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Obs & Gynae (Gynae) > Gynaecological Malignancies > Flashcards

Gynaecological Malignancies Flashcards

1
Q

What is the most common presentation of endometrial cancer?

A

Post-menopausal bleeding

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2
Q

If endometrial cancer occurs in pre-menopausal women, how would it present?

A

Inter-menstrual bleeding

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3
Q

At what age range is the peak incidence of endometrial cancer?

A

50-60 years

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4
Q

If endometrial cancer is diagnosed in a woman aged < 40, what should be considered?

A

Lynch syndrome

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5
Q

80% of endometrial cancers are what histological type?

A

Adenocarcinomas

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6
Q

What is the precursor lesion to endometrial adenocarcinomas?

A

Atypical endometrial hyperplasia

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7
Q

What is the main risk factor for the development of endometrial adenocarcinomas?

A

Exposure to unopposed oestrogen

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8
Q

In type 2 (non-endometrioid) endometrial cancers, what protein is almost always mutated?

A

Tp53

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9
Q

What is the biggest risk factor contributing to unopposed oestrogen exposure in women with endometrial cancer?

A

Obesity

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10
Q

How is Lynch syndrome (HNPCC) inherited?

A

Autosomal dominant

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11
Q

What screening do women with Lynch syndrome (HNPCC) undergo?

A

Colonoscopy from age 25, TVUS and CA125 levels from age 35

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12
Q

What endocrine condition is a risk factor for endometrial cancer?

A

PCOS

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13
Q

What are some medications that are risk factors for endometrial cancer?

A

Tamoxifen and oestrogen-only HRT

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14
Q

What are some examples of protective factors for endometrial cancer?

A

Hysterectomy, COCP, Mirena-IUS, pregnancy

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15
Q

Who should receive an urgent referral using the suspected cancer pathway for endometrial cancer?

A

Women aged 55+ with post-menopausal bleeding

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16
Q

What is the first line investigation for endometrial cancer? What is this used to establish?

A

TVUS- used to establish the endometrial thickness

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17
Q

What is a normal endometrial thickness in post-menopausal women?

A

< 4mm

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18
Q

Other than TVUS, what investigations are indicated for women with post-menopausal bleeding and suspected endometrial cancer?

A

Hysteroscopy and endometrial biopsy

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19
Q

How is endometrial cancer managed in the first instance?

A

Total abdominal hysterectomy, with bilateral salpingo-oophorectomy

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20
Q

What adjuvant treatment options can be used for endometrial cancer?

A

Radiotherapy +/- chemotherapy

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21
Q

What treatment can be utilised for women with endometrial cancer who are not suitable candidates for surgery, or who wish to preserve their fertility?

A

Progesterone supplements (POP or Mirena-IUS)

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22
Q

Who is cervical cancer most likely to present in?

A

Pre-menopausal women (most common aged 25-29)

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23
Q

How does cervical cancer present?

A

Post-coital, inter-menstrual or persistent vaginal bleeding

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24
Q

What are some clinical features of advanced cervical cancer?

A

Weight loss, back/pelvic pain, urinary/faecal leakage

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25
Q

What are the two most common types of cervical cancer, and how common is each?

A

Squamous cell carcinoma (80%) and adenocarcinoma (20%)

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26
Q

What is the precursor lesion to squamous cell cervical cancer?

A

Cervical intra-epithelial neoplasia

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27
Q

What is the precursor lesion to adenocarcinoma of the cervix?

A

Cervical glandular intra-epithelial neoplasia

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28
Q

Which histological type of cervical cancer is more associated with low socioeconomic status and early onset of sexual activity?

A

Squamous cell carcinoma

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29
Q

What is the most common cause of cervical cancer (be specific)?

A

HPV infection, mainly types 16 and 18

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30
Q

What are some risk factors for persistent genital HPV infection which doesn’t clear up on its own?

A

Smoking and immunosuppression

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31
Q

Which women get screened for cervical cancer, and how often do they get screened?

A

Women aged 25-49 get screened every 3 years, women aged 50-64 get screened every 5 years

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32
Q

Who is the HPV vaccine offered to?

A

Boys and girls aged 12-13 and MSM

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33
Q

What is the first line investigation for suspected cervical cancer?

