Gynaecological cancers Flashcards
Types of cancer
Ovarian cancer Endometrial cancer Cervical cancer - squamous cell carcinoma - adenocarcinoma Vulval cancer
Risk factors for ovarian cancer
Early menarche Late menopause FHx BRCA1/2 Nulliparity Unopposed oestrogen
Risk factors for endometrial cancer
Early menarche Late menopause Age - 60 - 70 yo FHx BRCA1/2 Nulliparity PCOS Unopposed oestrogen - tamoxifen Polyps Obesity
Risk factors for cervical cancer
Smoking COCP Immunosuppression HPV 16 and 18 - multiple sexual partners - early age of first intercourse - unprotected sex
Risk factors for vulval cancer
Lichen sclerosis Herpes simplex virus type 2 Smoking Immunocompromised HPV - multiple sexual partners - early age of first intercourse - unprotected sex
History
FLAWS Age of menarche IMB PCB Contraception use Sexual history FHx
Investigations for ovarian cancer
Pelvic exam Bloods - Ca 125, FBC, U+Es, LFTs Pelvic USS Biopsy Staging CT
Investigations for endometrial cancer
Bloods TV USS >5mm - further investigation Hysteroscopy and biopsy - pipelle - dilatation and curettage
Other:
Staging CT - CAP
MRI pelvis
FBC, U+Es, LFTs
Investigations for cervical cancer
Bloods - Ca 125
Speculum and HPV smear test
Colposcopy and biopsy
Investigations for vulval cancer
Biopsy
HPV testing
HSV testing
Presentation of ovarian cancer
Irregular periods Bloating FLAWS Abdominal pain Nausea Vomiting PMB Bowel symptoms
Presentation of endometrial cancer
IMB
PCB
FLAWS
Heavy, painful periods
Presentation of cervical cancer
IMB PCB PMB FLAWS Unusual discharge - may be bloodstained
Presentation of vulval cancer
Lump
Itching
Burning
Pain
Management of ovarian cancer
Oophorectomy if low stage
TAH + BSO + chemotherapy
Chemoradiotherapy
May require HRT if early menopause
Management of endometrial cancer
Hysterectomy + BSO
Adjuvant radiotherapy if high risk of recurrence
Palliative:
Chemoradiotherapy
Management of cervical cancer
LLETZ
Chemoradiotherapy
Management of vulval cancer
Excision
Antihistamine for itching
Chemoradiotherapy
How is endometrial cancer staged
FIGO staging
Cervical smear test
Age 25yo - 50 - every 3 years
Age 50 - 65 - every 5 years
Tests for HPV
If +ve - colposcopy and biopsy
CIN treatment
LLETZ
Complications of cervical treatment
Radiotherapy:
- vaginal dryness
- vaginal stenosis
- cystitis
Surgery:
- Infection
- haemorrhage
- vesicovaginal fistula
- bladder dysfunction
HPV vaccination
Gardasil - 6, 11, 16, 18
Cervarix - 16 and 18
3 injections over 3 months
5 years of protection
Require smears
