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CSB048 - TREATMENT 2 > Gynaecological > Flashcards

Gynaecological Flashcards

1
Q

Anatomy of Uterus

A
  • Upper 2/3 of uterus is the body
  • Lower 1/3 of the uterus is the cervix
  • Upper 2/3 of cervix = columnar glandular epithelium
  • Lower 1/3 of cervix = stratified squamous epithelium
  • Internal Os is the opening between cervix and corpus, external os is the opening between cervix and vagina
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2
Q

Regional LNs of the Uterus

A

paracervical, parametrial, presacral, sacral, external iliac, common iliac, hypogastric (obturator), internal iliac.

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3
Q

Endometrium epidemiology

A

4th most common cancer in women, common in menopausal women

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4
Q

Diagnosis of Gynae cancers

A

Papanicolaou test
Cancer of endometrium staged surgically
- Pathology review
- EUA
- Chest X-ray
CT/MRI for disease extent

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5
Q

Patterns of spread

A
  • May extend and involve greater proportion of endometrial surface readching cervix, extension in myometrium occurs simultaneously
  • Lymph: Fundus -> para aortic
  • Lymph: Middle/lower uterus -> broad ligament -> pelvic nodes -> round ligament -> inguinal nodes
  • Direct invasion of serosa to bladder, colon or extension into abdominal cavity
  • Small tumour fragments into peritoneal cavity by traversing the Fallopian tubes
  • Blood borne spread common
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6
Q

Endometrium/Cervix histology

A

Adenocarcinoma
Adenocanthoma
Adenosquamous carcinoma
Leiomyosarcoma

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7
Q

Endometrial cancer staging

A

Using FIGO
Stage I - The tumour is confined to the uterine fundus (the body of the uterus).

• Stage II - The tumour extends to the cervix (the lower part of the uterus).

• Stage III - There is regional tumour spread.

• Stage IV - There is bulky pelvic disease or distant spread.

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8
Q

Prognostic indicators

A
  • Pelvic or paraaortic LN spread
  • Tumour grade or cell type
  • Depth of myometrial invasion
  • Tumour extension to the cervix
  • Tumour vascularity
  • LVSI
  • Peritoneal mets
    Distant mets
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9
Q

RT treatment technique - endometrium

A
  • Stage 1 brachytherapy alone (16Gy in 4# or 22Gy in 4#)
    Stage 1-3 EBRT generally 45Gy in 25# +8 Gy in 2# in brachytherapy
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10
Q

Clinical management endometrium

A

Surgery is most common for Ca Endometrium
- Stage 1A- surgery alone
- Stage 1B - Surgery and brachytherapy
- Stage 1C - surgery +EBRT+BT
Stage 2-3 - Surgery + EBRT +BT

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11
Q

CT simulation

A

1-3mm slices
Scan length - lower border T10 - inferior border of ischial tuberosities
Ant tattoo - ML and 2 Lateral tattoos
Organ motion: 60-80% tumour regression possible during RT
Tumour shrinkage can affect position of OARs
Also affected by bladder and rectal filling

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12
Q

Acute side effects

A

vaginal dryness, fatigue, diarrhoea, nausea, erythema, desquamation.

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13
Q

Acute side effects

A

vaginal dryness, fatigue, diarrhoea, nausea, erythema, desquamation.

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14
Q

Late side effects

A

Dysuria, vaginal stenosis, fibrosis

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15
Q

Endometrial cancer symptoms

A

Bleeding and vaginal discharge

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16
Q

Vulva symptoms

A

Palpable mass but early diagnosis important

17
Q

Vulva management

A
  • Early invasion - wide local excision (WLE)
  • Stage 1 with 1mm larger tumour - WLE +lymph node assessment
  • Large Stage 1 and 2 tumours = WLE +partial or complete vulvectomy +node dissection
    Sentinel node biopsy - 25-35% of patients with stage 1 or 2 disease will have lymph node metastases
18
Q

Vulva rt technique

A

Nodal involvement > irregular volumes > increased conformality with IMRT/VMAT

19
Q

Vulva Cancer staging

A

TNM
Surgical staging
• Depth of invasion important indicator of nodal involvement
and prognosis

20
Q

Vulva cancer epidemiology

A

accounts for 5-6% of all gynae cancers, uncommon in women under 50 - mean age of 70
Increased risk associated with HPV and smoking

21
Q

Epidemiology of cervical cancer

A

7th most common cancer, high incidence in developing countries

22
Q

Cervical cancer staging

A

FIGO
Stage I: carcinoma strictly confined to the cervix

Stage II: carcinoma that extends beyond the cervix but has not
extended onto the pelvic wall; the carcinoma involves the vagina,
but not as far as the lower-third section

Stage III: carcinoma that has extended onto the pelvic sidewall and/or
involves the lower third of the vagina; all cases with hydronephrosis
or a non-functioning kidney should be included, unless they are
known to be due to other causes

Stage IV: carcinoma that has extended beyond the true pelvis or has
clinically involved the mucosa of the bladder and/or rectum

23
Q

Cervix RT technique

A
  • EBRT 50.4Gy in 28# over 5.5 weeks
    14Gy in 2# brachytherapy
24
Q

Cervix clinical management

A

Stage 1A1 and 1A2 - surgery alone
1A1 - cone biopsy for clear margins but simple hysterectomy is indicated if fertility is not an issue
1A2 - radical trachelectomy and node dissection to help maintain fertility
1B1 - fertility may be preserved if tumour is less than 2cm, choice between hysterectomy or chemo radiation
1B2- Iva - RT +concurrent chemo (cisplatin)
Ivb- treated palliatively with chemo +RT

25
Q

Ovary Symptoms

A

asymptomatic, symptoms are vague until patient presents with locally advanced cancer.
Lower abdominal pain, bloating, anorexia. Compression of adjacent structures - urinary frequency, constipation, pelvic discomfort, sensation of heaviness

26
Q

Ovary Management

A

Surgery and chemotherapy (cisplatin, carboplatin), RT may be use for recurrent or palliative disease

27
Q

Ovary epidemiology

A

6th most common female cancer. 75% women present when disease has spread beyond ovaries

28
Q

Vagina epidemiology

A

rare accounts for 2% of gynae malignancies, post menopausal women, linked to HPV infection, previous hysterctomy or prolapsed uterus

29
Q

Vaginal cancer treatment

A

Surgery and RT

30
Q

Pre treatment prep

A

radio opaque markers
empty bladder

31
Q

endometrial treatment field

A

4 field box

32
Q

Treatment considerations for cervix

A

60-80% tumour regression during RT
can affect OAR positioning

CSB048 - TREATMENT 2 (12 decks)

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