Gynaecological Cancers Flashcards
What group is affected by cervical cancer
Tends to be younger women, peaking in reproductive years
Common histology of cervical cancers
80% are SCC, adenocarcinoma is next most common type, very rarely other cancers
What is strongly associated with cervical cancers
HPV
What type of HPV is associated with the cause of cervical cancers
Type 16 and 18 - 70%
Risk factors for cervical cancer
Those with increased risk of catching HPV
Later detection - not engaging with screening
Smoking
HIV
COCP for more than 5 years
Increased number of full term pregnancies
FHx
Exposure to diethylstilbestrol
What factors increase someones risk of contracting HPV
Early sexual activity, increased number of sexual partners, not using condoms
Presentation of cervical cancer
Detected in cervical smears in otherwise asymptomatic women.
Can have abnormal bleeding, vaginal discharge, pelvic pain, dysparenuria, ulceration, inflammation, bleeding
What are the grading systems for cervical intraepithelial neoplasia
CIN I - CIN III which grades the levels of dysplasia in the cells of the cervix diagnosed at colposcopy
How often are smears for those aged 25 - 49
Every 3 years
What dyes are used in colposcopy
Acetic acid and iodine are used to differentiate abnormal areas - punch biopsy or LLETZ can be performed during to get sample tissue
What is a LLETZ procedure
Also known as a loop biopsy which involves using diathermy to remove abnormal epithelial tissue on the cervix, the electrical current cauterises the tissue and stops bleeding
What is a cone biopsy
Treatment for cervical intraepithelial neoplasia and very early stage cervical cancer
What are the main risks of cone biopsies
Pain, bleeding, infection, scar formation with stenosis if the cervix and increased risk of miscarriage and premature labour
What staging system is used for cervical cancer
S1 - confined to cervix
S2 invades uterus or upper 2/3 of vagina
S3 invades pelvic wall or lower 1/3 of vagina
S4 invades bladder, rectum or beyond pelvis
What is the main histological subtype of endometrial cancer
80% are adenocarcinoma
What hormone contributes to endometrial cancer
Oestrogen
What are the two types of endometrial hyperplasia
Hyperplasia without atypia, or atypical hyperplasia
What is the significance of endometrial hyperplasia
It is a precancerous condition involving thickening of the myometrium - most cases will rerturn to normal but 5% will go on to endometrial cancer
How is endometrial hyperplasia treated
Progesterones such as with IUS or continuous oral progesterones
Risk factors for endometrial cancer
In relation to patients exposure to unopposed oestrogen
Increased age
Earlier onset of menstruation
Late menopause
Oestrogen only HRT
No or few pregnancies
Obesity
PCOS
Tamoxifen
T2DM, HNPCC / Lynch syndrome
Protective factors for endometrial cancer
COCP
Mirena coil
Increased pregnancies
Cigarette smoking
Presentation of endometrial cancer
Postmenopausal bleeding
Postcoital bleeding
Intermenstrual bleeding
Usually heavy menstrual bleeding
Abnormal vaginal discharge
Haematuria
Anaemia
Raised platelet count
When is there a 2 week wait for endometrial cancer
Postmenopausal bleeding
Investigations into endometrial cancer
Transvaginal US for thickness
Pipelle biopsy
Hysteroscopy with biopsy
