Gynaecological malignancy Flashcards
Endometrial cancer - more common in pre or post menopausal women?
Post menopausal - 90%
What is the cause/are the risk factors for endometrial cancer?
Unopposed oestrogen (no progesterone)
-Obesity
- late menopause
- HRT
- Hereditary nonpolyposis colorectal cancer (HNPCC)
HNPCC is an autosomal dominant inherited condition which increased the likelihood of cancers
having kids and COCP protective
What is the symptom that makes you worry about endometrial cancer?
Post-menopausal bleeding
-> urgent referral
what investigations do you do for endometrial cancer?
TVS
endometrial biopsy (its an adenocarcinoma usually)
hysteroscopy
Treatment for endometrial cancer?
Hysterectomy +/- pelvic lymph node removal
radiotherapy
if surgery is not possible - progesterone therapy
Cervical cancer - what age women does it affect?
young - 25-34 years old
the most common cancer in under 35s
risk factors for cervical cancer
HPV 16,18 main factor
early sex multiple partners STDs OCP smoking missed vaccination
presentation of cervical cancer
post coital bleeding
intermenstrual bleeding
smelly, watery discharge
vagainal discomfort
late signs - ureteric obstruction, renal failure, pain from nerve invasion
cervical cancer screening. how often?
=smear test
every 3 years from 25-49
every 5 years from 50-65
in sexually active women
Annually if HIV+
what does cervical screening try to detect?
pre invasive state
cervical intra-epithelial neoplasia (CIN)
dyskaryosis - abnormalities found on smear which suggest CIN
if a smear gives an abnormal result what do you do
if moderate dyskaryosis or more - colposcopy
(if invasion suspected - urgent)
if mild or borderline - high risk HPV test - colposcopy if this is positive
if inflammatory change - repeat in 6/12 +swabs (colposcopy if 3 of these)
cervical cancer - treatment
radical hysterectomy
local excision - cervicectomy to maintain fertility
when would you do a LLETZ - large loop excision of the transformation zone
CIN 2 or more
CIN 1 - 60% regress themselves - LLETZ if persistent, HPV + - colposcopy every 6months
vulval cancer - age at risk and risk factors
30-50years old
high risk HPV
lichen sclerosis
vulval cancer presentation
vulval itching/soreness
persistent lump
bleeding
pain on passing urine
LOOKS LIKE A UTI
