Gynaecological Cancer

Question 0

Increase in uterine cancer

Answer 0

Obesity / decrease in children

Question 1

Common OSCE station - post menopausal bleeding or cervical smear

Answer 1

Learn this - read now

Question 2

What causes cervical cancer?

Answer 2

HPV / Smoking / OCP (oral contraceptive pill) - long term use

Question 3

Abnormal smears are more common in?

Answer 3

Smokers

Question 4

HPV infection

Answer 4

Easily transmitted through sexual contact, a condom won’t help. Up to 75% affected in there life / oncogenic and non-oncogenic

Question 5

Cervical screening programme

Answer 5

Starts at 25, every 3 years. Stops at 65 if all smears have been clear since 50.

Question 6

Cervical cancer is most common where?

Answer 6

Southern Hemisphere

Question 7

Cervical cancer symptoms

Answer 7

Post coital bleeding / foul discharge / asymptomatic / IMB or PMB

Question 8

Cervical staging

Answer 8

Clinical staging - by examination / MRI - 95% accurate / 1-confined to the cervix, 2- to an adjacent structure, 3- more advanced local spread 4- metastasis (lung, liver, bone, brain)

Question 9

Cervical cancer treatment

Answer 9

Surgery if stage 1 / Radiotherapy above stage 1, combine with chemo as it radio sensitises the cancer / Radial hysterectomy (curative treatment for stage 1 disease)

Question 10

Cervical cancer - radical trachelectomy

Answer 10

Remove cervix but implant the uterus directly onto the vagina

Question 11

What’s the prognosis for 5 year survival of cervical cancer according to staging

Answer 11

80,60,40,20

Question 12

Ovarian cancer risk factors

Answer 12

Related to number of ovulations - Nulliparity, infertility, diet, high socio economic status, family Hx (BRACA gene)

Question 13

Ovarian cancer - screening test

Answer 13

UKTOCS - not useful due to being advanced and small numbers. Screening must only be done for those who are very very high risk

Question 14

Ovarian cancer and primary care

Answer 14

Commonly told its irritable bowel, an examination must taken place, IBS not given to someone who has altered bowel habit over 55. Do a CA125 and then an ultrasound if abnormal

Question 15

Risk of malignancy index RMI

Answer 15

RMI = U x M (menaupause status) x Ca125 =>250 refer to specialist MDT

Question 16

Ovarian cancer features

Answer 16

Important sign is pelvic mass, upper abdominal mass (common site is the omentum due it blood supply), ascites

Question 17

Ovarian cancer staging

Answer 17

Surgical staging / CT staging. 1-ovaries, 2- pelvic extension, 3- peritoneal deposits, 4-

Question 18

Ovarian cancer treatment

Answer 18

Surgery - hysterectomy, removal of tubes and ovaries, biopsies. Debunking - hysterectomy, removal of tubes and ovaries / Chemo given

Question 19

Uterine cancer causes

Answer 19

Obesity, Nulliparity, late menopause, pcos, oestrogen replacement therapy (must be balanced, therefore also given progesterone replacement therapy) , Tamoxifen (2-3 x increase)

Question 20

Clinical features of uterine cancer

Answer 20

Post menopausal bleeding

Question 21

Uterine cancer treatment

Answer 21

Hysterectomy, remove ovaries, radiotherapy (15-20%), hormonal treatment (progesterone as most of these cancers are hormonally caused)

Question 22

Vulval cancer

Answer 22

More than 50% >70. HPV, VIN particularly in younger women

Question 23

Vulval cancer treatment

Answer 23

Radical excision (not commonly done, more common to use a wide local excision) / groin lymph nodes / Radiotherapy / Chemotherapy