Gynaecological Cancer

Question 1

What investigations would you do for someone with Cervical Cancer?

Answer 1

1) Vaginal exam
2) Colposcopy
3) HPV test
4) Biopsy

Question 2

What are some protective factors for cervical cancer?

Answer 2

1) COCP
2) Pregnancy
3) Breast feeding

Question 3

How does Rb work?

Answer 3

Acts as a TSG, controlling cell division by altering activity of transcription factors

Question 4

What happens if malfunctioning in Rb or p53?

Answer 4

If a mutation occurs in these genes a patient may have uncontrolled cell growth -> cancer.

Question 5

What is an example and the roles of Oncogenes?

Answer 5

Example: HER2
- Oncogenes stimulate excessive cell growth and cell division –> Chance of cancer development

Question 6

What is the most common type of Gynaecological cancer and it’s PP?

Answer 6

Endometrial Cancer
PP: Unopposed oestrogen -> Endometrial Hyperplasia -> Increased risk of endometrial adenocarcinoma

Question 7

What are the main RF for developing endometrial cancer?

Answer 7

1) Obesity
2) Diabetes
3) Nulliparity
4) Late menopause
5) Pelvic Irradiation
6) HRT

Question 8

Endometrial Cancer: Most common type and main red flag?

Answer 8

Most Common: Adenocarcinoma
Red Flag: Post-menopausal bleeding

Question 9

Endometrial Cancer: Staging system and main investigations

Answer 9

SS: FIGO staging
Investigations: Pevlic/Abdo exam, Transvaginal USS, Endometrial biopsy, Hysteroscopy,

Question 10

Endometrial Cancer: Main treatment

Answer 10

1) Hysterectomy +/- Pelvic Lymph Node removal
2) Adjuvant radiotherapy and progesterone therapy

Question 11

What oncoproteins are associated with HPV?

Answer 11

1) E6 - blocks p53
2) E7 - blocks Rb

Question 12

Why is the incidence of cervical cancer decreasing?

Answer 12

1. Screening - cervical smears.
2. HPV vaccine.

Question 13

Give 5 risk factors for HPV and so cervical cancer.

Answer 13

Early age intercourse (<16).
Multiple sexual partners.
STI’s.
Smoking.
Multiparity.
OCP.

Question 14

Cervical Cancer: Most common type and staging system

Answer 14

CT: Squamous
SS: FIGO

Question 15

Cervical Cancer: Red flag symptom?

Answer 15

Post-coital bleeding

Question 16

Describe the treatment for cervical cancer.

Answer 16

<2cm - loop removal, just removing part of the uterus.
> 2cm - radical hysterectomy.
> 4cm - radiotherapy, chemotherapy, palliative care.
CONSIDER FERTILITY

Question 17

Give 3 potential risks of performing a radical hysterectomy.

Answer 17

Bowel problems.
Sexual problems.
Bladder problems.
Lymphoedema.

Question 18

How is ovarian cancer treated?

Answer 18

Surgery and chemotherapy should be offered.

Question 19

Describe the epidemiology of ovarian cancer.

Answer 19

More common in women >50; post-menopausal. Often people present late and so it is advanced at presentation.

Question 20

What are the commonest types of ovarian cancer?

Answer 20

Epithelial (85%).
Sex cord.
Germ cell.

Question 21

Give the main symptoms of ovarian cancer.

Answer 21

Bloating.
Abdominal pain.
Change in bowel habit.
Urinary frequency.
Bowel obstruction.
Can often be asymptomatic.

Question 22

What investigations might you do in a patient who you suspect has ovarian cancer?

Answer 22

Measure CA125.
Trans-vaginal USS.
Calculate the RMI (risk of malignancy index) - if this is >250 the patient should be referred under the 2 week wait system.

Question 23

What are the RF for developing ovarian cancer?

Answer 23

Early menarche.
Late menopause.
Nulliparity.
Genetics e.g. BRCA1/2.

Question 24

What is the most common type of Vulval cancer?

Answer 24

Squamous

Question 25

What are the main symptoms of vulval cancer?

Answer 25

Itching.
Soreness.
Lump.
Bleeding.
Pain on micturition.

Question 26

What is the aetiology for vulval cancer?

Answer 26

Vulval intraepithelial neoplasia (VIN - skin disease). Abnormal cells develop in the surface layers of the skin covering the vulva. It is not vulval cancer but may turn into cancer - pre-malignant. Usual type is associated with HPV infection.

Question 27

What is the main treatment for vulval cancer?

Answer 27

Surgery - radical or conservative.
Radiotherapy.
Chemotherapy.