Gynaecological Cancers Flashcards
what is the most common cancer in female non-smokers
breast cancer
which factors are associated with an increased risk of developing breast cancer
older age
oestrogen exposure for long uninterrupted periods (the pill?/HRT)
large gap between menarche and the menopause
nulliparity
late first pregnancy
obesity
FHx
what is the typical presentation of breast cancer
painless breast mass +/-:
- discharge
- nipple changes
- skin tethering
- ulceration (late)
- oedema/erythema
at which point is a carcinoma (cancer of the epithelium) considered invasive?
once it penetrates the basement membrane
how might a breast cancer spread
via lymph
via blood (lungs, bones, brain)
locally
which genes are associated with breast cancer in first degree relatives
BRCA1 - 80% lifetime risk of breast Ca; autosomal dominant; also increased risk of bowel Ca, ovarian and prostate Ca
BRCA2 - men with BRCA2 have a 6% risk of developing breast Ca
HER2- overexpressed in breast ca tissue; targeted by monoclonal ab trastuzumab
how many women need to be screened (50-70 every 3 yrs) to save one person
500
what are the poor prognostic features of a breast cancer
young age/premenopausal large primary tumour size high grade tumour oestrogen and progesterone receptor negative positive lymph nodes
why can aromatase inhibitors only be given post menopausally
premenopausal women synthesize oestrogen in the ovary, where as post menopausally it is produced in the adrenal glands and in adipose tissue - aromatase inhibitors work on the adrenal gland and hence only work on post-menopausal women
what are the aims of screening
1) to make early diagnoses
2) to catch people in a PRECLINICAL condition
the aim of this is to detect the maximum number of people with cancer/pre cancer therefore a 2 stage test may be advisable. The first test being of a high sensitivity and the second with a high specificity
Wilson and Jungner classic screening criteria (from WHO website)
- The condition sought should be an important health problem.
- There should be an accepted treatment for patients with recognized disease.
- Facilities for diagnosis and treatment should be available.
- There should be a recognizable latent or early symptomatic stage.
- There should be a suitable test or examination.
- The test should be acceptable to the population.
- The natural history of the condition, including development from latent to declared disease, should be adequately understood.
- There should be an agreed policy on whom to treat as patients.
- The cost of case-finding (including diagnosis and treatment of patients diagnosed) should be economically balanced in relation to possible expenditure on medical care as a whole.
- Case-finding should be a continuing process and not a “once and for all” project.
what is the most common gynae cancer in the UK
uterine cancer (E2 therapies and weight) followed by : ovarian then cervical
what is the most common gynae cancer worldwide
cervical cancer
incidence is less in the UK owing to screening and the HPV vaccination programme
what is assessed in TNM staging
size and local invasion
lymph node involvement
distant mets
which gynae cancer does not follow FIGO staging
cervical cancer as it behaves differently with lymph node invasion