Gynae Oncology Busy SpR Flashcards
Diagram staging of endometrial cancer
Management stage 1a endometrial cancer?
Hysterectomy + BS0
Management stage 1b endometrial cancer
Hysterectomy + BSO + pelvic and peri-aortic node sampling should be performed.
Consider radiothapy
Management of stage 3 endometrial cancer that does not invade into pelvic side wall?
TAH + BSO + radiotherapy
Management of stage 3 endometrial cancer that does invade into pelvic side wall?
Radiotherapy with intra-cavitary and external-beam radiotherapy
or
chemotherapy
Overall survival for ovarian cancer at 5 years.
Ovarian cancer: 5 year survival rate 35-40%
FIGO staging for cervical cancer as diagram
Management of CGIN?
glandular neoplasia of endocervical type
Always surgical
Yonng/ TZ type 1 or 2 - 10mm Cone Bx
Older/ TZ 3 20-25mm Cone BX
How should stage 1a adenocarcinoma of the cervix be managed:
i) Fertility no desired
ii) Fertility disreed
Not desired - hysterectomy
Desired - Cone Bx 2.5cm and 5mm clear margins, otherwise repeat or hysterectomy
How is stage 1a squamous cell carcinoma of cervix managed? When can Lymph node dissection be avoided?
Cone Bx
If invasion <3mm and no lymph-vascular spread
When is chemo-radiation advised for cervical cancer based on FIGO stages
From stage 1 b (invasion >5mm) until stage 4a (Local mets)
Along side surgery
Surgical Management of stage 1b cervical cancer
Fertility not desired
Fertility desired
Not desired: Radical hysterectomy + BSO
Desired: Radical tracehelctoy
Draw FIGO diagram for ovarian cancer
Treatment ovarian cancer - Well / moderately well differentiated Stage Ia / Ib
TAH + BSO + omentectomy
Also Bx - pelvic/para-aortic LN, peritoneal washing, pelvic and peritoneal Bx + underside of diaphragm
(Involved one or both ovaries with no spill/spread)
Treatment for ovarian cancer - Poorly differentiated Stage Ia / Ib or Stage Ic – stage II
TAH + BSO + omentectomy ect
and
chemotherapy
Management of well/moderately well differentiated stage 1a + 1b ovarian cancer.
Fertility not desired
Fertility desired
Not desired: Hysterectomy + BSO + omentectomy
Desired: Unilateral SO + full staging (peritoneal washing, Bx para-aortic LN, omentectomy + endometrial Bx as 10-30% have endometrial Ca)
If cancer thought to isolated to ovary, how should staging procedure be conducted?
1.Midline laparotomy
2.Total abdominal hysterectomy + bilateral salpingo-oophorectomy + infracolic omentectomy
3.Biopsies of any peritoneal deposits
4.Random biopsies of the pelvic and abdominal peritoneum
5.Retroperitoneal lymph node sampling
If stage 1B1 or more (invasion >5mm) and > 16 weeks pregnant. How should this be managed?
CS once viability has been achieved, immediately followed by radical hysterectomy and pelvic lymphadenectomy
Can offer Neo-adjuvant chemotherapy until surgery
How are stage 1A1 cervcial cancers managed in pregnancy?
LLETZ or cold-knife cone alone, which should be undertaken early in the pregnancy (higher risk of preterm labour/PPROM as gestation increases)
When should pelvic Lymphadenectomy be performed in pregnancy to assess cervical cancer?
Cervical 1A2 and beyond, before 15 weeks
ie >3mm invasion
How is VIN classificed?
1) Usual/typical
- Low grade squamous intraepithelial lesion (LSIL)/ VIN1
- High grade squamous intraepithelial lesion (HSIL) VIN 2-3
2) differentiated VIN (dVIN)
Risk factors for VIN?
infection with the human papilloma virus (HPV)
smoking
having problems with your immune system such as HIV
long term skin problems such as lichen sclerosis
How is vulvar intraepithelial neoplasia managed?
