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Specialties Mx 2021 > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

How is threatened miscarriage managed?

A

discharge home and advise to seek help if bleeding persists after 14 days or worsens

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2
Q

What is the expectant management of a confirmed miscarriage?

A

If stable and showing no signs of complications

advise them to prep for bleeding for 7-14 days,
take pregnancy test on day 21

return if sign of infection, persistent bleeding/bleeding has not commenced

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3
Q

When is expectant miscarriage management not advised?

A

increase risk of haemorrhage e.g. late first trimester
previous trauma / adverse response to pregnancy
infection

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4
Q

What is the medical management of miscarriage?

A

Vaginal / oral misoprostol

advise if bleeding hasn’t started within 24h to return
offer analgesia and anti-emetic

NEVER GIVE MIFEPRISTONE TO MISSED / INCOMPLETE

advise side effects include diarrhoea

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5
Q

What is the surgical management of miscarriage?

A

Manual vacuum aspiration or dilation curettage
vaginal / sublingual misoprostol may be given for cervical ripening

anti-D prophylaxis for all women undergoing surgical Mx

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6
Q

PACES: Miscarriage

A

-explain RF: advanced age, infection, chromosomal, maternal condition, uterine structural abnormalities

  • Breaking news: ask if she wants anyone with her
  • common, 1/4 pregnancies
  • nothing they have done / caused
  • often no cause
  • explain management options ad pregnancy test in 21 days
  • SAFETY: if fever / infection/ persistent bleeding come in
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7
Q

What are the conditions for expectant Mx of ectopic?

A

no significant pain
adnexal mass < 30mm
no intrauterine pregnancy confirmed with USS
bHCG < 200 (1000 on nice)

can be used if another intrauterine pregnancy is there

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8
Q

What is the medical management of ectopic?

A

IM methotrexate

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9
Q

What are the conditions for medical management of ectopic?

A

stable,

mass < 35mm
no significant pain
BHCG< 1500
no visible heartbeat and unruptured

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10
Q

How are medically managed ectopic pregnancies followed up?

A

BHCG on days 4 and 7 then once a week until negative
avoid sexual intercourse during Tx
avoid conception for 3 months
avoid alcohol and prolonged sun exposure

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11
Q

What is the surgical management for ectopic?

A

salpingotomy: if other tube already lost

salpingectomy first line

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12
Q

What are the conditions for surgical management of ectopic?

A

pain
mass > 35mm
foetal heartbeat
BHCG > 5000

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13
Q

How are salpingotomy patients followed up?

A

1 test weekly until negative

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14
Q

How are salpingectomy patients followed up?

A

pregnancy test at 3 weeks

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15
Q

What is given in addition to treatment for surgical ectopic management?

A

anti-D

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16
Q

what is offered for ectopic with BHCG of 1500-5000?

A

either methotrexate or surgery, depends on:

no significant pain
unruptured ectopic 
mass < 35mm
no heartbeat
no intrauterine pregnancy
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17
Q

What are the risk factors for Ectopics?

A

ECTOPIC

Endometriosis, 
Contraception e.g IUD
Tubual surgery 
Other:  assisted conception
PID, Infection
Iatrogenic
Can't identify cause
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18
Q

PACES: ectopic

A
  • explain RF (ECTOPIC)
  • explain risks e.g. rupture, haemorrhage
  • explain treatment dependent on what’s found on USS

explain medical: 1 IM injection, HCG on day 4 and 7 then weekly, no intercourse, avoid conception for 3 months and avoid sun and alcohol

explain surgical: salpingectomy best but OTOMY if previous tubual surgery
OTOMY has 1/5 risk of further tx required
minimal impact on fertility

follow ups

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19
Q

What is the first line management for molar pregnancy?

A

suction curettage

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20
Q

How are molar pregnancies managed?

A

anti-D prophylaxis after evacuation
pregnancy test at 3 weeks (if products not sent for analysis)

refer to specialist trophoblastic centre e.g. Charing cross

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21
Q

When are women with gestational trophoblastic disease seen?

