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Reproduction > Gynaecological Malignancy > Flashcards

Gynaecological Malignancy Flashcards

1
Q

How common is ovarian cancer?

A

Fairly uncommon, decreasing perhaps due to protective effect of the COCP

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2
Q

Where do ovarian tumours orginate from?

A

Most cases originate from the fallopian tube

Some derive from pre-existing benign ovarian cysts

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3
Q

What is the most common type of ovarian cancer?

A

Serous cystadenocarcinoma

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4
Q

What is the prognosis of ovarian cancer?

A

Poor as most people present with late stage disease

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5
Q

Give risk factors for ovarian cancer

A

>Age

Genetics

  • HNPCC
  • BRCA 1 and 2

Incessant ovulation

  • Pregnancy and breast feeding is protective as ovaries are dormant during this time
  • Early menarche and late menopause

Oral contraceptive pill reduces risk

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6
Q

What mode of inheritence is BRCA 1/2?

A

Autosomal dominant

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7
Q

How does ovarian cancer present?

A

Vague GI Symptoms

  • Indigestion
  • Early satiety
  • Poor appetite
  • Bloating
  • Altered bowel habit

Pelvic mass, with pressure symptoms, late presentation

Ascites

Pain if ovarian torsion

Palpable lymph nodes

Usually systemically well

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8
Q

What investigations are used in ovarian cancer diagnosis?

A

Pelvic US picks up mass

Surgical laparotomy stages disease and obtain tissue diagnosis

CA 125

Staging imaging

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9
Q

What histological sign is associated with ovarin serous cystadenocarcinoma?

A

Psammoma bodies

Other associated cancers with this are papillary thyroid cancer, meningoma and mesothelioma

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10
Q

What is CA 125?

A

Glyco-protein antigen/marker in blood elevated due to peritoneum disease, so not a specific marker

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11
Q

What is a normal value of CA 125?

A

1-35

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12
Q

What CA 125 value is suggestive of malignancy?

A

>200 is considered significant risk

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13
Q

What is the screening programme for ovarian cancer?

A

Screening is not effective as there is not a sufficient pre-malignant stage to offer treatment for

However, prophylactic oophorectomy is offered to high risk women (cancer gene mutation carriers, 2 or more relatives)

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14
Q

Give differential diagnoses of ovarian cancer

A

Irritable Bowel Syndrome (IBS)

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15
Q

What is FIGO stage 1 ovarian cancer?

A

Limited to ovaries with capsule intact

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16
Q

What is FIGO stage 2 ovarian cancer?

A

One or both ovaries with pelvic extension

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17
Q

What is FIGO stage 3 ovarian cancer?

A

One or both ovaries with peritoneal implants outside the pelvis or + node

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18
Q

What is FIGO stage 4 ovarian cancer?

A

Distant metastasis

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19
Q

How is ovarian cancer managed?

A

Chemotherapy, unlikely to cure

Laparotomy for isease clearance or debulk disease

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20
Q

What is the first line chemotherapy for ovarian cancer?

A

Platinum and taxane (Taxol)

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21
Q

What is the recurrent management of ovarian cancer?

A

Chemotherapy

  • re-challenge disease with platinum

Palliative care

Tamoxifen

  • Anti-oestrogen, hormonal treatment, for those not suitable for other treatments
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22
Q

What is the risk of malignancy index?

A

RMI (risk of malignancy index) = Ultrasound (U) + menopausal status (M) + CA 125

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23
Q

What strains of HPV are low risk?

A

6, 11, 42, 44

Genital warts and low grade cervical intraepithelial neoplasia

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24
Q

What strains of HPV are high risk?

A

16, 18, 31, 45

Persistent infection increases risk of developing high grade cervical intraepithelial neoplasia and cancer

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25
Q

What strain of HPV has the highest risk?

A

HPV 16

(Group 1 carcinogenic and in its own category)

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26
Q

What type of epithelium is in the endocervix?

A

Columnar epithelium

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27
Q

What type of epithelium is in the ectocervix?

A

Squamous epithelium

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28
Q

What is the transformation zone?

