Gynaecological oncology Flashcards
Which types of HPV are responsible for cervical cancer?
Types 16 and 18
What types of HPV cause genital warts?
Types 6 and 11
What types of HPV does the current Gardasil vaccine protect against?
Types 6, 11, 16 and 18
Describe how the cervical screening programme is triaged?
- Intial screening for HPV
- If HPV+ve, cytology
- If abnormal cells: send for colposcopy
- If cells normal but HPV+ve, then repeat smear in 12/12
What ages are included in the cervical screening programme and how often should they have a smear?
25-49: every 3 years
50-64: every 5 years
If cytology returns an ‘inadequate’ result, how should the screening proceed?
Repeat in 3 months
What is the appropriate course of action:
Initially: HPV+ve, cytology normal
12/12 later: HPV-ve
Return to normal screening i.e. retest in 3yrs
What is the appropriate course of action:
Initially: HPV+ve, cytology normal
12/12 later: HPV+ve, cytology normal
Repeat in 12/12
What is the appropriate course of action:
Initially: HPV+ve, cytology normal
12/12 later: HPV+ve, cytology normal
12/12 later: HPV+ve, vytology normal
After 24 months with remaining HPV positive, refer to colposcopy
What is the appropriate course of action:
Initially: HPV+ve, cytology normal
12/12 later: HPV+ve, cytology normal
12/12 later: HPV-ve
Return to routine screening (e.g. next smear in 3 years)
How is CIN1 managed?
Nil required. Will likely spontaneously resolve.
Repeat screening in 12/12
How is CIN2 managed?
LLETZ
How is CIN3 managed?
LLETZ
How is CGIN managed?
LLETZ
How is cervical cancer staged?
FIGO staging
How might cervical cancer present?
Most are picked up on screening. Symptoms may include: PCB IMB Persistent and offensive discharge PMB
How is FIGO 1a1 cervical cancer managed?
Loop excision
How is FIGO stage 1a2-1b2 managed?
Hysterectomy + BSO + pelvic node clearance
What is the treatment for a woman with cervical cancer who wishes to preserve her fertility?
Cone biopsy OR radical trachelectomy
What type of endometrial hyperplasia is a precursor to endometrial cancer?
Complex atypical endometrial hyperplasia
How is endometrial hyperplasia treated?
Hysterectomy as it is likely that a cancer is already present.
How is endometrial hyperplasia managed if a hysterectomy is refused?
Progesterone given to thin the endometrium and endometrial biopsies to follow up.
Who gets endometrial cancer (generally)?
Post-menopausal women aged 50y/o+
What risk factor is most likely to blame for rising incidences of endometrial cancer?
Obesity
What are the types of endometrial cancer?
Oestrogen dependent - usually endometrioid adenocarcinomas
Non-oestrogen dependent - serous papillary carcinoma, clear cell carcinoma
What is the most important risk factor for endometrial cancer?
Tamoxifen use
How might endometrial cancer present?
PMB: typically heavy vaginal bleeding 1 year after the menopause
How is endometrial cancer investigated?
Transvaginal ultrasound - 4.5mm+ requires a pipelle endometrial biopsy or hysteroscopy wiht biopsy
How is endometrial cancer treated?
Hysterectomy + BSO +/- pelvic node clearance +/- omentectomy
What is the most common type of pvarian cancer?
Serous carcinoma
What is the most important risk factor for ovarian cancer?
BRCA1 gene
How might ovarian cancer present?
Weight loss
Abdominal pain
Bloating
Vague symptoms
What findings might be present on examination in ovarian cancer?
Pelvic mass
Omental cake
Ascites
What tumour markers shoudl be measured when concerned about ovarian cancers?
CA125
CEA
CA153
CA199
What additional tumour markers should be taken in a woman under 40 with symptoms of ovarian cancer and why?
AFP
hCG
LDH
To exclude a germ cell tumour
What tool is used to stratify risk in ovarian cancer and how is it used?
Risk of Malignancy Index (RMI)
Menopausal status x USS findings x CA125 level
How is ovarian cancer managed?
TAH + BSO + omentectomy + pelvic node clearance
How is ovarian cancer managed in a woman who wishes to get pregnant?
Only if early stage: remove affected ovary and Fallopian tube (+/- node clearance on affected side)
What is the most common vulval cancer?
Squamous cell carcinoma
What are the two most important risk factors for vulval cancer?
Lichen sclerosus
HPV
How might vulval cancer present?
Persistent itching Ulceration on the vulva Lump or lesion Thickened red or white skin patch Change in mole
How is vulval cancer treated?
Wide local excision +/- pelvic node clearanec +/- chemotherapy
