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Clinical Oncology > Gynaecological Cancer > Flashcards

Gynaecological Cancer Flashcards

1
Q

Risk factors of Ovarian Cancer

A
  • Low parity
  • Early menarche and late menopause
  • Obesity
  • Age
  • Inherited BRCA1 gene
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2
Q

How is ovarian cancer classified by WHO?

A
  • Epithelial tumours
  • Germ cell tumours
  • Stromal or sex cord tumours
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3
Q

What are the pathology epithelial origins of ovarian cancer?

A
  • Serous (80%) (high grade and low grade)
  • Endometrioid
  • Clear cell
  • Mucinous

Other:
Brenner (transitional cell)
Mixed cell epithelial tumors
Undifferentiated
Unclassified

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4
Q

What are the clinical features of ovarian cancer?

A
  • 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
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5
Q

What are the metastatic routes of spreading on ovarian cancer?

A
  • Direct: bowel, bladder, vagina, peritoneum etc
  • hematogenous
  • lymphagenous: iliac, hypogastric LN etc

Secondary Ovarian Cancer: krukenburg, breast etc

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6
Q

What is the FIGO classification for ovarian cancer?

A

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

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7
Q

Treatment ideas for Ovarian Cancer?

A

Surgical
Chemotherapy
Biologic therapy
Gene therapy
Immunotherapy
Hormonotherapy

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8
Q

What is the treatment for early stage I/IIA in ovarian cancer?

A
  • total hysterectomy
  • bilateral adnexectomy (salpingooforectomy)
  • omentectomy

If reproduction must be conserved:
- unilateral salpingo-ooforectomy simultaneous wedge resection of opposite ovary

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9
Q

What is the treatment for advanced IIb/c, III i IV in ovarian cancer?

A
  • total hysterectomy with bilateral adnexectomy and omentectomy
  • maximal cytoreduction if above not possible
    *residual tumour < 1cm
  • Chemotherapy after surgery (adjuvant tx)
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10
Q

What is the medical management for ovarian cancer?

A

Chemotherapy:
- Paclitaxel
- Carboplatin

Target Therapy:
- bevacizumab

Hormone therapy:
- tamoxifen
- anastrazole
- leuprolide

Immune therapy:
- pembrolizumab

Gene therapy: BRCA mutation
- olaparib

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11
Q

What are non-epithelial ovarian cancers?

A
  • 10% of all ovarian cancer
  • germ cell (dysgerminom & seminoma)- first 2 decades
  • sex cord (Granuloso-theca cell tumors - stromal tumours) - above 50
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12
Q

Treatment of non-epithelial ovarian cancer?

A

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)

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13
Q

What is cervical cancer?

A
  • 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)

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14
Q

Risk factors and Etiology of cervical cancer and how can it be prevented?

A
  • 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

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15
Q

Clinical features of cervical cancer?

A
  • abnormal vaginal bleeding: intermenstrual or post-coital
  • discharge
  • pelvic pain
  • lower back pain and symptoms of bladder and rectum (in advanced stages)
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16
Q

What is the FIGO staging for cervical cancer?

A

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

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17
Q

Treatment of microinvasive cervical cancer- stage Ia?

A

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

18
Q

What is the treatment plan for locally invasive cervical cancer (stage Ib and IIa)?

A
  • 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

19
Q

What is the treatment plan for locally advanced cervical cancer (stage IIb - IV)?

A
  • Standard approach is- radical
    chemoirradiation
  • Using cisplatin and brachytherapy and external radiation

*carboplatin if px is cisplatin intolerant
*pembrolizumab if PDL1 positive
+/- bevacizumab

20
Q

What is the most common type of uterine cancer and what are its risk factors?

A

Endometrial Cancer

RF:
- early menarche and late menopause
- low parity
- Age >55
- smoking
- tamoxifen use

*Other type is uterine sarcoma

21
Q

Clinical features of endometrial cancer?

A

Early stages:
- vaginal bleeding
- abnormal discharge

Advanced stages:
- pressure in pelvis
- Uterine enlargement

Premenopausal women:
- intermenstrual bleeding
- abnormal lengths of menstruation cycle

22
Q

What is the FIGO staging for endometrial cancer?

A

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

23
Q

Treatment for stage I endometrial cancer?

A
  • Total hysterectomy
  • with bilateral salpingo-oophorectomy
  • with or without lymphonodectomy
24
Q

Treatment for stage Ib-II for endometrial cancer?

A

Combine surgery with post-operative combined radiotherapy

25
Q

Treatment of stage III-IV for endometrial cancer?