A

depends on day 56 BHCG

if normal: follow up 6 months after evacuation
if still not normal: 6 months after HCG normalsied

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22
Q

How are women who have had GTD counseled for future pregnancies?

A

do not conceive until follow up complete
barrier contraception until HCG normal
once normal, COCP (IUD may perforate)

if also having methotrexate, do not conceive for 1 year after finishing

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23
Q

PACES: Molar

A

RF: age extremes, Asian, previous GTD, FHs

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24
Q

How many hours after UPSI can copper coil be used?

A

120 (5 days)

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25
Q

What is the mechanism of action of copper coil?

A

spermicide and prevents inhibits implanation

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26
Q

What should all people requesting emergency contraception be offered?

A

STI screen and prophylactic ABx if inserting copper coil and risk of STI

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27
Q

How long after UPSI can levonorgestrelle (Levonelle) be used?

A

72h

if they vomit within TWO HOURS, REPEAT

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28
Q

How does levonorgestrel work?

A

stops ovulation and inhibits ovulation

can be used more than once per cycle

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29
Q

How long after UPSI can ulipristal (EllaOne) be used?

A

120 hours

if vomit within 3 HOURS, repeat

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30
Q

How does EllaOne work?

A

Progesterone receptor modular, stops ovulation

DO NOT USE WITH LEVONORGESTREL

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31
Q

What are some contrainidications for EllaOne?

A

Asthma

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32
Q

What is the recommended method for women >70kg or BMI>26?

A

double dose of levonorgestrelle (3mg)

IDEALLY ELLA ONE (continue oral contraception after 5 days)

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33
Q

What are some side effects of EllaOne and Levonelle?

A

vomiting
headache
breast tenderness

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34
Q

What are the key aspects of a CONTRACEPTION history?

A 
VTE
Migraines + aura
Smoking
AEDs 
Breast cancer
HTN
Fertility plans 
Heavy periods? (not copper coil)
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35
Q

What are the categories of contraception?

A 
Barrier
Hormonal
Non-Hormonal 
Definite (e.g. sterilisation)
Natural
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36
Q

What are examples of LARCs?

A

IUD
IUS
Implant
Injection

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37
Q

What are examples of short acting contraceptions?

A

COCP
POP
Ring pessary
Patch

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38
Q

Which contraceptions need additional protection if not given in the first week of cycle?

A

Mirena
Nexaplanon
Depot-Provera

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39
Q

How is a missed COCP in week 1 managed?

A

take last and current pill, nothing else required

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40
Q

How are 2 missed pills in week 1 managed?

A

consider emergency contraception

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41
Q

How are 2 missed pills in week 2 managed?

A

no need for emergency contraception

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42
Q

How are 2 missed pills in week 3 managed?

A

finish current pack and restart, no pill free break

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43
Q

How does POPs work?

A

thicken cervical mucus, DESORGESTREL INHIBITS OVULATION

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44
Q

How is the POP taken?

A

continuously, no pill free break

within first 5 days of cycle, immediate protection
any other time: barrier for 48h

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45
Q

How is a missed POP managed?

A

< 3 hours late, take missed pill, and continue as normal

3+ late: take missed pill and rest of pack, condoms for until established for 48h

2 missed pills: last pill and next pill, condoms until 48h and may need emergency if UPSI in this time

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46
Q

How is a delayed patch change managed?

A

<48h change, no further precautions

> 48 in week 1 or 2: remove and apply new patch, barrier for 7 days, (if UPSI within the last 5 days consider emergency contraception)

delayed at end of patch free week: barrier for 7 days

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47
Q

What are the Rotterdam criteria for PCOS?

A
  • oligo/anovulation
  • clinical evidence of hyperandrogenism
  • polycystic ovaries (>=12 in one ovary measuring 2-9mm in diameter)
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48
Q

How is PCOS managed in women not planning pregnancies?

