension
- Bloating
- Urinary frequency
- Weight loss
- Fatigue
Signs:
- Abdominal/ pelvic mass
Investigations for ovarian cancer…
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
Stages of ovarian cancer…
Stage 1: limited to ovaries
Stage 2: limited to pelvis
Stage 3: limited to abdomen
Stage 4: metastases beyond abdominal cavity
Management of ovarian cancer…
Total abdomnial hysterectomy, bilateral salpingoopherectomy and partial omentectomy (removal of omentum in abdominal cavity) + adjuvant chemotherapy
Neo-adjuvant chemotherapy used in advanced disease
What are the two types of vulval intraepithelial neoplasia?
- 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
Presentation of vulval cancer…
- Vulval pruritus
- Bleeding
- Vulval discharge
- Lump/ ulcer on labia majora
Management of vulval carcinoma…
Local disease = wide local excision without lymphadenectomy
Extensive disease = add lymphadenectomy
Plastic surgeons may be needed for reconstructive surgery
