Gynaecological Cancer Flashcards
What is the most common pelvic mass?
Pregnancy
What is the most common uterine mass?
Fibroid
What is the most common ovarian mass?
Ovarian cyst
What is the most common symptom of cervical cancer?
Post-coital bleeding and/or intermenstrual bleeding.
What are non-gynaecological causes of pelvic mass?
Urinary distension
Bowel tumours
Appendicular abscess
What triad is involved in Meig’s syndrome?
Benign ovarian mass (usually a fibroma)
Ascites
Pleural effusion
What does a new onset IBS in an individual over 50 raise suspicion of?
Ovarian cancer
What must always be rule out in a woman of childbearing age that presents with a pelvic mass?
Pregnancy
What investigations are carried out in the context of an ovarian mass?
Tumour markers USS MRI (if premenopause) CT (if postmenopause) Urine pregnancy test
What marker is elevated in ovarian cancer?
Ca-125
Not always true, use to aid diagnosis.
Is the CEA marker detectable in adults?
No, only elevated in the context of ovarian cancer.
May also appear in other conditions too (non-specific).
What does a Ca-125 :CEA ratio of <25 suggest?
Ovarian metastases
When is AFP raised?
Embryonal carcinoma if less than 40.
When is HCG raised?
Choriocarcinoma if less than 40.
When is LDH raised?
Dysgerminoma if less than 40.
In which age group are germ cell tumours most common?
Under 40yo
What are the most common type of benign ovarian mass?
Functional cysts
How do functional cysts present?
Sharp iliac-fossa pain.
Usually less than 5cm, and will resolve spontaneously.
What are ‘chocolate’ cysts characteristic of?
Endometriosis
How does endometriosis present?
Chocolate cysts
Severe dysmenorrhoea
Pain
Deep dypareunia
Does endometriosis affect fertility?
Yes - these patients are sub-fertile.
What is dypareunia?
A persistent or recurrent genital pain experienced before, during or after intercourse.
How are the ‘chocolate cysts’ of endometriosis formed?
In endometriosis, cells of the ovary develop resembling the womb - these bleed during menstruation too.
Accumulation of this blood leads to the ‘chocolate’ appearance.
Where is tenderness felt in endometriosis?
Behind the uterus.
Caused by attachment of the ovaries together in the pouch of Douglas.
Which age group are benign ovarian masses most commonly seen in?
Young females
What benign mass can produce teeth, hair,sebaceous material or thyroid tissue within the ovaries?
Dermoid cysts.
How are benign ovarian masses treated?
OC pill
GnRH agonists
Surgery
What is a common presentation of ovarian cancer?
Ascites
How is ovarian cancer treated?
Chemotherapy and surgery
What is the most common form of ovarian cancer?
Germ cell tumour
What is neoadjuvant chemotherapy?
Chemotherapy which is given prior to surgery with the aim of shrinking a tumour, increasing the chance of a surgery being successful.
What is adjuvant chemotherapy?
Chemotherapy given after surgery aimed at killing any remnant cancer cells missed by surgery.
What is the main cause of cervical cancer?
HPV
What age group receive smear tests?
25-65 year olds.
How regularly are smear tests carried out normally?
Every 5 years
Is sex a risk factor for cervical cancer?
Yes - it is the only way HPV can be contracted.
If no sex occurs, there is no risk.
What are the 2 forms of cervical cancer treatment?
Cold coagulation
Lietz
What is the most common form of gynaecological cancer?
Uterine cancer
What encompasses a hysterectomy?
Removal of the uterus and cervix.
How is vulval cancer treated?
Wide local excision (1cm margin)
What are pathological causes of uterine bleeding?
Polyps
Endometriosis
Adenomyosis
Leiomyomata
Is endometrial hyperplasia a premalignant state?
No, unless it is the atypical subtype - then yes.
What age group is most commonly affected by endometrial carcinoma?
50-60 year olds.
What can predispose to endometrial cancer in young patients?
PCOS
Lynch syndrome
What does atypical hyperplasia precede?
Endometrioid carcinoma
What does serous intraepithelial carcinoma precede?
Serous carcinoma
How does endometrial carcinoma commonly present?
Abnormal bleeding usually sporadic/continuous bleeding post-menopause
OR
Intermenstrual bleeding in those of reproductive age.
What are the 2 subtypes of endometrial cancer?
Endometrioid carcinoma
Serous carcinoma
Which form of endometrial carcinoma is associated with unopposed oestrogen?
Endometrioid carcinoma
What is lynch syndrome?
An autosomal dominant disease caused by inheritance of a defective mismatch repair gene.
What is normally the cause of serous carcinoma of the endometrium?
p53 mutation
What is prognosis of an endometrial carcinoma dependent on?
Staging
Histological grade (in cases of endometrioid only)
Depth of myometrial invasion
What are fibroids associated with?
Heavy, prolonged, painful periods.
May also cause infertility.
What are the malignant tumours of the myometrium called?
Leiomyosarcomas
What condition do follicular cysts develop in?
PCOS
What is endometriosis?
The presence of endometrial gland and stroma outwith the uterine body.
How is ovarian cancer usually diagnosed?
Sampling of ascitic fluid.
What is the presence of embryonic elements within a germ cell tumour called?
An immature teratoma
What must be ruled out in a woman of reproductive age presenting with amenorrhoea and an acute abdomen?
Ectopic pregnancy
What is the most common site for an ectopic pregnancy?
Fallopian tube
How is cervical cancer treated?
Radical surgery.
In advanced disease, radical chemotherapy and radiotherapy may be given.
What % of oropharyngeal tumours are linked to HPV?
80%
Linked to oral sex.
What are risk factors for HOV-related cancer?
Smoking
Early age onset intercourse
High risk male
Multiple partners
What is brachytherapy?
Insertion of internal radiotherapy to target the area in question.
Used in cervical cancer treatment.
What is the main method of endometrial cancer treatment?
Surgery
What are risk factors for endometrial cancer?
Obesity
HRT/Tamoxifen
HNPCC gene carriage
How does endometrial cancer present?
Post-menopausal bleeding
An anterior pelvic mass is usually linked to what?
The bladder
A posterior pelvic mass is usually linked to what?
The uterus
What is the most common form of sex cord tumour?
A fibroma
