Gynaecological oncology Flashcards
What are the two types of cervical cancer and what is their prognosis
- Squamous cell carcinoma - most common lower mortality
- Adenocarcinoma - rarer higher mortality
Cervical cancer: epidemiology
Epidemiology
- Commonest cancer in young women
- Disease of low resource country w/out screening
Two cell types on endo and ecto cervix
On the vagina side - ectocervix - squamous
On the utrerus side - endocervix - columnar (mucous prodcing ergo cancer her is known as adenocarcinoma)
Cervical cancer: aetiology
Aetiology
Oncogenic HPV w/ smoking as co-factor –> premalignant disease–>ca over years
Cervical cancer: risk factors
Risk factors
Smoking
Having children
Immunosuppression
HPV
Herpes/STIs
OCD/IUD
Exposure to DES (abortion drug)
Young age
Cervical cancer: sx
Sx
Irregular periods (IMB)
Post coital bleeding
Smelly vaginal discharge from the surface of the tumour
Late stage – malignant pain and fistula
Cervical cancer: clinical assessment
Clinical assessment
Mass felt of seen on cervix
Screening detecting (subclinical)
Cervical cancer diagnosis
Diagnosis
Colposcopy and biopsy of lesion
MRI to assess for invasion
Cervical cancer: prognosis.
Prognosis
Good if picked up early
Poor if locally advanced
Good life quality if in remission, but late effects of radiotherapy might be an issue
Cervical cancer:management
Management
Loop diathermy (microscopic disease)
Hysterectomy w/ node removal (macroscopic disease)
May also have chemo radiotherapy
Cervical screening: frequency
- Cervical screening offered to all women aged 25-49 every 3 years and 50-64 every 5 years
- Screening involves a smear from the surface of the cervix via a speculum
- If the cells are found to be abnormal the follow up is colposcopy
Endometrial cancer: epidemiology
Epidemiology
- Commonest gynae cancer
- Disease of affluent west
Endometrial cancer: aetiology
Aetiology
Disease of the menopause
Type one (low grade) – related to obesity and PCOS (polycystic ovary syndrome)
Type two (high grade) – genetic mutations?
Endometrial cancer: sx
Sx
Post menopausal bleeding/discharge (1 year after last period)
Endometrial cancer: clinial assessment
Clinical assessment
Often nothing to find as at early stage
Endometrial cancer: diagnosis
Diagnosis
USS
Endometrial biopsy
MRI for invasion
Endometrial cancer: management
Management
Surgery: removak of uterus, ovaries, LNs
Post op radiotherapy if bad
Endometrial cancer: prognosis.
Prognosis
Good if early stage type 1
Vuval cancer: epidemiology
Epidemiology
- Rare 1800 cases a year
Vuval cancer: aetiology
Aetiology
Premalignant vulval disease, intraepithelial neoplasm
Lichen sclerosis (autoimmune)
Vuval cancer: sx
Sx
Vulval pain
Bleeding
Feeling of a lump
Vuval cancer: clinical assessment
Clinical assessment
Vulval mass
Groin node enlargement at advanced stage
Vuval cancer: diagnosis
Diagnosis
Biopsy
USS
Vuval cancer: management
Management
Surgical removal
If LNs involved radoitherapy and chemo
Vuval cancer: prognosis.
Prognosis
Stage 1 no LN 90% 5yr
Stage 3 w/ LN 50% 5yr
Ovarian cancer: epidemiology
Epidemiology
- Second commonest gynae cancer
Ovarian cancer: aetiology
Aetiology
Disease of menopause
Type 1 (low grade)
Type 2 (high grade) ?genetic mutation BRACA1
Ovarian cancer: sx
Sx
Persistent Bloating
Abdominal pain
Eating trouble (feeling full after a meal)
Trouble with the bladder (Urinary frequency)
Ovarian cancer:clinical assessment
Clinical assessment
Clinically challenging
Abdopelvic mass
Ascites
Ovarian cancer: diagnosis
Diagnosis
USS
Bloods for tumour marker
CT to assess spead
Ovarian cancer: management
Management
Surgery - remove uterus, ovaries, LNs and debulk
Chemo
Ovarian cancer: prognosis
Prognosis
Good if early type 1
Most present at late stage and die from reoccurence in 5 yrs
