Gynaecological Cancers Flashcards
How is ovarian cancer classified?
Histolologically:
- high grade serous (most common)
- clear cell
- endometroid
- mucinous invasive
What genetic testing should be perfomed in patients with high grade serous ovarian cancer?
BRCA1/2
What is the primary treatment of ovarian cancer?
debulking surgery, primary chemothapy (6 x carbo/taxol Q3W)
What percentage of patients with ovarian cancer get recurrence after treatment?
80%
What is the managment for patients with ovarian cancer who are suboptimally debulked or have stage IV disease?
carbo/taxol plus bevacizumab
What is the management for patients with ovarian cancer who have a BRCA1/2 mutations?
carbo/taxol plus maintenance olaparib (PARP inhibitor)
What is the tumour marker for ovarian cancer?
CA125
What is the difference in management between patients who have a recurrence of disease less than 6 months from initial treatment versus more than 6 months?
if less than 6 months they are platinum resistant so need to be treated with a non platinum agent
Is there are role for neoadjuvant chemothearpy, dose dense chemotherapy or intraperitoneal chemotherapy in ovarian cancer?
yes
What novel treatments are available for ovarian cancer?
anti-angiogenic agents, PARP inhibitors, immune check point inhibitors
What is the most common gynaecological cancer?
endometrial cancer
Why is there increasing incidence of endometrial cancer?
increased prevalence of obesity and metabolic syndrome
What is the mortality rate of endometrial cancer?
2 per 100,000
What are the risk factors for endometrial cancer?
unopposed oestrogen, age, lynch syndrome
What are protective factors for endometrial cancer?
OCP
What are the types of endometrial cancers?
Type I - oestrogen dependent, good prognosis
Type II - oestrogen independent, less good prognosis
What is the usual presentation of endometrial cancer?
PV bleeding, abdo pain, bloating, nausea, fatigue, LOA, LOW
How is endometrial cancer invetigated?
US +/- pipelle, may require hysteroscopy/D+C, pre-operative MRI to determine local invasion/potential nodal involvement
What is the treatment for endometrial cancer?
total hysterecotmy and bilateral salpingo-oophrectomy
Should patients with endometrial cancer have adjuvant chemotherapy?
depends on risk
What is the management for advanced endometrial cancer?
depends on patient factors, tumour factors and biomarker factors
can consider surgery
can consider chemo/radiotherapy
What are the risk factors for cervical cancer?
HPV, smoking, immunosupression
What percentage of cervical cancer does HPV account for?
95%
Which are the most common types of HPV associated with cervical cancer?
HPV 16 and HPV 18
What is the median survival of advanced cervical ca?
12-13 months
What is the management for early stage cervical cancer?
surgery +/- adjuvant chemoRT
What is the management for locally advanced cervical cancer?
definitive chemo-RT
What is the management for recurrent/metastatic cervical ca?
carbo/taxol +/- bevacizumab