A

Lifestyle advice

Treatment of hirsutism / androgenic symptoms

  • topical eflornithine cream
  • dianetee (most anti-androgenic pill)
  • cytoprotone acetate

Metformin
GnRH analogues

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49
Q

How is PCOS managed in women planning a pregnancy?

A

Weight loss if overweight

Clomiphene (SERM) only if normal BMI, max 6 months

Laparoscopic ovarian drilling

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50
Q

PACES: PCOS

A

RF: FHx, obesity
Explain Dx
1/10 women
no known cause

Consequences: irregular periods, subfertility, acne, hirsutism

Mx according to patient’s biggest concern
fertility: wt loss and clomiphene
periods: COCP, 3-4 periods per year
Metabolic syndrome: check for DM, cholesterol

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51
Q

What is the medical management for TOP?

A
  1. mifepristone
  2. 48h later, buccal / sublingual / vaginal misoprostol

bleeding for 7-14 days, urine pregnancy test 2-3 weeks after
analgesia and anti-emetics

0-9 weeks: at home
9+ - clinic (repeated doses of miso every 3h if required, max 5 doses)

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52
Q

What is the surgical management for ToP?

A

<14 weeks: vaccuum aspiration: gentle cervix dilation and local anaesthetic

> 14 weeks: dilation and evacuation; general anaesthetic, given misoprostol 3h before surgery to ripen cervix

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53
Q

What are some risks of surgical ToP?

A

faillure to end
haemorrhage
infection
perforation

54
Q

What additional drug is given if 21+6?

A

intracardiac KCl for feticide to ensure abortion

55
Q

What else should be discussed with all ToP patients?

A

LARCs

56
Q

PACES: ToP

A

explain Tx based on gestation

m: one pill followed by another 48h later, bleeds for 2 weeks and test at 3 weeks
surgical: gentle dilation, removal of products, may need a tablet 3h before

57
Q

PACES: subfertility?

A

RF: smoking, alcohol, advanced age, obesity, irregular periods

explain there is still a chance they may naturally conceive
Explain you want to start investigations e.g. hormone profile
encourage regular UPSI at least 3 times a week

58
Q

What is the name of the oestrogen only and combo medication given as HRT?

A

solo: Elleste Solo
combo: ellest duo

59
Q

What is the management for BV?

A

metronidazole 400mg BD (5-7 days)

or intravaginal metronidazole / clindamycin gel

60
Q

How is vulvovaginal candidiasis treated?

A

local: clotrimazole pessary / cream (eg clotrimazole 500mg PV stat)
oral: itraconazole 200mg PO BD 1/7, or fluconazole 150mg PO stat

girls 12-15 , topical clotrimazole 1% or 2% ONLY
pregnant: intravaginal ONLY not oral

vulval symptoms: topical imidazole in addition to oral / intravaginal

61
Q

PACES: Thrush

A

RF: recent ABx, oral contraceptoin, DM, excessive washing and douching

Explain Dx
Explain Tx: intravaginal or oral
Explain hygiene: no excessive washing and douching, loose clothing

62
Q

How is PID managed?

A

Remove IUD if in situ (usually if failure to respond to Tx after 72h)

1g IM stat ceftriaxone
400mg BD 14 days metronidazole
doxycycline 100mg BD 14 days

alternative: moxifloxacin and metro for 14 days

63
Q

How is PID treated if pt is pyrexial / oral management has failed?

A

1st: IV cefoxitin + doxycycline
2nd: IV clindamycin and gentamicin

64
Q

What else is offered when treating PID?

A

Chlamydia and Gonorrhoea screen, partner within last 6 months should be traced

advice about barrier contraception and potential fertility problems

65
Q

How is PID followed up?