A

During puberty, cervix becomes bigger and cells in squamous-columnar junction change/grow, so the area between the original squamous-epithelial junction and new one is the transformation zone

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29
Q

What is cervical intraepithelial neoplasia (CIN)?

A

Disorganised proliferation of abnormal cells in squamous epithelium (dysplasia), precursor of invasive cancer

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30
Q

What are the two classifications of cervical cancer?

A

Squamous carcinoma

Adenocarcinoma

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31
Q

Which type of cervical cancer is most common?

A

Squamous carcinoma

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32
Q

Descibe stage 1A1 cervical cancer

A

Invasive cancer identified only microscopically

Depth <3mm, width <7mm

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33
Q

Describe stage 1A2 cervical cancer

A

Invasive cancer identified only microscopically

1A2: Depth <5mm, width <7mm

34
Q

Describe stage 1B cervical cancer

A

Clinically visible tumours confined to the cervix, or greater size than 1A

35
Q

Describe stage 3 cervical cancer

A

Spread to lower vagina and pelvis

36
Q

Describe stage 4 cervical cancer

A

Spread to rectum and bladder

37
Q

What is the overall prognosis of cervical cancer?

A

Good cure rate If detected early

Major cause of death in women in developing countries

38
Q

Give risk factors for cervical cancer

A

Age

  • Peak is 45-55 years
  • Those who did not benefit from cervical screening and immunisation

HPV related

Multiple partners

Early age at first intercourse

  • Transformation zone is more susceptible to infection at a younger age

Older age of partner

Smoking

HIV

  • HIV positive women who have low-grade lesions (CIN1) do not clear these lesions and these can progress to high-grade CIN or cervical cancer
39
Q

What is the strongest risk factor for cervical cancer?

A

Smoking

40
Q

How does cervical cancer present?

A

Abnormal vaginal bleeding

  • PCB
  • IMB
  • PMB

Discharge

Pain

  • Unusual, suggests very advanced cancer extended outwith the pelvis
41
Q

Describe the cervical cancer screening programme

A

Women aged 25-50 have smears every 3 years, then 50-64 have smears every 5 years

Brush cervix to obtain cells and microscopically assess the vial using reflex cervical cytology to look for abnormal cells/dyskaryosis/CIN

If dyskaryosis, test vial for HPV

If negative, repeat in 1 year

If dyskaryosis, refer for urgent colposcopy

If 3 inadequate samples in a row, refer for colposcopy

42
Q

What investigation is used in cervical cancer diagnosis

A

Colposcopy and Biopsy

  • Refer if HPV positive and cytology abnormality
  • Use of acetic acid or iodine to identify lesion
  • Treat on visit if obvious high grade changes
  • Urgent is within 2 weeks
43
Q

How is cervical cancer managed?

A

Large loop Excision of the Transformational Zone

  • Stage 1a and CIN

Chemo-radiotherapy

  • Stage 1b>

Radical hysterectomy

  • Stage 1b-2a

Thermal coagulation and laser ablation

  • CIN
44
Q

Can pregnant women recieve cervical smear tests?

A

Reschedule for 12 weeks post delivery, unless missed screening or previous abnormal smears

45
Q

How does the cervical screening programme differ for HIV+ women?

A

Should be offered cervical cytology at diagnosis and cervical cytology should then be offered annually for screening

46
Q

What are the two types of endometrial cancer?

A

Adenocarcinoma

Uterine serous and clear cell carcinoma

47
Q

Which type of endometrial cancer is most common?

A

Adenocarcinoma

48
Q

Which type of endometrial cancer has worst prognosis?

A

Serous and clear cell is high grade and more aggressive

49
Q

What age group does each type of endoemtrial cancer affect?

A

Adenocarcinoma is typically younger patients

Serous clear cell is older patients

50
Q

Describe stage 1A endometrial cancer

A

Inner half of myometrium

51
Q

Describe stage 1B endometrial cancer

A

Outer half of myometrium

52
Q

Describe stage 2 endometrial cancer

A

Invades cervix

53
Q

Describe stage 3A endometrial cancer

A

Invades serosa/adnexa

54
Q

Describe stage 3B endometrial cancer

A

Invades vagina/parametrium

55
Q

Describe stage 3C endometrial cancer

A

Invades pelvic or para-aortic nodes

56
Q

Describe stage 4 endometrial cancer

A

Invades bladder, bowel, intra-abdominal, inguinal nodes

57
Q

At what stage does endometrial cancer mostly present?

