Gynaecological Cancers Flashcards by Eva Dolan

List 3 types of ovarian cancer

Epithelial
Germ cell tumours
Ovarian stromal tumours

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Define epithelial ovarian cancer

Arises from single layer of cells covering ovary or cysts

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What are the two subtypes of epithelial ovarian cancer?

High grade serous
OR
Those arising from surface epithelium/Mullerian inclusion cysts

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Where do germ cell ovarian tumours arise from?

Oocytes

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Name 3 ways which ovarian cancer can metastasise

Trancoelemic

Exfoliation into peritoneal cavity

Lymphatic invasion

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Give 4 risks factors for ovarian cancer

Smoking
Low parity
Early menarche
Late menopause

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Give 3 features which may be suggestive of familiar ovarian cancer

o Early onset breast cancer <50y/o
o Male breast cancer
o Ashkenazi Jewish

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Which surgery is used as risk reduction in familiar ovarian cancer

Prophylactic bilateral salpingo-oophrectomy

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Give 4 symptoms of ovarian cancer

Altered bowel habit
Abdominal pain/bloating
Feeling full quickly
Difficulty eating

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Give 4 clinical signs of ovarian cancer

Abdominal distension
Upper abdominal mass (omental disease)
Pleural effusion
Nodules on PV exam

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Give 5 methods which may be used to investigate ovarian cancer

USS
Ca125
RMI
CT
Biopsy

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How is risk of malignancy index (RMI) calculated?

RMI = USS x menopausal status x CA125

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What are the main treatment options for ovarian cancer?

Chemotherapy
Surgery
Palliative

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In general terms, define the surgical staging of ovarian cancer

1: limited to ovaries
2: limited to pelvis
3: limited to abdomen
4: distant metastases to outside abdominal cavity

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Which is the most common gynaecological cancer in the UK?

Endometrial

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Give 4 symptoms of endometrial cancer

Post-menopausal bleeding
Post coital bleeding
Intermenstrual bleeding
Altered menstrual pattern

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What is the difference between type 1 and type 2 adenocarcinoma of the endometrium?

1: oestrogen excess
2: no osterogen excess

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What is sarcoma of the endometrium?

Cancer derived from the muscle layer

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What is the significance of endometrial hyperplasia in endometrial cancer?

Hyperplasia can progress to cancer, especially atypical hyperplasia

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Give 5 risks of developing endometrial cancer

Unopposed oestrogen exposure
Nulliparity
Obesity
Physical inactivity
HRT

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What is the difference between type 1 and type 2 Lynch syndrome?

1: Predisposes to site-specific colorectal cancer
2: Predisposes to many types of cancer including endometrial and ovarian

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In general, what are the 4 stages of endometrial cancer according to FIGO?

1: Confined to uterus
2: Cervical stromal invasion but not beyond uterus
3: Tumour outside uterus
4: Distant metastases

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Give 4 investigations which may be used to diagnose endometrial cancer

TV USS (measuring endometrial thickness)
CT
MRI
Pipelle biopsy

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According to the SIGN guidelines for the investigation of post-menopausal bleeding, at which endometrial thickness should non-HRT users go for biopsy?

> 3mm endometrial thickness

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According to the SIGN guidelines for the investigation of post-menopausal bleeding, at which endometrial thickness should HRT users go for biopsy?

>5mm endometrial thickness

Which patients should automatically go for biopsy or hysteroscopy if presenting with post-menopausal bleeding?

Those on Tamoxifen

What is the treatment for early stage endometrial cancer?

Total hysterectomy/bilateral salpingo-oophrectomy + washings

Give 3 treatment options for patients with advanced endometrial cancer

Surgery Chemotherapy Hormonal therapy

Give 4 side effects of radiotherapy

- Proctitis - Cystitis - Lethargy - Skin changes

What are the two peaks of incidence of cervical cancer?

25-29 years | >80 years

Which two type of HPV are associated with cervical cancer?

16 and 18

Give 4 risks for the development of cervical cancer

- HPV infection - Smoking - Early first episode of sexual intercourse - COCP use

The vaccination scheme against HPV in Scotland occurs when and protects against which types of HPV?

2nd year pupils in Scotland with Gardasil HPV 6, 11, 16, 18

Where do abnormal smear results get automatically referred?

Colposcopy clinic

Which ages receive cervical screening in Scotland and how often?

- 25-65y/o’s screened o 25-49 every 3 years o >50s every 5 years

Which type of epithelium line the outer cervix?

Squamous cell epithelium

Which type of epithelium line the inner cervix?

Columnar epithelium

What joins the inner and outer cervical epithelium?

Tranformation Zone (TZ)

How does HPV cause CIN?

By altered the transformation zone

In which circumstances are smear tests inappropriate?

When the cervix appears visibly abnormal

What is CIN 1?

Low grade changes which are given time to resolve on their own

What is CIN2 and 3?

High grade changes for which treatment is offered

Give 3 types of treatment for CIN

- Cold coagulation - LLETZ - Cryotherapy

Which is the most common type of cervical cancer?

Squamous cell carcinoma

Give 2 symptoms of cervical cancer

- Unscheduled vaginal bleeding | - Offensive discharge

Give 4 investigations used in the diagnosis of cervical cancer

- Examination - Colposcopy - MRI/CT - Biopsy

What is the general staging of cervical cancer?

- 1: confined to cervix - 2: upper 2/3rds vagina/parametrial involvement - 3: lower 1/3 vagina or extending to pelvic side wall - 4: tumour to adjacent pelvic organs/distant organs

How can early stage cervical cancer be managed surgically?

Trachelectomy (cervix removal)

Give 2 surgical procedures used to treat advanced cervical cancer

Simple hysterectomy Radical hysterectomy and pelvic lymphadenectomy

What is the peak incidence of vulval cancer?

80-84 years old

What is the most common type of vulval cancer?

SCC

Give 4 contributing factors to vulval cancer

- VIN (HPV and non-HPV related) - HPV - Squamous metaplasia - Smoking

What is VIN1?

Usual changes, not a precursor to VIN2/3

What are VIN2 and VIN3?

HIGH GRADE CHANGES 2: Warty 3: Basaloid

Name 3 common sites for VIN

Labia majora Labia minora Posterior fourchette

Give 4 symptoms of VIN

- Pruritis - Pain - Ulceration - Leukoplakia (thickened white areas)

How is VIN diagnosed?

Biopsy

Give 2 management options for VIN

Excisions surgery | Imiquimod

Give 4 symptoms of vulval cancer

Lump Pain Bleeding Discharge

Give 4 signs of vulval cancer

Mass Ulceration Elevated surface Inguinal lymphadenopathy

Give 3 surgical procedures which may be used to treat vulval cancer

o Simple or radical vulvectomy o Wide local excision o +/- inguinal lymphadenectomy