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Gynaecology > Gynaecological Cancers > Flashcards

Gynaecological Cancers Flashcards

1
Q

What group is affected by cervical cancer

A

Tends to be younger women, peaking in reproductive years

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2
Q

Common histology of cervical cancers

A

80% are SCC, adenocarcinoma is next most common type, very rarely other cancers

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3
Q

What is strongly associated with cervical cancers

A

HPV

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4
Q

What type of HPV is associated with the cause of cervical cancers

A

Type 16 and 18 - 70%

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5
Q

Risk factors for cervical cancer

A

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

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6
Q

What factors increase someones risk of contracting HPV

A

Early sexual activity, increased number of sexual partners, not using condoms

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7
Q

Presentation of cervical cancer

A

Detected in cervical smears in otherwise asymptomatic women.
Can have abnormal bleeding, vaginal discharge, pelvic pain, dysparenuria, ulceration, inflammation, bleeding

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8
Q

What are the grading systems for cervical intraepithelial neoplasia

A

CIN I - CIN III which grades the levels of dysplasia in the cells of the cervix diagnosed at colposcopy

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9
Q

How often are smears for those aged 25 - 49

A

Every 3 years

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10
Q

What dyes are used in colposcopy

A

Acetic acid and iodine are used to differentiate abnormal areas - punch biopsy or LLETZ can be performed during to get sample tissue

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11
Q

What is a LLETZ procedure

A

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

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12
Q

What is a cone biopsy

A

Treatment for cervical intraepithelial neoplasia and very early stage cervical cancer

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13
Q

What are the main risks of cone biopsies

A

Pain, bleeding, infection, scar formation with stenosis if the cervix and increased risk of miscarriage and premature labour

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14
Q

What staging system is used for cervical cancer

A

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

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15
Q

What is the main histological subtype of endometrial cancer

A

80% are adenocarcinoma

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16
Q

What hormone contributes to endometrial cancer

A

Oestrogen

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17
Q

What are the two types of endometrial hyperplasia

A

Hyperplasia without atypia, or atypical hyperplasia

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18
Q

What is the significance of endometrial hyperplasia

A

It is a precancerous condition involving thickening of the myometrium - most cases will rerturn to normal but 5% will go on to endometrial cancer

19
Q

How is endometrial hyperplasia treated

A

Progesterones such as with IUS or continuous oral progesterones

20
Q

Risk factors for endometrial cancer

A

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

21
Q

Protective factors for endometrial cancer

A

COCP
Mirena coil
Increased pregnancies
Cigarette smoking

22
Q

Presentation of endometrial cancer

A

Postmenopausal bleeding
Postcoital bleeding
Intermenstrual bleeding
Usually heavy menstrual bleeding
Abnormal vaginal discharge
Haematuria
Anaemia
Raised platelet count

23
Q

When is there a 2 week wait for endometrial cancer

A

Postmenopausal bleeding

24
Q

Investigations into endometrial cancer

A

Transvaginal US for thickness
Pipelle biopsy
Hysteroscopy with biopsy

25
Q

Staging system for endometrial cancer

A

FIGO system
S1 - Confined to uterus
S2 - Invades cervix
S3 - Invades ovaries, fallopian tubes, vagina or lymph nodes
S4 - Invades bladder, rectum or beyond pelvis

26
Q

Why does ovarian cancer present late

A

Non-specific symptoms - 70% present after it has spread to uterus

27
Q

Types of ovarian cancers

A

Epithelial cell tumours
Dermoid cysts (Germ cell tumours)
Sex cord stroma tumours
Metastasis

28
Q

What are epithelial cell ovarian cancers

A

Most common type, which can be classified into serous tumours (most common), endometroid carcinomas, clear cell tumours, mucinous tumours and undifferentiated tumours

29
Q

What are germ cell ovarian tumours

A

Benign ovarian tumours, teratomas meaning they come from the germ cells, and can contain various tissue types. Associated with ovarian torsion and can cause raused alpha-fetoprotein and hCG

30
Q

What are sex cord stromal ovarian tumours

A

Rare tumours which can be benign or malignant. Arise from stroma or sex cords including several types - Sertoli-Leydig cell tumours, granulosa cell tumours

31
Q

What does a Krukenberg tumour refer to

A

Metastasis in the ovary usually from the GI tract, particularly the stomach - characteristic signet ring sign on histology

32
Q

Risk factors for ovarian cancer

A

Peaks at age 60
BRACA1/2 gene
Increased number of ovulations - early periods, late menopause, no pregnancies
Obesity
Smoking
Recurrent use of clomifene

33
Q

Protective factors for ovarian cancer

A

Factors stopping ovulation
COCP
Breast feeding
Pregnancy

34
Q

Presentation of ovarian cancer

A

Non-specific symptoms
Abdominal bloating, easy satiety, loss of appetite, pelvic pain, urinary symptoms, weight loss, abdominal or pelvic masses, ascites, ovarian mass may press on obturator nerve causing referred hip or groin pain

35
Q

What is the tumour marker for ovarian cancer

A

CA125 - >35 IU/mL is significant

36
Q

Investigations into ovarian cancer

A

Pelvic USS
Risk of malignancy index
CT scan
Histology
Paracentesis

37
Q

Causes of raised CA125

A

Endometriosis, fibroids, adenomyosis, pelvic infection, liver disease, pregnancy

38
Q

What are the histological subtypes of vulval cancer

A

90% are SCC
Less commonly malignant melanomas

39
Q

Risk factors for vulval cancer

A

Advanced age - over 75
Imunnosuppression
HPV infection
Lichen sclerosis

40
Q

Risk factors for vulval cancer

A

Advanced age - over 75
Imunnosuppression
HPV infection
Lichen sclerosis

41
Q

What is vulval intraepithelial neoplasia

A

Premalignant condition affecting the squamous cells of the skin that can preceed vulval cancer

42
Q

Management of VIN

A

Watch and wait, wide local excision, imiquimod cream, laser ablation

43
Q

Presentation of vulval canaer

A

Incidental finding inolder women
Vulval lump, ulceration, bleeding, pain, itching, lymphadenopathy in the groin, labia majora frequently

44
Q

Management of vulval cancer

A

Biopsy of lesion, sentinel node biopsy, CT abdo pelvis

Gynaecology (7 decks)

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