A

Colposcopy and punch biopsy

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34
Q

For a final diagnosis of cervical cancer to be made, one of which two types of biopsy must be done?

A

LLETZ or cone biopsy

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35
Q

What imaging investigation is used to determine the size and assess the spread of a cervical cancer?

A

Pelvic MRI

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36
Q

What is the gold standard management for early stage (localised to the cervix) cervical cancer?

A

Hysterectomy +/- lymph node clearance

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37
Q

What surgical management is available for women with early stage cervical cancer who want to maintain their fertility?

A

Cone biopsy

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38
Q

What adjuvant treatment is recommended in addition to surgery, in women with cervical cancer who have positive surgical margins or where lymph nodes are positive for metastatic disease?

A

Chemotherapy

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39
Q

What is the gold standard management for late stage (outwith the cervix) cervical cancer?

A

Radical chemoradiotherapy

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40
Q

What chemotherapy agent is commonly used in the management of cervical cancer?

A

Cisplatin

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41
Q

What are two fertility sparing treatment options for cervical cancer?

A

Cone biopsy and LLETZ

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42
Q

What happens with regard to cervical screening in pregnancy, assuming the woman is up to date with her smears?

A

Withhold until 3 months post-partum

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43
Q

How long does it take for results of cervical screening to come back?

A

2 weeks

44
Q

What action is required for a cervical screening result that states ‘borderline or mild dyskaryosis’?

A

High risk HPV test

45
Q

What action is required if a woman has undergone high-risk HPV testing and it comes back negative?

A

Back to routine screening

46
Q

What action is required if a woman has undergone high-risk HPV testing and it comes back positive?

A

Colposcopy within 6 weeks

47
Q

What action is required for a cervical screening result that states ‘moderate or severe dyskaryosis’ or ‘invasive cancer or glandular neoplasia suspected’?

A

Refer for colposcopy within 2 weeks

48
Q

What action is required for a cervical screening result that states ‘inadequate’?

A

Repeat test in 3 months

49
Q

How many inadequate cervical smears warrant a colposcopy?

A

Three

50
Q

How is CIN 1 normally treated?

A

It usually resolves spontaneously, a repeat colposcopy should be done at 12 months to ensure resolution

51
Q

If CIN 1 has not resolved after a year, what treatment is required?

A

LLETZ or cold coagulation

52
Q

How is CIN 2 normally treated?

A

LLETZ

53
Q

What are some treatment options for CIN 3?

A

LLETZ, cone biopsy or hysterectomy

54
Q

After a LLETZ procedure, women are advised to avoid sex, the use of tampons and swimming for how long?

A

4 weeks

55
Q

What is the main obstetric complication associated with LLETZ and cone biopsies?

A

Preterm delivery

56
Q

What test of cure is required after undergoing treatment for CIN?

A

Cervical cytology and high-risk HPV testing at 6 months

57
Q

If a woman has undergone follow-up after treatment of CIN, and high-risk HPV testing comes back negative, what is done next with regards to future screening?

A

Return to routine screening

58
Q

If a woman has undergone follow-up after treatment of CIN, and high-risk HPV testing comes back positive or if moderate/severe dyskaryosis is detected, what is done next?

A

Colposcopy

59
Q

Vulval carcinoma is usually seen in who?

A

Older women

60
Q

Vulval carcinoma is now sometimes seen in younger women (30s/40s) as a result of what?

A

High-risk HPV infection

61
Q

How does vulval carcinoma tend to present?

A

Vulval lump or ulcer (may be associated with pain, discharge, itch)

62
Q

What is the most common histological type of vulval cancer?

A

Squamous cell carcinoma

63
Q

What are some factors contributing to carcinogenesis of vulval cancer?

A

Intra-epithelial neoplasia, lichen sclerosus and chronic inflammation

64
Q

What is the gold standard investigation for vulval cancer?

A

Vulval biopsy

65
Q

What imaging investigations are required for advanced cases of vulval cancer?

A

Pelvic CT/MRI

66
Q

Where are vulval carcinomas most likely to spread to?

A

Inguinal lymph nodes

67
Q

How is vulval cancer normally managed?

A

Radical vulvectomy + bilateral inguinal lymphadenectomy

68
Q

What adjuvant treatment may be required for vulval cancer?

