Gynaecological Cancers

Question 1

Protective factors for endometrial cancer?

Answer 1

COCP use
Smoking (unclear why)
Multiparity

Question 2

Risk factors for endometrial cancer?

Answer 2

Excess oestrogen exposure:
- Early menses
- Nulliparity
- Late menopause
- Unopposed oestrogen HRT (providing progesterone continuously alongside eliminates the increased risk)

Metabolic syndrome:
- Diabetes
- Obesity
- PCOS

Previous tamoxifen use

Hereditary Non-Polyposis Colorectal Carcinoma

Question 3

FIGO staging of cervical cancer

Answer 3

Stage IA - confined to the cervix, microscopically visible and <7mm wide
AI = < 3mm in depth
A2 = 3-5mm in depth
Mx:
Gold standard = hysterectomy +/- node clearance if A2
Stage IA can mx with cone biopsy w/ negative margins (fertility preserving) or radical trachelectomy

Stage IB - confined to the cervix, clinically visible and >7mm wide
B1 < 4cm - radio and chemo therapy
B2 > 4cm - radical hysterectomy & node clearance
Stage IB2 onwards INOPERABLE DUE TO THE SIGNIFICANT RISK OF POSITIVE MARGINS AND POSITIVE NODES - INSTEAD FOR RADIOTHERAPY + CHEMOTHERAPY WITH CISPLATIN

Stage II - extension of the tumour beyond the cervix but NOT involving the pelvic wall
IIa = involving upper 2/3rds of vagina
IIb = parametrial involvement

Stage III - involvement of the pelvic wall
IIIa = involving lower 1/3rd of the vagina
IIIb = involving pelvic side wall

Stage IV - involvement of the bladder or rectum or extension beyond the pelvis

Question 4

What is Meig’s syndrome?

Answer 4

The triad of benign ovarian tumour (usually fibroma) & ascites & pleural effusion

Removal of the tumour helps the other 2 resolve.

Question 5

What are the FIGO stages for ovarian cancer?

Answer 5

Stage 1 - confined to ovary
Stage 2 - confined to pelvis
Stage 3 - confined to abdomen
Stage 4 - distal mets

Question 6

What is the risk of ovarian cancer with BRCA1 and BRCA 2 mutations respectively?

Answer 6

BRCA 1 = ~ 44% lifestime risk of ovarian cancer
BRCA 2 = ~ 17% lifestime risk of ovarian cancer