A

if in outpatients, should be seen wtihin 72h
no improvement - admit for IV

follow up at 2-4 weeks to ensure resolution

reassure if compliant no affect on fertility

66
Q

PACES: PID

A

Explain RF: young, IUD, STI, multiple partners
assess if admission needed

explain Dx: infection that has spread upward toward womb
explain risks: fertility, ectopic, chronic pelvic pain,
explain tx: Abx

NO SEX UNTIL TX FINISHED

discuss contraception and STI screen

follow up in 3 days

67
Q

What is the first line management for stress incontinence?

A

conservative: avoid caffeinated drinks, weight loss, avoid excessive drinking

pelvic floor exercise 3 months, 3/day

68
Q

What is the second line Mx for stress incontinence?

A

surgery:

colposuspension
Autologous rectus fascial sling

retropubic mid urethral mesh sling
intramural urethral bulking agents

69
Q

What is the 3rd line for stress incontinence?

A

duloxetine and review in 2-4 weeks

70
Q

How is urge incontinence managed?

A

conservative: avoid caffeinated drinks, weight loss, avoid excessive drinking

71
Q

What is the first line management for urge incontinence?

A

bladder retraining for six weeks - increase intervals between voiding

72
Q

what is the second line Mx for urge incontinence?

A

antimuscarinics:

oxybutynin / tolterodine

NOT IF ELDERLY AND FRAIL

mireabegnon if old

73
Q

What surgical procedures are performed for urge incontinence?

A

botox injection, percutaneous tibial or sacral nerve stimulation

74
Q

PACES: stress / urge incontinence

A

RF:

  • s: overweight, instrumental delivery, chronic cough,
  • u: smoking, weight, age, FHs, DM
explain Dx and mechanism 
explain lifestyle measures
explain Tx:
-u: bladder retraining 6 weeks 
-s:  pelvic floor exercises for 3 months
75
Q

What lifestyle measures are suggested for vaginal prolapse?

A

losing weight if BMI>30
avoid heavy lifting
prevent / treat constipation

76
Q

What medical managements options are offered for vaginal prolapse?

A

pelvic floor exercise (4 months)

oestrogens: pill, patch, cream (can help esp if atrophy)

ring pessary: changed every six months
- can cause discharge, irritation, UTI,

NO SEX WITH SHELF

77
Q

What surgical options are there for vaginal prolapse with uterus preservation / no preference?

A

vaginal hysterectomy +/- sacrocpinous fixation

vaginal sacrospinous hysteropexy

manchester repair

sacro-hysteropexy

78
Q

What surgical options are there for vaginal prolapse without preserving the uterus?

A

vaginal sacrospinous hysteropexy

manchester repair

79
Q

How is vault prolapse managed?

A

pessary

vaginal sacrospinous fixation

sacrocolpopexy

80
Q

PACES: vault prolapse

A

RF: multiparity, aeg, obesity, prolonged second stage of labour, heavy lifting

explain diagnosis

explain lifestyle suggestions, weight, smoking

explain conservative

explain ring pessary or surgery

81
Q

How is asherman syndrom emanaged?

A

hysteroscopic adhesiolysis + foley catheter or IUCD to prevent recurrence

82
Q

How is atrophic vaginitis treated?

A

EXCLUDE ENDOMETRIAL MALIGNANCY

vaginal lubricants before intercourse and moisturisers

topical oestrogen and inform patients will be relieved after 3 weeks
- ring can be inserted into vaginal posterior fornix and changed every 3 months

systemic HRT if menopause co-existent

83
Q

How is an asymptomatic bartholins cyst managed?

A

conservative, sitz bath and warm compression

84
Q

How is a symptomatic bartholins cyst managed?

A

maruspilisation / catheter drainage +/- oral ABx
surgical excision, silvery nitrate cauterisation or sclerotherapy

catheter - word catheter for 4-6 weeks

85
Q

How is a Bartholin’s abscess treated?

