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GOSH > Gynaecology: Cancer > Flashcards

Gynaecology: Cancer Flashcards

1
Q

What is CIN?

A

Cervical intraepithelial neoplasia - occurs when dyskaryosis (dysplasia) occurs in transformation zone (TZ).

NB: squamous epithelium is found in the ectocervix, columnar in endocervix, both regions meet at squamous-collumnar junction in ectocervix.

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2
Q

What is the peak incidence of CIN?

A

25-29 years old

90% of CIN is found in women < 40yo

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3
Q

What are the key RFs for CIN?

A

Infection with HPV
- strain 16, 18 most infective also 31, 33 found in 70% of cervical cancers

COCP

Smoking

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4
Q

What is the national screening system for cervical cancer?

A

National cervical screening

Speculum and smear

Every 3 years from 25-49
Every 5 years from 50-65

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5
Q

What are the grading of CIN?

A

CIN1 = mild dysplasia present in lower 1/3rd of TZ epithelium

CIN2 = moderate dysplasia present in lower 2/3rd of epithelium

CIN3 = severe dysplasia present in full thickness of epithelium

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6
Q

What is the investigative ladder for CIN?

A
  1. Speculum and Smear
    a. mild dysplasia with high risk HPV –> refer to colposcopy
    b. mild dysplasia with no HPV –> return to 3/5 year recall
    c. severe dysplasia –> colposcopy
  2. Colposcopy - biopsy and diagnosis via histology sample
    a. CIN 1 = r/v in 6 months with cytology
    b. CIN2/3 = LLETZ (large loop excision of transformation zone)
    c. nothing seen –> refer to hysteroscopy
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7
Q

What is the investigation pathway for cervical cancer?

A
  1. Colposcopy and biopsy - confirms diagnosis
  2. FIGO system stages cancer
    - Vaginal and Rectal exam under anaesthetic (EUA)
    - Cystoscopy detects bladder involvement
    - MRI detects size, spread and LN involvement
    - CXR detects chest involvement
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8
Q

What are the four stages of cervical cancer?

A

FIGO system staging:

Stage 1 - confined to cervix
Stage 2 - invasion into vagina
Stage 3 - invasion into lower vagina and pelvic wall which causes ureteric obstruction
Stage 4 - invasion into bladder, rectal mucosa or beyond pelvis

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9
Q

What is the treatment of cervical cancer?

A

Treatment depends on staging of tumour according to FIGO system

stage 1a
- LLETZ

stage 1b-4 - surgical or chemo-radiotherapy

  • Other stage 1 = hysterectomy + pelvic node resection
  • stage 3/4 and LN involvement = chen-radiotherapy
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10
Q

What are the symptoms and signs of cervical cancer?

separate into occult and clinical

A

Occult carcinoma
- often asymptomatic, detected only after speculum/colposcopy or LLETZ

Clinical carcinoma

  • PMB
  • Offensive vaginal discharge
  • IMB
  • PCB
  • Later develops into uraemia, haematuria, rectal bleeding or pain, cervical mass
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11
Q

What is the most common types of cervical cancer?

A

Squamous cell carcinoma 90%

Adenocarcinoma 10%

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12
Q

What is the peak incidence of cervical cancer?

A

Peaks in 30s and 80s

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13
Q

What is the most common genital tract cancer in women?

A

Endometrial cancer

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14
Q

What is the peak incidence of endometrial cancer?

A

Post-menopausal

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15
Q

What are the risk factors for endometrial cancer?

A

Concept: high in patients with high oestrogen to progesterone ratio. Risk is highest when there is high, unopposed oestrogen

  • Obesity - peripheral conversion of androgens in fat to oestrogen
  • HRT - oestrogen only
  • PCOS - polycystic ovaries have high levels of oestrogen and cause early menarche and late menopause
  • Tamoxifen - antagonist of oestrogen in breast but agonist in uterus
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16
Q

What are protective factors against endometrial cancer?

A

COCP and pregnancy

17
Q

What is the most common kind of endometrial cancer

A

Adenocarcinoma

18
Q

What is the investigative pathway for endometrial cancer?

A
  1. Bimanual and Speculum - exclude causes of bleeding and identify uterine size and adnexal masses
  2. TV USS
    - if < 4mm = endometrial Ca unlikely
    - if ≥ 4mm = endometrial Ca likely send for biopsy and hysteroscopy
    - MRI if suspected spread
  3. Hysteroscopy (staging) and biopsy (confirms diagnosis)
19
Q

What is the investigative pathway for endometrial cancer?

A
  1. Bimanual and Speculum - exclude causes of bleeding and identify uterine size and adnexal masses
  2. TV USS
    - if < 4mm = endometrial Ca unlikely
    - if ≥ 4mm = endometrial Ca likely send for biopsy and hysteroscopy
    - MRI if suspected spread
  3. Hysteroscopy (staging) and biopsy (confirms diagnosis)
20
Q

What is the treatment for endometrial cancer?

A

Stage 1 =
- hysterectomy and salpingostomy

Late stage =
- Hysterectomy, LN excision and adjuvant radiotherapy

21
Q

What are the symptoms of ovarian cancer?

A

Often present in late stages (3-4) of cancer

  • Persistant chronic abdominal or pelvic pain
  • Bloating
  • Early satiety or loss of appetite
  • Increased urinary frequency due to bladder compression
  • Pelvic or adnexal mass
  • Ascites or pleural effusion
22
Q

What is the most common site of mets for ovarian Ca?

A

Breast

23
Q

What is the investigative pathway for ovarian cancer?

A
  1. CA125 level
    - if > 35IU/ml refer for USS abdomen and pelvis
  2. USS abdomen and pelvis
    - if ascites or pelvic/abdominal mass found on USS or physical exam refer secondary care for CT
  3. CT
    - size, spread and stage of cancer
24
Q

What is the most common type of ovarian cancer?

A

Epithelial caricinoma (90%)

Germ cell tumours rare

25
Q

How can you differentiate the two types of ovarian canceR?

A

AFP and HCG

- These will be raised in germ cell tumours but not epithelial carcinoma

26
Q

What is the treatment for ovarian cancer?

A

Surgery or Chemotherapy

27
Q

What are the RF for ovarian cancer?

A

Ovarian cancer is oestrogen dependent

  • Prolonged exposure to oestrogen i..e early menarche, late menopause, Oestrogen only HRT
  • BRCA 2 (80%), BRCA1 (15%)
  • Nulliparous
  • endometriosis
  • Obesity
  • Smoking
  • Caucasian women
28
Q

What type of cancer is vulval and cervical cancer?

A

squamous cell cancer

29
Q

What are the RF for vulval cancer in young women and old women?

A

Young - HPV associated

Old - non-HPV associated, often presents with lichen planus

30
Q

What are the symptoms and signs of vulval cancer?

A
  1. Lump develops on vulva usually at clitoris or labia –> ulcerated and painful
  2. Bleeding upon contact or irritation of ulcer
  3. Pruritis and Discharge
  4. Vulvial pain
  5. Enlarged inguinal LN - hard and non-mobile
31
Q

What is the investigation for vulval cancer?

A
  1. Biopsy (diagnostic)
32
Q

What is the treatment

A

Surgery

- wide local excision and lymphadenectomy if LN involvement

GOSH (14 decks)

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