Gynaecological Cancers

Question 1

A 44 year old women has noticed spotting between periods. On PV examination a mass was seen protruding through the external os into the vagina. A biopsy is taken for histology:

What is the most likely cause?

1. Adenomyoma
2. Cervical hyperplasia
3. Cervical polyp
4. leiomyoma
5. SCC

Answer 1

C - cervical polyp

Adenomyoma - difficult to distinguish from fibroid, glands and muscle derived

Cervical hyperplasia - not a thing

Cervical polyp - most likely

leiomyoma - fibroid

SCC - picture not showing

Question 2

What is the cervical cancer screening guideline? How is it going to change?

Answer 2

• Old - PAP smear 2 yearly from 20 or 2years from first sex.
• HPV test - PCR and liquid cytology 5 yearly from 25
  
  • negative for high risk HPV more predictive for not having an abnormality.

Question 3

What is a way of classifying ovarian tumours? Why is it important?

Answer 3

important - BRCA has targeted treatment, prognosis, chemosensitivity.

• Epithelial - older age
  
  • serous (70-80%) - BRCA 20% (drug target), chemosensitive, CA125
  • mucinous <3% - appendiceal/colorectal - CEA
  • endometroid 5-10% endometriosis, not chemosensitive, CA125 (slightly high)
  • clear cell 5-10% endometrosis (normal CA125)
• Stromal (solid tumours)
  
  • granulosa - AMH/Inhibin B
  • sertoli/leydig - androgens
• germ cell
  
  • dermoid
  • dysgerminoma - LDH
  • yolk sac tumours - ƔCFP
  • choriocarcinomas - βHCG

Question 4

What are some considerations on investigations when diagnosing endometrial cancer?

Answer 4

• RFs
  
  • BMI
  • no real tumour markers
  • oestrogen load (nulliparous, HRT, # of children, contraception)
• TVUS
  
  • endometrial thickness (15-18 premenopause, <4mm postmenopause, up to 8mm with HRT)
    
    • premenopause consider time of cycle.
• surgical
  
  • often take lymph nodes (sentinel with dye) but difficult to find
  • how the cancer is staged. (FIGO).

Question 5

What are some vulval cancers and what are their precursors?

Answer 5

1. vulval VIN (SCC) 90% - lichen sclerosus precursor
2. melanoma (2nd most common)
3. adenocarcinoma - Pagets disease extramammory precursor - (in bowel, breast and cervix too).

other DDx that can confuse - Psoriasis

do a PAP smear, chlamydia screen and a acetic acid application at the same time.

Question 6

What are the different gynaecological cancers from most common to least?

Answer 6

1. endometrial cancer
2. ovarian
3. cervical
4. other:
   
   • vaginal
   • vulval
   • GTD

Question 7

Talk about lymph nodes and where different cancers will spread to

Answer 7

• vulva - groin
• uterus + cervix - pelvic
• ovaries - paraaortic

Question 8

What are common presentations of ovarian cancer?

Answer 8

• ascites/swelling
• AUB/PMB - ovarian tumours can produce oestrogen, cause bleeding (especially granulosa cells 15% incidence of endometrial cancer)
  
  • endometrial hyperplasia.