A

conservative (sitz bath and analgesia) or incision and drainage with ABx

86
Q

PACES: bartholins cyst / abscess

A 
RF: nulliparous, child bearing age, previosu cyst 
explain Dx (blockage of duct which is now infected)

Explain Mx
C: observation and ABx
M / s : Word catheter / marsupiliation

STI screen

87
Q

How is endometriosis treated?

A

NSAIDs
COCP / POP
GnRH

Surgical: ablation, hysterectomy or oophrectomy

88
Q

PACES: endometriosis

A

RF: early menarache, family history, nulliparity, prolonged menstruation (>5 days) and short menstrual cycles (< 28 days)

Dx: a condition where the lining of the womb appears outside of the womb

10% of women have it

Mx options: NSAIDs, COCP, LNG-IUS, POP, Surgical: laparoscopy and ablation

explation the potential impact on fertility

89
Q

What is the medical treatment for fibroids?

A

conservative if asymptomatic

for HMB: LNG-IUS, COCP or progesterone
non-hormonal: tranexamic acid / NSAIDs

these may be ineffective if large submucosal fibroid that is palpable abdominally

Injectable GnRH agonist - induces menopausal state

Ulipristal acetate (selective progesterone receptor modulator)

90
Q

What is the surgical treatment of fibroids?

A

minimally invasive hysteroscopic surgery can be used to remove submucosal fibroids and fibroid polyps

if bulky and causing pressure symptoms:

  • myomectomy (good for fertility preservation), can be done laparoscopically
  • hysterectomy (give GnRH agonsti 3 months before to shrink the fibroid) - can facilitate vaginal hysterectomy over abdominal hysterectomy
91
Q

What are the radiological treatment options for fibroids?

A

Uterine artery embolisation

reduces fiborid volume by about 50%
only offered if not desiring fertility
required admission for analgesia

complications: fever, infection, fibroid expulsion, potential ovarian failure
1/3rd of women required further intervention within five years

92
Q

summarise the different management options for fibroids

A

1 - LNG-IUS
NH: tranexamic acid, COCP
GnRH used to reduce size of fibroid

Surgery: myomectomy or hysterectomy

radiology: UAE

93
Q

PACES: fibroids

A

RF - increasing age until menopause, early puberty, obesity, Afro-Carribean and FHx

Dx: common smooth muscle masses that can cause HMB
increases in prevalence with age until menopause, 20-50% of women over the age of 30 years

Mx: LNG-IUS, COCP, tranexamic acid

94
Q

How are endometrial polyps managed?

A

small - may resolve spontaneously

polypectomy to relieve the AUB symptoms, optimise fertility and exclude hyperplasia / cancer

  • day case under GA
  • outpatient with / without local
95
Q

How is FGM managed?

A

< 18 contact police and social services
check for other young girls in family who may be at risk

De-infibulation:
-ideally identify pre conception
- analgesia to prevent flashbacks 
incision along vulva incision scar
-prior urinary infection and ABx
-support groups if needed
96
Q

how is lichen sclerosus managed?

A

skin care - soap substitute, emollients and avoid irritants

steroids - clobetasol proprionate for 3 months and review

biopsy if it does not resolve with treatment, consider UV therapy

97
Q

how is a cyst <50mm (5cm) invstigated?

A

physiological and likely to resolve with 3 cycles, no follow up

98
Q

How are cysts between 5-7cm investigated

A

yearly USS follow up

99
Q

How are cysts >70mm in diameter investigated?

A

further imaging i.e. MRI or surgical intervention (laparoscopic removal) (if solid components, may need laparotomy)

100
Q

How is an acutely unwell woman with a cyst managed?

A

urgent exploration (laparoscopy or laparotomy) to manage ovarian torsion / cyst rupture or haemorrhage and resus and broad spec ABx

101
Q

How is a post menopausal woman with a solid or complex ovarian cyst managed?

A

undergo TVUSS for RMI
- USS features of cyst, menopausal status and CA125

requires gynaecology oncology and laparotomy

102
Q

How is PMS managed?

