Gynaecological Cancers Flashcards
List 3 types of ovarian cancer
- Epithelial
- Germ cell tumours
- Ovarian stromal tumours
Define epithelial ovarian cancer
Arises from single layer of cells covering ovary or cysts
What are the two subtypes of epithelial ovarian cancer?
High grade serous
OR
Those arising from surface epithelium/Mullerian inclusion cysts
Where do germ cell ovarian tumours arise from?
Oocytes
Name 3 ways which ovarian cancer can metastasise
Trancoelemic
Exfoliation into peritoneal cavity
Lymphatic invasion
Give 4 risks factors for ovarian cancer
Smoking
Low parity
Early menarche
Late menopause
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
Which surgery is used as risk reduction in familiar ovarian cancer
Prophylactic bilateral salpingo-oophrectomy
Give 4 symptoms of ovarian cancer
- Altered bowel habit
- Abdominal pain/bloating
- Feeling full quickly
- Difficulty eating
Give 4 clinical signs of ovarian cancer
- Abdominal distension
- Upper abdominal mass (omental disease)
- Pleural effusion
- Nodules on PV exam
Give 5 methods which may be used to investigate ovarian cancer
- USS
- Ca125
- RMI
- CT
- Biopsy
How is risk of malignancy index (RMI) calculated?
RMI = USS x menopausal status x CA125
What are the main treatment options for ovarian cancer?
- Chemotherapy
- Surgery
- Palliative
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
Which is the most common gynaecological cancer in the UK?
Endometrial
Give 4 symptoms of endometrial cancer
- Post-menopausal bleeding
- Post coital bleeding
- Intermenstrual bleeding
- Altered menstrual pattern
What is the difference between type 1 and type 2 adenocarcinoma of the endometrium?
1: oestrogen excess
2: no osterogen excess
What is sarcoma of the endometrium?
Cancer derived from the muscle layer
What is the significance of endometrial hyperplasia in endometrial cancer?
Hyperplasia can progress to cancer, especially atypical hyperplasia
Give 5 risks of developing endometrial cancer
- Unopposed oestrogen exposure
- Nulliparity
- Obesity
- Physical inactivity
- HRT
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
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
Give 4 investigations which may be used to diagnose endometrial cancer
- TV USS (measuring endometrial thickness)
- CT
- MRI
- Pipelle biopsy
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
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
