Gynaecological Cancer Flashcards
Risk factors of Ovarian Cancer
- Low parity
- Early menarche and late menopause
- Obesity
- Age
- Inherited BRCA1 gene
How is ovarian cancer classified by WHO?
- Epithelial tumours
- Germ cell tumours
- Stromal or sex cord tumours
What are the pathology epithelial origins of ovarian cancer?
- Serous (80%) (high grade and low grade)
- Endometrioid
- Clear cell
- Mucinous
Other:
Brenner (transitional cell)
Mixed cell epithelial tumors
Undifferentiated
Unclassified
What are the clinical features of ovarian cancer?
- Early diagnosis not possible due to lack of symptoms
- Pelvic pain
- Obstipation due to tumour compression
- Diarrhea
- Vaginal bleeding
- Ascites in advanced stage: abdominal
distention - enlarged LN
- nausea, vomiting, weight loss
What are the metastatic routes of spreading on ovarian cancer?
- Direct: bowel, bladder, vagina, peritoneum etc
- hematogenous
- lymphagenous: iliac, hypogastric LN etc
Secondary Ovarian Cancer: krukenburg, breast etc
What is the FIGO classification for ovarian cancer?
STAGE 1: tumour limited to ovaries
STAGE 2: tumour limited to 1/2 ovaries with pelvic organ spread or primary peritoneum
STAGE 3: tumour in both ovaries, fallopian tubes with spread beyond peritoneum outside of pelvis or metastasis to retroperitoneal LN
STAGE 4: Distant metastases outside of peritoneal cavity
*Stage I-3 is curative and Stage 4 is palliative
Treatment ideas for Ovarian Cancer?
Surgical
Chemotherapy
Biologic therapy
Gene therapy
Immunotherapy
Hormonotherapy
What is the treatment for early stage I/IIA in ovarian cancer?
- total hysterectomy
- bilateral adnexectomy (salpingooforectomy)
- omentectomy
If reproduction must be conserved:
- unilateral salpingo-ooforectomy simultaneous wedge resection of opposite ovary
What is the treatment for advanced IIb/c, III i IV in ovarian cancer?
- total hysterectomy with bilateral adnexectomy and omentectomy
- maximal cytoreduction if above not possible
*residual tumour < 1cm - Chemotherapy after surgery (adjuvant tx)
What is the medical management for ovarian cancer?
Chemotherapy:
- Paclitaxel
- Carboplatin
Target Therapy:
- bevacizumab
Hormone therapy:
- tamoxifen
- anastrazole
- leuprolide
Immune therapy:
- pembrolizumab
Gene therapy: BRCA mutation
- olaparib
What are non-epithelial ovarian cancers?
- 10% of all ovarian cancer
- germ cell (dysgerminom & seminoma)- first 2 decades
- sex cord (Granuloso-theca cell tumors - stromal tumours) - above 50
Treatment of non-epithelial ovarian cancer?
Surgery:
- total hysterectomy with bi adenxectomy and omentectomy
From stage IC till stage IV PEB (BEC) regimen is mandatory:
(Cisplatin+Etopozid+Bleomicyn) aka BEC
-PE (Amp.Cisplatin +Amp.Etopozid)
-TC (Paclitaxel +Carboplatin)
What is cervical cancer?
- changes of epithelium leading to cervical intraepithelial neoplasia (CIN)
CIN is included in one of the groups of squamous intraepithelial lesions (L-SIL)
CIN 2 and CIN 3 (neoplasia of intermediate and high grade): invasive forms of squamous cell carcinoma (H-SIL)
Risk factors and Etiology of cervical cancer and how can it be prevented?
- HPV 16 and 18
- Smoking
- Multiple sex partners
- Early age sexual initiation
*prevention by HPV vaccination e.g. bivalent vaccine for type 16 and 18
Clinical features of cervical cancer?
- abnormal vaginal bleeding: intermenstrual or post-coital
- discharge
- pelvic pain
- lower back pain and symptoms of bladder and rectum (in advanced stages)
What is the FIGO staging for cervical cancer?
STAGE 1: confined to cervix
STAGE 2: invades beyond uterus (but no lower 3rd of vagina or to pelvic wall)
STAGE 3: Invasion of lower 3rd of vagina, extends to pelvic wall, hydronephrosis/non-functioning kidneys
STAGE 4: extended beyond pelvis into mucosa of bladder and rectum
Treatment of microinvasive cervical cancer- stage Ia?
Conization
If treatment, then margins must be good
If stage Ia has CIN on the margins of the cone, and the clinical finding is such that the vaginal part of the cervix is completely flattened, the assessment of the extent of reintervention/operation is made by a multidisciplinary team
Consider:
- depth of invasion
- tumour width
- LN invasion
- differentiation of tumour
What is the treatment plan for locally invasive cervical cancer (stage Ib and IIa)?
- radical surgical intervention
- hysterectomy
- resection of the parametrium
- bilateral salpingectomy with ovariectomy
- removal of the upper part of the vagina
- pelvic lymph node dissection
*postoperative chemoirradiation are mandatory
What is the treatment plan for locally advanced cervical cancer (stage IIb - IV)?
- Standard approach is- radical
chemoirradiation - Using cisplatin and brachytherapy and external radiation
*carboplatin if px is cisplatin intolerant
*pembrolizumab if PDL1 positive
+/- bevacizumab
What is the most common type of uterine cancer and what are its risk factors?
Endometrial Cancer
RF:
- early menarche and late menopause
- low parity
- Age >55
- smoking
- tamoxifen use
*Other type is uterine sarcoma
Clinical features of endometrial cancer?
Early stages:
- vaginal bleeding
- abnormal discharge
Advanced stages:
- pressure in pelvis
- Uterine enlargement
Premenopausal women:
- intermenstrual bleeding
- abnormal lengths of menstruation cycle
What is the FIGO staging for endometrial cancer?
STAGE 1: confined to uterus
STAGE 2: invasion of cervix
STAGE 3: local regional spread e.g. serosa, adnexa
STAGE 4: extends outside of pelvis and into rectum and bladder
Treatment for stage I endometrial cancer?
- Total hysterectomy
- with bilateral salpingo-oophorectomy
- with or without lymphonodectomy
Treatment for stage Ib-II for endometrial cancer?
Combine surgery with post-operative combined radiotherapy