A

conservative:

  • stress reduction
  • alcohol and caffeine limit
  • exercise
  • sleep hygiene
  • small frequent meals with complex carbs
  • pain relief (NSAIDs)

if moderate (impact on personal, professional and social life)

  • COCP (Yasmin has best evidence base)
  • cyclical or continuous

Severe: (withdrawal and prevention of normal social functioning)

  • COCP
  • SSRI (continuous or just during luteal phase)
  • monitor closely especially for self harm, trial for 3 months
103
Q

How is pruritic vulvae managed?

A

General:

  • use emolient for washing vulval area (not water only or soap) and dab dry
  • avoid OTC, wet wipes, perfumed products, tight clothes, fabric softener and spermicide condoms
  • use emollients liberally
  • anti-histamine at bed time to help

manage underlying cause:
-contact dermatitis - remove irritant exposure and use emollients instead of soap,
1% hydrocortisone if mild and betamethasone if severe or lichenified
refer to derm if irritant removal has not resolved

lichen simplex - treat underlying skin condition, potent topical steroids for 14 days and emollient instead of soap

unknown cause: emollient and mildly anxiolytic anti-histamine hydroxyzine for symptomatic treatment, consider 1% hydrocortisone, refer to derm/gyane/vulval clinic and use emollient and anti-histamine while waiting if Sx persist

refer to specialist under TWR if suspected lymphoma or cancer

104
Q

how is CIN managed?

A

colposcopy and biopsy, excise if moderate to severe abnormalities

LLETZ to excise

LLETZ increases risk of midtrimester loss and preterm delivery, can do cone biopsy (less common)

test of cure 6 months later

105
Q

how is cervical cancer grade IA1 (microinvasive) managed?

A

conservative approach (cone biopsy)

106
Q

How is cervical cancer grade IA2-IIA( early) managed?

A

<4cm = radical hysterctomy and lymphadenectomy

risks of RH: bladder dysfunction (atony), common immediately post op and may require self catheterization

  • sexual dysfunction
  • lymphedema (due to pelvic lymph node removal) manage with leg elevation and skin care

> 4cm - chemoradiation

107
Q

How is cervical cancer grade IIB - IVA (locally advanced) managed?

A

chemoradiation

radiotherapy, two ways:

  • external beam radiotherapy over 4 weeks, each delivery is about 10 minutes long
  • internal radiotherapy (brachytherapy): rods of selenium inserted under anaesthetic into the affected area, effects up to 5mm away from rod

risks: lethargy, bowel and bladder urgency, skin erythema for ER,

long term: fibrosis, vaginal stenosis, cystitis like Sx, malabsorption and mucuous diarrhoea, radiotherapy induced menopause

chemotherapy: usually cisplatin, indeally in addition to radiotherapy

108
Q

How is cervical cancer stage IVB (metastatic cancer) managed?

A

combination chemo (Alt single agent therapy) and palliative care

109
Q

How is a pregnant woman with cervical cancer managed?

A

MDT, deliver at 35 weeks

110
Q

How is recurrent cervical cancer managed?

A

surgery / palliative chemo / supportive care

111
Q

PACES: CIN and cervical cancer

A

explain purpose of screening and encourage vaccine
explain Mx:
- CIN1 - repeat smear in 1 year
CIN2, CIN3, CGIN: LLETZ or cone

LLETZ - outpatient procedure with local anaesthetic
cone biopsy: used for larger lesion and done under GA

risk: may need cerclage

F/U: repeat smear in 6 months for test of cure

112
Q

What adjuvant therapy is given for endometrial hyperplasia and endometrial cancer?

A

postoperative readiotherapy reduces local recurrence rate but does not improve survival
local radiotherapy or brachytherapy are options
chemotherapy is used for advances or metastatic disease (little evidence to support its use)

113
Q

What hormone treatment is provided for endometrial hyperplasia or cancer?