When occult invasion is not a concern, vulvar HSIL (VIN usual type) can be treated with excision, laser ablation, or topical imiquimod (off-label use).
LSIL/VIN 1 - can jut be monitored, unless there are symptomatic
How should women with HSIL/VIN 2-3 be followed up following treatment?
6 months, 12 months then yearly
What is transformation zone type 1, how much should be removed in cone Bx
TZ completely visible, on ectocervix 7-10mm
What is transformation zone type 2, how much should be removed in cone Bx
TZ completely visible with manipulation, has ectocervix and endocervix component 10-15mm
What is transformation zone type 3, how much should be removed in cone Bx
TZ not completely visible, has endocerivcal component
15-25mm
What is the treatment for lichen sclerosus?
Ultra-potent topical steroids such as Clobetasol proprionate.
Various regimens are used one of the most common being
daily use for one month
alternate days for one month
twice weekly for one month with review at 3 months.
What % of women with lichen sclerosis does not respond to topical steroids?
10 - 25% will not respond
Management for simple ovarian cyst in pre-menopausal women?
<50mm - discharge
50-70mm - yearly scan
>70mm - remove surgically
How to assess for metastasis in breast cancer when pregnancy
CXR and liver USS
What % of endometrial cancers have Lynch syndrome?
1-3%
Life time risk of endometrial cancer in those with Lynch syndrome?
1/400 to 1/2000
1st line chemo for ovarian cancer?
Paclitaxel and cisplatin
What % of those will ovarian cancer response to Paclitaxel and cisplatin?
What % relapse within 2 years
70-80%
55-75% relapse within 2 years
What is define as partial and complete resonse to chemotherapy for ovarian cancer?
Partial - reduction 50% in 4 weeks
Total - not detectable for at least 4 weeks
When should Neo-adjuvant chemotherapy for ovarian cancer, followed by debunking surgery be consider?
If bulky supra colic omental disease or extensive liver mets not suitable for resection
What is definition of platinum resistance disease in ovarian cancer?
Recurrence within 6 months of stopping last dose of platinum
Partially resistant if recurrence within 6-12months
If platinum sensitive, what is the response rate to second line chemotherapy
> 12 months to recurrence - 40-75%
If partially platinum sensitive, what is the response rate to second line chemotherapy
6-12 months
25-30%
If platinum resistant, what is the response rate to second line chemotherapy
<6 months
10-20%
If platinum refectory, what is the response rate to second line chemotherapy
<10%
Can HRT be used in the following ovarian cancers:
Epithelial
Germ cell
Sex cord stromal
Borerline
Epithelial: Limited Data
Germ cell: avoid
sex cord: Avoid
Borderline: Caution/avoid
Can HRT be used in after the following endometrial cancers:
Type 1 Endometroid 1&2
Type Endometriod 3&4
Type 2
Type 1 Endometroid 1&2 → Can used combined, oestrogen only if possible occult foci
Type 1 Endometriod 3&4 → Avoid
Type 2 → Avoid
Can HRT be used in following cervical cancer:
Squamous 1&2
Squamous 3&4
Adenocarcinoma
Squamous 1&2: Oestrogen only if hysterectomy, or cont combined
Squamous 3&4 Avoid/caution
Adenocarcinoma: Avoid/caution
Can HRT be used in the following vulval cancers:
Squamous cell
Non squamous cell
Squamous cell: Oestrogen only if hysterectomy, or cont combined
Non squamous cell: Avoid
Can HRT be used in the following vulval cancers:
Squamous cell
Non squamous cell
Squamous cell: Oestrogen only if hysterectomy, or cont combined
Non squamous cell: Avoid
What medication can be given to those with Lynch syndrome as cancer prevention?
Aspirin from 18 years
From the age of menarche until natural age of menopause
When should TAH and BSO be offered in Lynch Syndrome if
MLH1/MSH2 mutation
MSH6 mutation
Path_PMS2 mutation
For path_MLH1 and path_MSH2 at 35 years
For path_MSH6 at 40 years
For path_PMS2 at 50 years
