Gynaecological Oncology Flashcards
2 types of cervical cancer
Squamous cell carcinoma – about 70-80% of cases of cervical cancer.
Cervical adenocarcinoma – about 10% of cases of cervical cancer.
2 peaks for cervical cancer incidence age groups
30-39 and over 70s.
5 symptoms of cervical cancer (early)
Postcoital and/or postmenopausal bleeding
Intermenstrual bleeding
Watery vaginal discharge/ blood stained vaginal discharge
Pelvic pain
Dyspareunia
7 symptoms of cervical cancer (advanced)
Postcoital and/or postmenopausal bleeding
Intermenstrual bleeding
Watery vaginal discharge/ blood stained vaginal discharge
Pelvic pain
Dyspareunia
3 methods of examining cervix
colposcopy, bimanual examination, speculum examination
what can be seen on Colposcopy for cervical cancer
: shows an irregular cervical surface, abnormal vessels and a dense uptake of acetic acid.
signs of cervical cancer to look for on Bimanual examination:
cervix feels roughened and hard. If disease is advanced, there is loss of the fornices and the cervix is fixed.
signs of cervical cancer Speculum examination:
shows and irregular mass that will often bleed on contact. Cervix may appear inflamed or friable and bleed on contact (this is most commonly caused by chlamydia though). There may be a visible ulcerating or fungating lesion. There may be serosanguineous discharge.
An urgent referral to gynaecology (2ww pathway) should be arranged for post-menopausal women who:
Have not received HRT and have vaginal bleeding.
Have persistent or unexplained vaginal bleeding after cessation of HRT for 6 weeks.
Referral to gynaecology or GUM should be arranged for premenopausal women who have:
Persistent intermenstrual bleeding, post-coital bleeding or blood stained vaginal discharge, AND
Infection has been excluded or treated, but the bleeding has continued for 6-8 weeks post treatment, or a polyp, ectropion, cervicitis or warts are present.
Define stage I cervical cancer stages (Ia and Ib)
Stage I: tumours are confined to the cervix.
Ia: microscopic
Ib: macroscopic
Define stage II cervical cancer stages (a and b)
tumours have extended locally to the upper 2/3 of the vagina.
IIb: if have spread to parametria (fibrous and fatty connective tissue that surrounds the uterus).
Define stage III cervical cancer stages (a and b)
Stage IIIa: tumours have spread to lower third of the vagina.
IIIb: tumour spread to the pelvic wall.
Define stage IV cervical cancer stages (a and b)
Stage IV: tumour spread to bladder or rectum.
IVb: if there is spread to distant organs.
Treatment for stage Ia (1 and 2) cervical cancer
Stage Ia1 (<3mm depth): local excision (fertility sparing) or hysterectomy. Stage Ia2 (<5mm depth) and Ib1 (<4cm diameter): lymphadenectomy and if node negative, proceed to Wertheim’s hysterectomy.
Treatment stage Ib2 and early stage II cervical cancer
Stage Ib2 (>4cm diameter) and early IIa: chemoradiotherapy. If negative lymph nodes, consider Wertheim’s hysterectomy.
Treatment >stage IIb cervical cancer
> stage IIb: combination chemoradiotherapy.
Treatment stage IVb cervical cancer
Stage IVb: chemoradiotherapy. Palliative radiotherapy to control bleeding.
**Cisplatin is the main chemotherapy agent used.
The HPV jab covers against…
HPV 6, 11, 16 and 18 (the causes of 99.7% of cervical cancers)
Cervical screening aims to…
reduce the incidence of, and mortality from, cervical cancer through a systematic, quality assured population-based screening programme for eligible women
When is Liquid based cytology to detect abnormalities of the cervix done?
done if high-risk HPV detected in cervical cell sample from smear
5 risk factors for cervical cancer
Persistent high-risk HPV infection.
Exposure to HPV is increased by multiple partners.
Smoking
Immunocompromise (HIV, transplant patients, immunosuppressants)
COCP is associated with CIN but this is probably due to reduced use of barrier contraception, thereby increasing exposure to HPV.
6 abnormalities which can be detected from cell cytology
Borderline changes in the squamous or endocervical cells. Low-grade dyskaryosis. High-grade dyskaryosis (moderate) High-grade dyskaryosis (severe) Invasive squamous cell carcinoma. Glandular neoplasia
Individual tests positive for high-risk HPV and receive a negative cytology report next step
should have the HPV test repeated at 12 months.
If HPV testing is negative at 12 months, individuals can be safely returned to the routine recall system.
2 stains used in colposcopy and their effects
Acetic acid: makes abnormal areas (such as CIN) turn white – sometimes referred to as ‘acetowhite’.
Iodine solution: normal tissue on the outside of the cervix stains brown, pre-cancerous abnormalities may not stain with iodine.
The cells on the inner part of the cervix do not stain brown.
2 stains used in colposcopy and their effects
Acetic acid: makes abnormal areas (such as CIN) turn white – sometimes referred to as ‘acetowhite’.
Iodine solution: normal tissue on the outside of the cervix stains brown, pre-cancerous abnormalities may not stain with iodine.
The cells on the inner part of the cervix do not stain brown.
5 reasons for referral to colposcopy
previous abnormal cytology
unable to obtain cervical sample on smear
inadequate cervical sample (repeat smear)
dr concerned about appearance of cervix
dr referral due to symptoms
when is punch biopsy taken
to confirm histological diagnosis if any abnormalities are suspected after acetic acid and iodine tests
CIN abbreviation
cervical intraepithelial neoplasia
Significance of CIN grading
the higher the grade of CIN, the higher the risk of progression to carcinoma.
Most common type of ovarian cancer
Epithelial ovarian tumours:
Most common – 90% ovarian cancers.
6 subtypes of epithelial ovarian cancer
Serous Endometroid Clear cell tumours Mucinous tumours Brenner tumours: Undifferentiated: do not fit into any of the above categories.
Less common type of ovarian cancer
Germ cell tumours:
Derived from primitive germ cells of embryonic gonad.
5-10% of all ovarian tumours.
Ovarian cancer which is most common in younger women <35.
germ cell tumour
Ovarian cancer risk factors (11)
smoking, obesity, hx infertility, nulliparous, early menarche/late menopause, HRT, Family Hx, BRCA1 and 2 gene, medical Hx breast ovarian or bowel cancer, Hx endometriosis
4x protective factors ovarian cancer
Childbearing
Breastfeeding
Early menopause
COCP
Symptoms ovarian cancer (9ish)
Very non-specific, can be: Abdominal pain Abnormal vaginal/ uterine bleeding Loss of appetite Abdominal distension Change in bowel habits Urinary frequency Dyspepsia Pelvic or abdominal mass that may be associated with pain Constitutional symptoms – fatigue, weight loss, anorexia, depression. Ascites.
Blood test for ovarian cancer
CA125
Next step in ovarian cancer investigations following positive CA125 (>35)
USS, particularly trans-vaginal USS
definitive diagnosis for ovarian cancer
biopsy which is performed in secondary care.
which type of endometrial/uterine cancer is not linked to oestrogen, grows faster and more likely to spread
type 2