A

high dose or intra uterine progestine (LNG-IUS)

useful for women with complex atypical hyperplasia and low grade stage 1A endometrial tumours

relapse rates are high
may be suitable if women are not suitable for surgery

114
Q

Summarise the treatment for endometrial cancer

A

localised disease: TAHBSO

high risk patients may receive chemo

progestogen therapy in frail women

115
Q

PACES: endometrial hyperplasia and cancer

A

Dx: abnormal thickening of the endometrium
serious due to risk of progression to cancer
Explain Mx:
- no atypia: LNG-IUS and review in 3-6 months

-Atypia: TAHBSO, if medical Mx surveillance every 3 months

116
Q

What endometrial thickness would required require further investigations?

A

post menopausal >4mm

pre-menopausla >10mm

117
Q

Which route of HRT is preferrable for obese women?

A

Transdermal, lower risk of clots

118
Q

How is stage 1 ovarian cancer managed?

A

TAHBSO, if 1A then only affected ovary removed to preserve fertility

119
Q

How is Stage 2 ovarian cancer managed?

A

debulking to remove as much of tumour as possible, neo-adjuvant or adjuvant chemo

120
Q

How is stage 3 ovarian cancer managed?

A

debulking to remove as much of tumour as possible, neo-adjuvant or adjuvant chemo

also bevacizumab (anti-VEGFA)

if surgery not possible, platinum based chemo is given and symptomatic treatment e.g. ascites drain

121
Q

How is stage 4 ovarian cancer treated

A

similar to stage 3, but palliative care is more likely

122
Q

What is the first line chemotherapy given in ovarian cancer?

A

combination of platinum compound with paclitaxel, given as outpatient 3 weeks apart for 6 cycles

123
Q

How are platinum compounds used in ovarian cancer?

A

most effective in ovarian cancer
causes cross linking of DNA leading to cell cycle arrest

carboplatin is main agent as it is less nephrotoxic and causes less nausea

124
Q

How does paclitaxel work for ovarian cacner?

A

causes mictotubular damage
prevents replication and cell division
pre emptive steroids are given to reduce hypersensitivity reactions and reduces side effects (e.g. neutropaenia and myalgia)
causes total loss of body hair

125
Q

How is bevacizumab used in ovarian cancer?

A

Monooclonal antibody aain VEGF
inhibits angiogenesis
avaible for treatment of recurrent disease

126
Q

How is ovarian cancer followed up?

A

CT after finishing chemo to assess response

F/U includes clinical examination and CA125 measurement

if disease recurrs, largely palliative treatment

127
Q

PACES: ovarian cancer

A

RF: age, FHx, obesity, HRT, endometriosis, smoking and diabetes

protective: COCP, pregnancy and breastfeeding, hysterectomy

Explain Dx

Explain that further Ix may be needed

Explain that definitive Mx will be surgical with or without chemo

128
Q

How is vulval cancer managed?

A

vulva excision: radical surgical excision aiming for a clear margin fo 15mm is the mainstay

large lesions may be shrunk using neoadjuvant radiotherapy often with chemo

sentinel lymph node biopsy: full inguinofemoral lymphadenectomy (for all tumours with invasion >1mm)

radiotherapy: adjuvant is indicated if excision margins are two close or if two or more groin node mets

radical radiotherapy may be used instead of surgery if patient is unfit

129
Q

Describe a sentinel lymph node biopsy and lymphadenectomy

A

groin lymphadenectomy is very morbid, with complications including wound healing problems, infections, VTE and chronic lymphedema

groin nodes are involved in about 15% of vulval cancers

full lymphadenectomy can be avoided by biopsying first

dye and radioactive nucleotide can be injected in the vulval tumour to identify the sentinel node

if sentinel node positive, do lymphadenectomy

130
Q

Which tumours arise from the stroma of the ovary?

A

granulosa
thecoma
fibroma

131
Q

Which tumours arise from the ooctye within an ovary?

A

teratoma and dysgerminoma

Specialties Mx 2021 (4 decks)

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