Gynaecological Cancers Flashcards
Where is ovarian cancer usually found? and Where does it spread to?
Attaches to the surface of the organ rather than invading the parenchyma
Peritoneal cavity
Bowel mesentery
Liver capsule
What are the causes of ovarian cancer?
BRCA mutation
Precursor lesion
p53 mutation
What is the most common cause of gynaecological cancer death?
Ovarian
What are the signs & symptoms of ovarian cancer?
Asymptomatic Weight loss Fatigue Pressure effects on bowel & bladder Bloating/feeling full/loss of appetite Pelvic/abdo pain Dragging sensation Urinary frequency/urgency (pressure effects)
What are the risk factors for ovarian cancer?
Nulliparity/continuous ovulation Early menarche/late menopause HRT Endometriosis Difficulty conceiving Genetics: BRCA 1-2, Lynch II Syndrome
COCP-Protective
When is a 2week wait appropriate for query ovarian cancer?
Ascites
Abdo/pelvic mass NOT fibroids
What markers can be considered for ovarian cancer?
Ca125: Serous, endometrioid
Ca19.9: Mucinous
CEA
How specific is Ca125?
Not very
Also elevated in inflammation & during periods
What other investigations can be done for ovarian cancer?
Abdo exam, palpate supraclavicular lymph nodes, breast/chest/vaginal/rectal exam Staged at time of laparotomy Pelvic USS Biopsy Staging: CT & MRI Ascites: Paracentesis Peritoneal biopsy & washing
How is ovarian cancer treated?
Stage 1: TAH & bilateral S-O
OR unilateral S-O without TAH
Retroperitoneal lymph node assessment
Stage 2-4: TAH, lymph node dissection, bilateral S-O
Adj: Omentectomy & platinum based chemo
What are the stages of ovarian cancer and which stage do most ovarian cancers present?
- Macroscopically confined to ovaries
- Beyond ovaries confined to pelvis
- Beyond pelvis confined to abdomen
- Disease beyond abdomen
MOST PRESENT: Stage 3 or 4
Most common gynaecologist cancer causing death
What are the malignant types of ovarian cancer?
Adenocarcinoma
Adenocarcinofibroma
SCC
Transitional cell carcinoma
What are the benign types of ovarian cancer?
Cystadenoma
Epiermoid cyst
Adenofibroma
What type of cancer makes up the majority of vulval cancers?
SCC
What is a pre-cancerous sign of vulval cancer?
Lichen Sclerosus (autoimmune loss of collagen leading to thin epithelium) Progresses to differentiated VIN
How is vulval cancer investigated?
Incisional biopsy >1mm
How is vulval cancer treated?
1a: WLE 15mm margin
1b: Triple incision, WLE & dissect groin nodes
2: Neo RT/chemo & reconstruction (flap coverage/ skin graft)
3-4: Radical vulvectomy
How is endometrial cancer defined?
An epithelial malignancy of the uterine corpus mucosa
What is the most common type of endometrial cancer?
Adenocarcinoma
How common is endometrial cancer?
Common
Most common gynaecologist tumour in the developed world
What is the pathophysiology of endometrial cancer?
OE affects expression of genes leading to altered regulation of cellular signals= endometrial hyperplasia.
What stage is precancerous in endometrial cancer?
Atypical hyperplasia
What are the causes of endometrial cancer?
Endometrial hyperplasia
Familial cancer syndromes
Endogenous OE stimulation of the endometrium (obesity, PCOS)
Exogenous OE stimulation of the endometrium (HRT)
What are the signs & symptoms of endometrial cancer?
PMB!!! (1year after cessation of periods) Discharge (pyometra-pus in uterus) Irregular menstrual cycle in older women Uterine/adnexal mass Fixed uterus
What are the RFs of endometrial cancer?
Mostly OE dependent = linked to unopposed OE Obesity Nulliparity Late menopause >50 PCOS Endometrial hyperplasia Tamoxifen Fhx
How is endometrial cancer investigated?
Urgent TVUS: Endometrial thickening >5mm Biopsy Histopathology Hysteroscopy MRI
How is endometrial cancer managed?
1: TAH & bilateral S-O
2: TAH, bilateral S-O, lymph node sampling
3: Radical RT +/- TAH OR Progesterone OR combined chemo
4: Internal/external brachy OR Progesterone
How is endometrial cancer staged?
Locally invasive cancer
1: Confined to uterus
2: Spread to cervix
3: Spread outside of the uterus
4: Spread to bowel & surrounding organs
What is the cause of cervical cancer?
HPV 16 & 18
What is the most common type of cervical cancer?
SCC
How does cervical cancer spread?
Spreads along the embryological development pattern
What are the signs & symptoms of cervical cancer?
Abnormal vaginal bleeding- PCB/IMB/PMB
Chronic mucoid/purulent/blood stained discharge
Pelvic pain
Dyspareunia
Cervical mass/bleed
Advanced: Malaise, weight loss, pain, haematuria
What RFs are associated with cervical cancer?
HPV infection 16 & 18 HIV/immunoS Early onset of sexual activity <18 Multiple sexual partners Smoking
What investigations are done in suspected cervical cancer?
VE/Speculum Smear test Colposcopy: Punch biopsy w/ acetic acid HPV testing Staging: MRI & CT
In Cervical cancer what will a smear test show?
Dyskaryosis
How is cervical cancer managed?
1a1: LLETZ/ cone biopsy
1b1 WANTING FERTILITY: Radical trachelectomy
1-2a: Radical AH & lymph node dissection & upper 1/3 of vagina, adjuvant chemo
2b-4: RT/Chemo
What are the stages of cervical cancer?
0: Carcinoma in situ
1: Confined to cervix, only surgically treatable stage
a1= <3mm deep
a2= <5mm deep
b1= <4cm
b2= >4cm
2: Upper vagina NOT pelvic wall
a= not parametrium
b= invasion of parametrium
3: Pelvic wall or 1/3 lower vagina or ureteric obstruction
4: Bowel wall, bladder, distal mets
What does CIN mean?
Cervical intraepithelial neoplasm
1: Low grade, can regress back to normal
2-3: Full thickness
In what cancer are signet cells seen?
Krukenberg’s tumour
Mucin secretion
Secondary ovarian Ca
Primary usually Gastric/colon
What are the types of epithelial ovarian cancer?
SEROUS Mucinous Endometrioid Clear cell Transitional cell Mixed Undifferentiated
What are the components of Meig’s syndrome?
Ovarian fibroma Ascites Pleural effusion (R sided most common)
