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Gynaecology and Breast Disease > Gynaecological Malignancies > Flashcards

Gynaecological Malignancies Flashcards

1
Q

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

A

Endometrial cancer

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2
Q

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

A

Adenocarcinoma

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3
Q

List some risk factors for developing endometrial cancer

A 
Increasing age
Late menopause
Nulliparity
PCOS
Tamoxifen therapy
HRT
Obesity
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4
Q

Why is obesity a risk factor for developing endometrial carcinoma?

A

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

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5
Q

Give 3 factors which are protective against endometrial cancer

A

COCP
Pregnancy
Smoking

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6
Q

How does endometrial cancer present?

A

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

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7
Q

How would you investigate a woman with ? endometrial cancer

A

Transvaginal ultrasound scan

Hysteroscopy and endometrial biopsy

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8
Q

What is the management of endometrial cancer?

A

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

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9
Q

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

A

Ovarian cancer

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10
Q

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

A

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

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11
Q

What are the 3 types of ovarian cancer?

A

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

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12
Q

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

A

Ca-125

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13
Q

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

A

Beta-hCG

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14
Q

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

A

Alpha feto-protein

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15
Q

What does CIN mean?

A

Cervical intraepithelial neoplasia

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16
Q

What is a typical presentation of ovarian cancer?

A

Abdominal pain and persistent abdominal distension (bloating)

17
Q

What does CIN I, II and III mean?

A

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

18
Q

Which infection is strongly associated with developing cervical cancer?

A

Human papilloma virus (HPV)

19
Q

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

A

HPV-16 and -18

20
Q

From where are cells taken during a cervical smear test?

A

Transformation zone

21
Q

Who gets a cervical smear? And how often?

A

3 yearly in women age 25 - 49

5 yearly in women age 50 - 64

22
Q

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

A

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.

23
Q

Which 2 staining agents are used in colposcopy?

A

Acetic acid

Iodine

24
Q

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

A

Abnormal cells stain white

25
Q

What colour do abnormal cells stain with iodine in colposcopy?

A

Pale / yellow

26
Q

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

A

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

27
Q

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

A

Large loop excision of the transformation zone (LLETZ)

28
Q

What is the peak age for developing cervical cancer?

A

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

29
Q

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

A

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

30
Q

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

A

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

31
Q

What is the presentation of a woman with cervical cancer?

A

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

32
Q

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

A

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

33
Q

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

A

Radical hysterectomy and pelvic node dissection

34
Q

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

A

Radiotherapy and concurrent chemotherapy

35
Q

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

A

HPV-16

36
Q

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

A

Lichen sclerosis

37
Q

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

A

Squamous cell carcinoma

38
Q

Which lymph nodes does ovarian cancer spread to?

A

Para-aortic nodes

39
Q

Which type of malignant ovarian tumour typically affects younger women?

A

Germ cell ovarian cancer

Gynaecology and Breast Disease (6 decks)

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