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Y4 Reproductive Health > Gynaecological Cancer > Flashcards

Gynaecological Cancer Flashcards

1
Q

What is the most common form of endometrial cancer?

A

Adenocarcinoma

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2
Q

What is atypia?

A

Precancerous state (endometrial hyperplasia can predispose to atypia)

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3
Q

Risk factors for endometrial hyperplasia

A

Unopposed oestrogen (stimulation of endometrium without effects of progesterone)

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4
Q

Risk factors of endometrial cancer

A

Anovulation (early menarche, late menopause, low parity, PCOS, unopposed HRT, tamoxifen)
Age (65-75)
Obesity (^ SC fat = faster rate of peripheral aromatisation of androgens > oestrogen = ^ unopposed oestrogen levels)
Hereditary factors (hereditary non-polyposis colorectal cancer AKA Lynch syndrome)

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5
Q

Clinical features of endometrial cancer

A

PMB
O/E abdominal / pelvic masses, vulval / vaginal atrophy, cervical lesions

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6
Q

DD of endometrial cancer

A

Vulval atrophy
Vulval pre-malignant / malignant conditions
Cervical polyps
Cervical cancer
Endometrial hyperplasia without malignancy
Benign endometrial polyps
Endometrial atrophy

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7
Q

Investigations for endometrial cancer

A

TVUS (^ endometrial thickness)
Endometrial biopsy (indicated in women with endometrial thickness >3mm)
MRI / CT used for staging

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8
Q

Biopsy findings for endometrial cancer

A

Hyperplasia +/- atypia
Malignancy

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9
Q

FIGO staging

A

Endometrial cancer
Stage I - carcinoma within uterine body
Stage II - carcinoma may extend to cervix but not beyond uterus
Stage III - carcinoma extends beyond uterus but confined to pelvis
Stage IV - carcinoma involved bladder or bowel, or metastasised to distant sites

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10
Q

Endometrial hyperplasia management

A

Progestogens (Mirena IUS)
Surveillance biopsies

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11
Q

Endometrial hyperplasia with atypia management

A

Total abdominal hysterectomy + BL salpingo-oophroectomy
Regular surveillance biopsies (if surgery contraindicated)

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12
Q

Endometrial carcinoma Stage I management

A

Total hysterectomy + BL salpingo-oophroectomy

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13
Q

Endometrial carcinoma Stage II management

A

Radical hysterectomy +/- lymphadenectomy)

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14
Q

Endometrial cancer Stage III management

A

Maximal de-bulking surgery
Additional chemotherapy + radiotherapy

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15
Q

Endometrial cancer Stage IV management

A

Maximal de-bulking surgery
Palliative approach (radiotherapy + low dose progestogens)

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16
Q

Most common type of cervical cancer

A

Squamous cell carcinoma
Adenocardinoma
Mixed

17
Q

Cervical cancer development (cellular)

A

Cervical intraepithelial neoplasia
1 = mild dysplasia
2 = moderate dysplasia
3 = severe dysplasia + in situ carcinoma
4 = invasive carincoma

18
Q

Risk factors for cervical cancer

A

Smoking
STIs inc HPV 16 & 18 (cont proteins that suppress p53 in cervical epithelial cells)
LT COCP
Immunodeficiency

19
Q

Clinical features of cervical cancer

A

abnormal vaginal bleeding (PCB, PMB, IMB)
Vaginal discharge (blood, foul)
Dyspareunia
Pelvic pain
Weight loss
Oedema, loin pain, rectal bleeding, radiculopathy, haematuria (advanced disease)

20
Q

DD of cervical cancer

A

STI
Cervical ectropion
Polyp
Fibroid
Pregnancy related bleeding

21
Q

Cervical cancer investigations

A

Pre-menopausal: Chlamydia trachomatis, colposcopy + biopsy
Post-menopausal: urgent colposcopy + biopsy

22
Q

Cervical cancer staging

A

Stage 0 - carcinoma in situ
Stage 1 - confined to cervix (A = microscopic identification, B = gross lesions + clinically identifiable)
Stage 2 - beyond cervix but not pelvic sidewall OR involves vagina but not lower 1/3 (A = no parametrise involvement, B = obvious parametrial involvement)
Stage 3 - extends to pelvic sidewall / involves lower 1/3 of vagina / hydro nephrons is not explained by other cause (A = no extension to sidewall, B = extension to side wall and / or hydronephrosis)
Stage 4 - extends to bladder or rectum, or metastasis (A = involves bladder / rectum, B = involves distant mets)

23
Q

Cervical cancer surgical management (staging)

A

Stage 1a - radical trachelectomy
Stage 1b/2a - radical hysterectomy + lymphadenectomy
Stage 4a / recurrent disease - Ant/Post/Total pelvic extenteration

24
Q

Cervical cancer non-surgical management (staging)

A

Radiotherapy = gold standard for stage 1a-3
Chemotherapy = mostly used in palliative setting although used as an adjunct to surgery / radiotherapy

Y4 Reproductive Health (7 decks)

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