A

Stage 1

58
Q

Give risk factors for endometrial cancer?

A

Post-menopausal women

Obesity, peripheral fat produces oestrogen

Unopposed E2 therapy/tamoxifen

PCOS

Early menarche/late menopause, longer time exposed to oestrogen

HRT

Oestrogen secreting tumours

Atypical endometrial hyperplasia

HNPCC/Lynch type 2 familial cancer syndrome

DM

59
Q

Give protective factors for endometrial cancer?

A

Parity

COCP

Smoking

60
Q

How does endometrial cancer present?

A

PMB

Usually no pain, urinary or bowel symptoms

61
Q

Give differential diagnoses of PMB

A

Hormone replacement therapy

Peri-menopausal bleeding

Atrophic vaginitis

Polyps (cervical/endometrial)

Other cancers such as cervix, vulva, bladder, anal

62
Q

What investigations are used in endometrial cancer diagnosis

A

Trans-vaginal US, to look at endometrial thickness and contour

Endometrial Biopsy

Hysteroscopy to look at endometrial cavity via camera

MRI to assess lymph node involvement

63
Q

At what endometrial thickness is patient referred for a biopsy?

A

>4cm (or irregular)

64
Q

How is endometrial cancer managed?

A

Total abdominal hysterectomy and bilateral salpingo-oophorectomy

  • Removal of uterus, tubes, ovaries and peritoneal washings due to residual malignant activity, early stage

Additional chemotherapy

  • High risk histology, for any residual malignant activity

Additional radiotherapy

  • Advanced stage

Progesterone

  • Palliative
65
Q

What is the management of endometrial hyperplasia?

A

Total hysterectomy with bilateral salpingo-oophorectomy, in addition, is advisable for all postmenopausal women with atypical endometrial hyperplasia, due to the risk of malignant progression

66
Q

What is vulval intraepithelial neoplasia?

A

Abnormal proliferation of squamous epithelium, can progress to carcinoma

67
Q

Give risk factors for VIN

A

Smoking

Other genital intra-epithelial neoplasia

Immunosuppression

Previous related malignancy

HPV infection

68
Q

How does VIN present?

A

Raised papular or plaques lesions

Erosions, nodules, warty

Keratotic roughened appearance

Sharp border

Discoloration

69
Q

How is VIN managed?

A

Topical

  • Multiple lesions, as have to preserve tissue so can not use excision

CO2 laser

  • Suitable for mucosal skin
70
Q

What are the types of vulval cancer?

A

Mostly squamous cell carcinoma

Basal cell carcinoma

Melanoma

Bartholin’s gland

71
Q

What is the most common type of vulval cancer?

A

Squamous cell carcinoma

72
Q

How is vulval cancer managed?

A

Radiotherapy

Chemotherapy

Radical local excision and skin flap repair

73
Q

What investigations are used in VIN/Vulval cancer diagnosis?

A

Punch biopsy or excisional biopsy

Groin node dissection

  • Associated with wound infection, Lymphocysts and nerve damage
74
Q

How does vulval cancer present?

A

Pain

Itch

Bleeding

Lump/ulcer

75
Q

Describe stage 1 vulval cancer

A

<2cm

76
Q

Describe stage 2 vulval cancer

A

>2cm

77
Q

Describe stage 3 vulval cancer

A

Local spread

Unilateral nodes

78
Q

Describe stage 4 vulval cancer

A

Distant or advanced local spread

Pelvic nodes

79
Q

Describe the properties of HPV related vulval cancer/VIN

A

Usual type VIN

Younger women

Multifocal and multizonal

Past history of intra-epithelial neoplasia

Associated with Immunosuppression

Can be low or high grade

80
Q

Describe the properties of non HPV related vulval cancer/VIN

A

Differentiated VIN

Older women

Lichen Sclerosus

Presents as cancer at first diagnosis

High grade

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