A

Radiotherapy

69
Q

80% of vaginal cancers are metastatic spread from where?

A

The endometrium or cervix

70
Q

When is the peak incidence of vaginal cancer?

A

60-70 years

71
Q

How is a vaginal cancer most likely to present?

A

Vaginal bleeding or discharge

72
Q

What is the most common histological type of vaginal cancer?

A

Squamous cell carcinoma

73
Q

What is responsible for 60% of vaginal cancers?

A

HPV (especially type 16)

74
Q

What iatrogenic treatment may contribute to the development of vaginal cancer?

A

Radiotherapy

75
Q

What is the gold standard investigation for vaginal cancer?

A

Examination under anaesthesia and biopsy

76
Q

How are most cases of vaginal cancer treated?

A

Radiotherapy

77
Q

Where do leiomyosarcomas arise from?

A

The myometrium

78
Q

What are the three red flag symptoms for ovarian cancer, especially if they are persistent or frequent?

A

Bloating, abdominal pain, fluctuating bowel habit

79
Q

At what age is the median diagnosis of ovarian cancer?

A

60 years

80
Q

What are two things that may be noted on examination of a woman with ovarian cancer?

A

Pelvic mass and free fluid (ascites)

81
Q

> 90% of ovarian cancers are what broad type?

A

Epithelial cancers

82
Q

What is the most common type of epithelial ovarian cancer?

A

Serous carcinoma

83
Q

Which type of ovarian cancer is associated with BRCA mutations?

A

Serous carcinoma

84
Q

After serous, what is the next most common type of epithelial ovarian cancer?

A

Mucinous carcinoma

85
Q

Having endometriosis increases the risk of developing which ovarian epithelial cancers?

A

Endometrioid and clear cell

86
Q

What is the name for a rare, placental, trophoblastic tumour that can develop in the ovary, and is associated with a raised HCG?

A

Choriocarcinoma

87
Q

What is the most common malignant germ cell tumour of the ovary, which is seen almost exclusively in children and young women, and is associated with a raised HCG and AFP?

A

Dysgerminoma

88
Q

What type of ovarian cancer is a slow growing tumour that produces oestrogen, is associated with raised inhibin levels, and presents with irregular/heavy bleeding or precocious puberty in young females?

A

Granulosa cell tumour

89
Q

Which type of ovarian cancer produces androgens +/- testosterone, and leads to progressive masculinisation?

A

Sertoli cell tumour

90
Q

What diagnosis should always be considered in cases of small, bilateral ovarian cancers?

A

Metastases from another primary

91
Q

What are the most common mutations causing genetic ovarian cancer?

A

BRCA1 and BRCA2

92
Q

How are the BRCA genes inherited?

A

Autosomal dominant

93
Q

What prophylactic management for ovarian cancer is offered to women aged > 35 with a BRCA mutation?

A

Bilateral salpingo-oophorectomy

94
Q

What is the tumour marker for ovarian cancer?

A

CA125

95
Q

What can be a useful test to rule out a GI primary in someone with suspected ovarian cancer?

A

CEA

96
Q

What is the first line imaging investigation for ovarian cancer?

A

Trans-vaginal ultrasound

97
Q

If an ovarian cancer is suspected following TVUS, what is the next line imaging investigation?

A

CT or MRI chest/abdo/pelvis

98
Q

What is the gold standard method of obtaining a sample of ovarian cancer for pathology?

A

Laparoscopy

99
Q

Patients with an RMI score of more than what should be referred to gynae-oncology?

A

200

100
Q

Which lymph nodes do ovarian cancers spread to?

A

Para-aortic (lumbar)

101
Q

How is ovarian cancer which is confined to the ovary managed?

A

Surgery only

102
Q

How is ovarian cancer which is not confined to the ovary managed?

A

Surgery + chemotherapy (adjuvant or neo-adjuvant)

103
Q

What is the most commonly used chemotherapy agent for ovarian cancer?

A

Platinum based agents e.g. carboplatin

104
Q

What are Krukenberg tumours? What histological feature do they show?

A

Gastric adenocarcinomas which metastasise to the ovary, they show signet-ring cells

105
Q

How often should HIV positive women receive cervical cytology testing?

A

Annually

Obs & Gynae (Gynae) (5 decks)

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