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
why is staging used in cancer
provides a objective representation tool for communicating about disease
what does grading measure
the behaviour of the cells
ie how well differentiated they are
MRI is used in the local staging of which gynae cancers
cervical
uterine
not ovarian as less sensitive to abdominal contents as can move
is surgery the primary curative treatment for all gynae cancers
YES - if caught early enough
for which gynae cancers might radiotherapy be used as the primary curative treatment
cervical
endometrial
why is concomittant chemotherapy and radiotherapy more effective than monotherapy in the treatment of advanced cervical Ca
both cisplatin and radiotherapy target the DNA- it is attacked on two fronts!
how does bevacizumab work? for which gynae cancers is it licensed?
it is a VEGF inhibitor
prevents angiogensis which is increased in tumours as they have a high metabolic demand.
it is NICE approved for ovarian cancer
it is FDA approved for cervical Ca
what is the difference between adjuvant and neo-adjuvant chemotherapy?
adjuvant is chemo after surgery
neo-adjuvant is chemo before surgery
which is the only surgical proceedure for gynae cancers which preserves fertility
radical tacelectomy
only used for stage Ia of disease (endometrial cancer)
What investigation should all menopausal bleeding under go
pipelle biopsy
how does endometrial cancer most commonly present
its present early with post menopausal bleeding
which genes are associated with ovarian cancer
BRCA1/2 and HNPCC
how does ovarian cancer most commonly present
it presents late with non-specific symptoms such as bloating, change in bowel habit and abdominal distention
what is the most common type of vagina cancer
80% SCC
15% Adenocarcinoma
how does vagina cancer present
discharge pain and bleeding
how does cervical cancer present
through screening or irregular bleeding
which HPV viruses are most associated with cervical cancer and CIN
16 and 18
what are the risk factors for cervical cancer
sexual behaviour
smoking
immunosuppresion
genetics (link with vulval ca and GI/resp on paternal side)
what are the risk factors for endometrial cancer
unopposed oestrogen therapy nuliparity late menopause PCOS obesity DM FHx (HNPCC)
which cell type is the most common endometrial cancer
adenocarcinoma
what are the treatment options for endometrial cancer
surgery - TAH + BSO
radiotherapy
Brachytherapy
Chemo - carboplatin or doxorubicin + carboplatin/cisplatin
Hormone treatments - high dose progesterones
which skin conditions are associated wtih vulval cancer
lichen planus
lichen sclerosis
paget’s disease
