Gynaecological cancers

Question 1

three layers of the uterus

Answer 1

endometrium
myometrium
perimetrium

Question 2

uterus supplied by what

Answer 2

uterine artery (branch off internal iliac)

Question 3

proliferative phase fuelled by what hormone

Answer 3

oestrogen

Question 4

luteal phase fuelled by what hormone

Answer 4

progesterone

Question 5

most endometrial cancers are what type

Other type

Answer 5

adenocarcinoma/endometroid
- excess oestrogen, slow growing
Non-endometroid
- serous, clear cell, carcinosarcoma (faster growing and more likely to spread. not oestrogen driven)

Question 6

risk factors for endometrial cancer

Answer 6

excess oestrogen: 
nulliparous women 
late menopause 
obesity (fat produces oestrogen) 
PCOS 
Lynch syndrome

Question 7

what is protective for endometrial cancer

Answer 7

smoking
COCP
coil

Question 8

presentation of endometrial cancer

Answer 8

post menopausal bleeding

intermenstrual bleed, heavy

Question 9

Investigating endometrial cancer

Answer 9

USS looking at endometrial thickness
if over 5mm
pipelle biopsy

Question 10

endometrial cancer:
stage 1A 
stage 1B
stage 2
stage 3A
stage 3B
stage 3c
stage 4a
stage 4b

Answer 10

stage 1A : endometrium
stage 1B: myometrium 
stage 2: cervix 
stage 3A: ovary 
stage 3B: vagina 
stage 3c: lymph nodes 
stage 4a: bladder or bowel
stage 4b: liver

Question 11

where does the ovarian vascular supply enter

Answer 11

suspensory ligament (which holds ovary to pelvic wall)

Question 12

L ovarian vein drains into what

R ovarian vein drains into what

Answer 12

L -> renal artery

R-> IVC

Question 13

two layers of ovary

Answer 13

outer cortex (connective tissue stroma with ovarian follicles) 
inner medulla (contains neurovascular structures)

Question 14

from which cells do ovarian cancer arise

Answer 14

epithelial (90%)
some germ cell
some stromal cell

Question 15

risk factors for ovarian cancer

Answer 15

age 
family history 
BRCA gene 
obesity 
smoking 
HRT 
having endometriosis 
(COCP is protective)

Question 16

symptoms of ovarian cancer

Answer 16

inc urinating
abdo pain
bloating
weight loss/appetite

Question 17

investigating ovarian cancer

Answer 17

bimanual/speculum
blood: CA-125 tumour marker
pelvic USS

Question 18

staging ovarian cancer 
stage 1A 
stage 1B
stage 2
stage 3A
stage 3B
stage 3c
stage 4a
stage 4b

Answer 18

stage 1A: cancer in one ovary
stage 1B: cancer in both ovaries
stage 1c: cancer in ovary and surface of one ovary
stage 2A: also in fallopian tube
stage 2B: cancer spread to bowel or bladder
stage 2C: cancer cells in fluid of abdomen
stage 3A: spread into ovary
stage 3B: spread into vagina
stage 3c: spread into LN
stage 4: spread to other organs

Question 19

if epithelial ovarian ca - management

Answer 19

total hysterectomy asap

Question 20

where do most cervical cancers arise

Answer 20

in the transformation zone

columnar of cervix and squamous of vagina junction

Question 21

which HPV strains are genital warts

Answer 21

16 and 11

Question 22

which HPV strains do we vaccinate against

Answer 22

11, 16 and 18

Question 23

cervical screening

Answer 23

if dyskaryotic cells
do cytology on that sample
if cytology positive, invited for colposcopy

(abnormal cells are CIN cervical intraepithelial neoplasia graded 1-3 how deep they go)

Question 24

risk factors for cervical cancer

Answer 24

people more exposed to the virus (more sex, sexually active at younger age)
factors affecting immune system (smoking)
intermenstrual bleed
post menopausal bleed
discharge
dyspareunia

Question 25

staging cervical cancer 
stage 1A 
stage 1B
stage 2
stage 3A
stage 3B
stage 3c
stage 4a
stage 4b

Answer 25

1A in transitional zone

1b: 4mm or smaller
1b2: 4cm+
2a: grown into top part of vagina
2b: grown into top part of vagina
3a: grown into lower 1/3rd of vagina

Question 26

management options for cervical cancer

Answer 26

hysterectomy
remove cervix (uterus left intact)
chemo (neo-adjuvant)