Gynaecological Cancer Flashcards
What are the RF for endometrial Ca?
Obesity Early menarche/late menopause Nulliparity PCOS Unopposed oestrogen Tamoxifen Previous breast/ovarian Ca BRCA1/2 Endometrial polyps DM Parkinsons
How does endometrial Ca present
Pre-menopausal (1%)
- prolonged frequent vaginal bleeding
- intermenstrual bleeding
Post-menopausal
- bleeding
- less common: blood stained, watery or purulent discharge
Outline the pathology of endometrial Ca
Pre-malignant = endometrial hyperplasia
Endometrial carcinoma =
- 80% = endometrial adenocarcinoma
- 20% = papillary serous, clear cell, carcinosarcoma
Sarcoma = extremely rare
How is endometrial Ca staged?
FIGO staging
1 = myometrium 2 = cervical 3 = uterine serosa, ovaries, tubes, vagina, pelvic/para-aortic LN 4 = bladder, bowel, distant mets
How is endometrial Ca Dx?
Hysteroscopy (gold standard)
Endometrial sampling by pipelle
Transvaginal USS - endometrial thickness (>5mm cut off)
FBC, CRP, U+E
CT chest/abdo/pelvis
MRI
How is endometrial Ca tx?
Surgery = hysterectomy, BSO, peritoneal washing
Progestagens
Primary RT - external beam, brachytherapy
Advanced = chemo, RT, hormones, palliative care
What cell lines can ovarian Ca come from?
Ep (85-90%) - serous, mucinous (benign or malig)
Germ cell - teratoma
Stroma/sex cell
Metastatic
List the RF for ovarian Ca
Obesity Early menarche/late menopause Nulliparity Unopposed oestrogen, HRT FH Endometriosis BRCA1 (50%)/2 (27%)
How does ovarian Ca present
Abdo swelling Pain Anorexia N+V Weight loss Vaginal bleeding Bowel symptoms
How should suspected ovarian Ca be investigated?
Pelvic exam USS Bloods = Ca125, FBC, U+E, LFTs CXR CT - peritoneal, omental, retroperitoneal disease Cytology of ascetic tap Surgical exploration Histopathology
Outline how ovarian Ca should be correctly managed?
Ep Ca
- Surgery + chemo
- staging lap, TAH + BSO and debulking
- cisplatin + paclitaxel
Non-ep
- Conservative surgery + chemo
Recurrent disease
- Palliative chemo
Outline the pathophysiology of cervical Ca
RF = young sex, multiple partners, no barrier, smoking, long COCP, immunosuppression/HIV, no screening
HPV 16/18 = produce protein E6/7 that supress product of p53
Cervical intraep neoplasia (CIN) = pre-malignant
How does cervical Ca present?
PCB
PMB
IMB
Bloody discharge
Describe the Tx of cervical Ca
Hysterectomy
Chemo
RT
CIN = loop excision, diathermy, cryocautery
Vaccine =
- Gardasil 6, 11, 16, 18
- Cervarix 16+18
How is cervical Ca Ix?
Smear = cells collected from transformation zone - liquid cytology
Mild dyskaryosis - HPV test
Severe dyskaryosis - colposcopy
Biopsy
