Gynaecological Cancers Flashcards
At what age do women most commonly get cervical cancer?
Younger women in peak reproductive years
What are the two main types of cervical cancer?
Which is more common?
Squamous cell (most common) Adenocarcinoma
What is the most common cause of cervical cancer?
HPV
What types of HPV cause cervical cancer? (3)
16, 18 and 33
Vaccination is available
Apart from HPV what are risk factors/causes for developing cervical cancer?
Early sexual activity Multiple partners Smoking HIV COCP
What symptoms are associated with cervical cancer?
Post-coital bleeding (+ IMB, post menopausal)
Vaginal discharge
Pelvic pain
Urinary symptoms
Outline the staging for cervical cancer
Stages 1 - 4
1 = confined to cervix
2 = invades uterus/upper 2/3 of vagina
3 = invades pelvic wall/lower 1/3 of vagina
4 = invades bladder/rectum/beyond pelvis
What is cervical intraepithelial neoplasia?
Abnormal growth of (pre-cancerous) cells on the surface of the cervix
What is the grading system for CIN?
CIN I - III
I = mild dysplasia, likely to return to normal without treatment
II = moderate dysplasia, likely to progress to cancer without treatment
III = severe dysplasia, will progress to cancer if untreated
What is another name for CIN III?
Cervical carcinoma in situ
Which smear results are tested for HPV?
Smears that show mild dyskaryosis
Outline the cervical screening programme in the UK
Smear every 3 years - ages 25-49
Smear every 5 years - ages 50-64
What should the next step be for the following smear results?
CIN I
CIN II
CIN III
HPV +ve
CIN I = no further investigation needed, continue routine screening
CIN II = refer for colposcopy under 2WW
CIN III = refer for colposcopy under 2WW (suspected cancer)
HPV +ve = colposcopy
Apart from cervical cancer, what other cancers is HPV linked to?
Anal Vulval Vaginal Penis Mouth Throat
How is HPV transmitted?
Sexually transmitted
How does HPV cause disease and cancer?
Invades cells and interrupts the normal replication process, inhibiting tumour suppressor genes p53 and pRb
What strains of HPV causes genital warts? (2)
6 and 11
What strains of HPV cause cervical cancer?
16 and 18
Who is the cervical cancer vaccine offered to? (2)
What strains of HPV does it protect against?
All girls from age 12
Boys with HIV
6, 11, 16, 18
What are risk factors for endometrial cancer?
Increased age Early menarche Late menopause No pregnancies Unopposed oestrogen HRT Obesity Tamoxifen - breast cancer drug
Related to INCREASED EXPOSURE TO OESTROGEN
What are the two most common symptoms of endometrial cancer?
Post-menopausal bleeding
IMB
What investigations should be considered for suspected endometrial cancer? (2)
Transvaginal USS
Hysteroscopy with endometrial biopsy
What does a transvaginal USS for endometrial cancer look for?
What values are normal?
Endometrial thickness
Less than 4mm = normal
What is the name given to the surgery that removes the uterus and adnexa?
Total hysterectomy with bilateral saplingo-oophorectomy
Out of endometrial, cervical and ovarian cancer, which has the worst prognosis?
Why?
Ovarian
Presents late due to non-specific symptoms
What are risk factors for ovarian cancer?
LINKED TO INCREASED OVULATIONS
Early menarche Increased age Late menopause No pregnancies Obesity Unopposed oestrogen HRT Smoking FH - BRCA1 and BRCA2 genes
Is breastfeeding a risk factor for ovarian cancer?
No - is protective
What are some symptoms of ovarian cancer?
Vague, non-specific
Bloating
Pelvic pain
Weight loss
Abdominal mass
Name some occasions where an elevated CA125 would be seen
Ovarian cancer During menstruation Endometriosis Liver cirrhosis Benign ovarian cysts Fibroids
What investigations are indicated for suspected ovarian cancer?
CA125 blood test
USS
Diagnostic laparoscopy
What staging system is used for ovarian cancers?
Outline stages 1-4
FIGO staging system
1 = only in ovary
2 = out of ovary, inside pelvis
3 = outside pelvis, inside abdomen
4 = distant metastases
What is a Krukenberg tumour?
Ovarian malignancy that is a metastasis from another site
What type of cancer are most vulval cancers?
Squamous cell carcinomas
State 3 risk factors for vulval cancer
Increased age
HPV Infection
Lichen sclerosus
What is the diagnosis and management of vulval cancer?
Biopsy
Surgery - wide local excision
What is VIN?
Vulval intraepithelial neoplasia
Pre-malignant condition affecting the intraepithelial layer of the skin
