Gynaecological Cancers (FRANZCOG lecture 2022) Flashcards
PMB rate of benign, pre-malignant and malignant pathology?
benign 60%
malignant 20%
pre-malignant 20%
Relative risk of developing endometrial cancer in post-menopausal women with tamoxifen therapy?
RR 4.01
- 6% 5y
- 1% 5-14y
Lifetime risk of endometrial cancer?
1/36 (3%)
Familial syndromes increasing risk of endometrial cancer?
BRCA (maybe uterine papillary serous in small studies not replicated)
Cowden
Lynch
Prognostic factors for endometrial cancer?
patient: comorbidities, performance status, age
disease: high grade, high stage, LVSI
centre: access to treatment
How do you pre-surgically stage low risk endometrial cancer?
MRI or USS +CXR
When is laparoscopy gold standard to endometrial cancer?
early stage disease as per LACE and LAP 2 trials.
What is the efficacy of sentinel lymph node biopsy in endometrial cancer?
sensitivity 96%
less morbidity
same oncological outcomes compared to full nodal dissection.
What is the evidence regarding endometrial cancer screening for women with Lynch syndrome?
no evidence to support TVUSS screening.
studies with biopsy/TVUSS have failed to demonstrate survival benefit
What counselling should be offered to women with Lynch syndrome?
TH BSO recommended from age 40yo, or 5y prior to sentinel family cancer event. ?chemoprophylaxis with COCP and aspirin.
Then give HRT
Refer urology and gastro for FU
In what proportion of early stage and advanced ovarian cancer is Ca125 elevated?
early = 50% advanced = 80%
Sensitive, low specificity, low PPV.
What studies looked at methods of ovarian cancer screening?
low risk population
UKCTOCS 2021
PLCO 2010
high risk population
UKFOCS
UKTOCS OUTCOME
rates and mortality of ovarian outcome same between groups
PLCO outcome
no difference in incidence or mortality for ovarian ca
3000 false positive results
1000 had surgical intervention
15% complication rate
compare advantages and disadvantages of BSO and TH BSO for risk reducing surgery with BRCA.
BSO ad - shorter less morbidity - uterus for fertility disad: - risk of UPSC (>3%), HRT must have progesterone, ?increased risk of breast ca with progesteron - if needs tamoxifen risk of EC
THBSO ad - eliminates EC risk - treats DUB - E2 only for HRT
disad:
- longer and more morbidity
- loss of fertility options.
Proportion of cervical cancer that is adenocarcinoma?
20%
Incidence cervical cancer and mortality rate
4-7/100,000
1-3% mortality.
High risk HPV
16 and 18 (70% cervical ca)
intermediate risk HPV
31, 33, 35, 39
45,
51, 52, 56, 58, 59
Prevalence of HPV infection?
80%
Percentage of CIN 3 that persists or invades?
56% persist
12% invade
Percentage of CIN 2 that persists, progresses or invades?
35% persist
22% progress
5% invade
Strains of HPV covered by Gardasil-9?
6 & 11 (warts) 16,18, 31, 33, 45, 52, 58
- covers both high risk
- missing intermediate strains 35, 39, 51, 56, 59
Proportion of high grade CIN and adenocarcinoma prevented with vaccination?
97-100% in HPV naive population
(60% general population)
Incidence risk rate if vaccinated 0.12(00-0.34)
What are the advantages of HPV vs. LBC?
more sensitive
better NPV therefore longer screening interval.
What is the expected reduction in cervical cancer incidence and mortality with HPV testing vs. LBC?
24-36% reduction
Treatment CIN 2?
consider conservative management for CIN2 if under 25-30yo.
Relate types of TZ to depth of excision required
T1TZ = 8-10mm T2TZ = 10-15mm T3TZ= >15mm
What type of cervical abnormality would be observed in pregnancy?
CIN 2 or 3.
Colp and biopsy safe
Avoid lletz or cone
high rate of regression in pregnancy