Gynaecological Malignancies

Question 1

What is the most common type of malignancy affecting the genital tract?

Answer 1

Endometrial cancer

Question 2

What is the most common underlying pathology in an endometrial cancer?

Answer 2

Adenocarcinoma

Question 3

List some risk factors for developing endometrial cancer

Answer 3

Increasing age
Late menopause
Nulliparity
PCOS
Tamoxifen therapy
HRT
Obesity

Question 4

Why is obesity a risk factor for developing endometrial carcinoma?

Answer 4

Risk increases with more exposure to oestrogen…Androgens are converted to oestrogen in adipose cells and so obese people have a higher level of oestrogen

Question 5

Give 3 factors which are protective against endometrial cancer

Answer 5

COCP
Pregnancy
Smoking

Question 6

How does endometrial cancer present?

Answer 6

Abnormal mentrual bleeding - Usually post-menopausal bleeding but if a woman is presenting young it might be inter menstrual bleeding or new menorrhagia

Question 7

How would you investigate a woman with ? endometrial cancer

Answer 7

Transvaginal ultrasound scan

Hysteroscopy and endometrial biopsy

Question 8

What is the management of endometrial cancer?

Answer 8

Total hysterectomy and bilateral salpingectomy ± pelvic and para-aortic node dissection depending on stage.
Adjuvant radiotherapy

Question 9

What is the second most common malignancy to affect the genital tract?

Answer 9

Ovarian cancer

Question 10

True / False: There is a national screening programme for ovarian cancer

Answer 10

False - There is no national screening programme for ovarian cancer. Women with a high risk of hereditary epithelial ovarian cancer may be offered genetic testing for BRCA1 and BRCA2 and offered yearly transvaginal ultrasound and Ca-125 screening if mutations found to be present

Question 11

What are the 3 types of ovarian cancer?

Answer 11

Epithelial (most common)
Germ cell
Stromal ‘sex cord’

Question 12

Which tumour marker can be used for investigation of ovarian cancer?

Answer 12

Ca-125

Question 13

Which marker might a dysgerminoma (germ cell ovarian tumour) classically produce?

Answer 13

Beta-hCG

Question 14

Which marker might an endodermal sinus tumour (a type of germ cell ovarian tumour) classically produce?

Answer 14

Alpha feto-protein

Question 15

What does CIN mean?

Answer 15

Cervical intraepithelial neoplasia

Question 16

What is a typical presentation of ovarian cancer?

Answer 16

Abdominal pain and persistent abdominal distension (bloating)

Question 17

What does CIN I, II and III mean?

Answer 17

Describes the amount of dysplasia in the cervical epithelium.
CIN I = Dysplastic cells in lower 1/3 of epithelium
CIN II = Dysplastic cells in lower 2/3 of epithelium
CIN III i.e. carcinoma in situ = Dysplastic cells covering full thickness of epithelium but not invading through basement membrane

Question 18

Which infection is strongly associated with developing cervical cancer?

Answer 18

Human papilloma virus (HPV)

Question 19

Which subtypes of HPV virus are particularly associated with developing cervical cancer?

Answer 19

HPV-16 and -18

Question 20

From where are cells taken during a cervical smear test?

Answer 20

Transformation zone

Question 21

Who gets a cervical smear? And how often?

Answer 21

3 yearly in women age 25 - 49

5 yearly in women age 50 - 64

Question 22

What happens when a woman receives a ‘borderline’ smear result?

Answer 22

This means there is mild dyskaryosis. The smear will be tested for HPV. If negative, there is little chance of malignancy so the woman will return to routine screening. If positive, the woman will be referred for colposcopy.

Question 23

Which 2 staining agents are used in colposcopy?

Answer 23

Acetic acid

Iodine

Question 24

What colour do abnormal cells stain with acetic acid in colposcopy?

Answer 24

Abnormal cells stain white

Question 25

What colour do abnormal cells stain with iodine in colposcopy?

Answer 25

Pale / yellow

Question 26

What is the management of CIN I if found on colposcopy?

Answer 26

Watch and wait as 60% will spontaneously resolve. Repeat colposcopy in 6 months.

Question 27

What is the management of CIN II or III if found on colposcopy?

Answer 27

Large loop excision of the transformation zone (LLETZ)

Question 28

What is the peak age for developing cervical cancer?

Answer 28

There are 2 peaks in incidence: Aged 30-35, and then age 80-85

Question 29

True / False: Over half of cases of cervical cancer occur in women over 50 years old

Answer 29

FALSE - Over half of cases of cervical cancer occur in women UNDER 50 years old

Question 30

What are the two types of underlying pathology of cervical cancer?

Answer 30

Squamous cell carcinoma (most common - accounts for up to 90%) Adenocarcinoma

Question 31

What is the presentation of a woman with cervical cancer?

Answer 31

No symptoms i.e. 'occult' finding - May be discovered only on LLETZ biopsy at colposcopy Bleeding: Post-coital, intermenstrual, post-menopausal Offensive, blood-stained vaginal discharge

Question 32

What is the treatment for cervical cancer stage Ia(i)?

Answer 32

Cone biopsy is likely to be sufficient (allows preservation of fertility), or radical hysterectomy

Question 33

What is the treatment for cervical cancer stage Ia(ii) or Ib?

Answer 33

Radical hysterectomy and pelvic node dissection

Question 34

What is the treatment for cervical cancer stage II - IV?

Answer 34

Radiotherapy and concurrent chemotherapy

Question 35

Which particular sub-type of HPV is associated with vulval intraepithelial neoplasia (VIN)?

Answer 35

HPV-16

Question 36

Which is associated with vulval intraepithelial neoplasia (VIN): Lichen planus or lichen sclerosis?

Answer 36

Lichen sclerosis

Question 37

What is the underlying pathology in 95% of vulval cancers?

Answer 37

Squamous cell carcinoma

Question 38

Which lymph nodes does ovarian cancer spread to?

Answer 38

Para-aortic nodes

Question 39

Which type of malignant ovarian tumour typically affects younger women?

Answer 39

Germ cell ovarian cancer