A
  • maximal debulking
  • adjuvant post-op combined radiotherapy

Chemotherapy:
- Doxirubicin
- Cisplatin

*if relapse, consider carboplatin and pacliataxel

26
Q

What is the choice of target and immune therapy for endometrial cancer? Mention hormone therapy too.

A

Target and Immune Therapy:
- Pembrolizumab

Hormone therapy:
- Levonorgestrel
- megestrol
- anastrazole

27
Q

What are the etiologies and risk factors of vulvar cancer?

A
  • HPV infection: 16 and 18
  • smoking
  • atypical vulvar hyperplasia
  • lichen sclerosis
  • Anogenital region neoplasm
28
Q

Clinical picture of vulvar cancer?

A
  • precancerous lesion appearing as a wart or crusted ulcer
  • Carcinoma IS appear as blue wart with itchiness
  • Smelly discharge
  • pruritus
29
Q

How is vulvar cancer classified in FIGO staging?

A

STAGE 1: confined to vulva and/or perineum
(Tumour < 2cm and stromal invasion <1mm)
(Tumour > 2cm and stromal invasion >1mm)

STAGE 2: invasion of adjacent perineal structures e.g. lower/distal third of urethra/vagina or anal involvement without LN

STAGE 3: invasion of any adjacent perineal structure of upper third with any number of non-fixed LN

STAGE 4: fixed to bone or distant metastases with ulcerated LN metastases

Stage 2,3,& 4: is tumour of any size

30
Q

What are the risk factors of vaginal cancer and clinical picture?

A

Vaginal cancer has 2 types:
- SCC (most common) and ADC

Risk Factors:
- HPV
- Chronic vaginal irritation
- smoking

Clinical features:
- contact bleeding
- bloody discharge
- wart like lesions
- itchiness

31
Q

What is the FIGO staging for vaginal cancer?

A

STAGE 1: confined to vagina

STAGE 2: invades paravaginal tissue but not pelvic wall extension

STAGE 3: extends to pelvic wall

STAGE 4: invades mucosa of rectum and bladder and extends beyond pelvis

32
Q

What organs does vaginal cancer metastasise to?

A

SCC:
- lung
- liver

ADC:
- lung
- supraclaviclar LN
- pelvic LN

33
Q

What is the treatment plan for vulvar and vaginal cancer?

A

First line: vulvectomy when possible
- lymphadencetomy

Radiotherapy and chemotherapy when metastasis occurred to LN or nearby organs
- Cisplatin
- Brachytherapy

34
Q

MoA of Bevacizumab for Ovarian Cancer

A
  • multiple effects which contributes to improvement of therapy efficacy
  • regression
  • inhibition
  • anti-permeability

*can lead to HTN: reduction of NO production and renal injury leading to sodium misbalance, volume overload

35
Q

What is Olaparib? Indications?

A
  • strong inhibitor of human poli (ADP-ribose) polymerase enzyme (PARP-1, PARP-2 i PARP-3)
  • PARP needed for single stranded DNA repair
  • prevents the dissociation of PARP and traps it on the DNA

Indications:
- platinum intolerance
- BRCA mutated
- serous and endometrioid epithelial ovarian
- Fallopian and primary peritoneal carcinoma of high grade

36
Q

What is pembrolizumab?

A
  • immunotherapy drug (Keytruda®) may be used to treat recurrent ovarian cancer
  • an immune checkpoint inhibitor
37
Q

How do you treat platinum resistant recurrent ovarian cancer?

A
  • Paclitaxel (weekly)
  • AC regimen (Cyclophosphamide +Doxorubicin)
  • Mono Gemcitabine
  • Caps. Etopozid oral (Vepezid, Lastet)
    Tbl. Melfalan (Alkeran) +Pronisone
38
Q

Diagnostics of non-epithelial?

A
  • US of abdomen or pelvis
  • MSCT of chest
  • MSCT of abdomen/pelvis
  • MRI of abdomen/pelvis
  • Determination of beta-HCG,AFP,LDH,all other laboratory.
  • Determination of Inhibin
39
Q

What is Cervical Intraepithelial Neoplasia?

A
  • The cancer develop through sequential changes of epithelium which are denoted as 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) precede to most of invasive forms of squamous cell carcinoma (H-SIL)
40
Q

Diagnostics in Cervical Cancer.

A
  • Inspection and palpation of primary tumor.
  • Palpation of ingvinal and supracervical lymph nodes.
  • Colposcopy.
  • Endocervical curretage.
  • Conisation.
  • Hysterscopy.
  • Cystoscopy.
  • PET for extrapelvic metastases
  • CT/MRI/PET for determining stage
41
Q
A

Clinical Oncology (11 decks)

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