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Obstetrics & Gynaecology > Gynaecology Oncology and Screening > Flashcards

Gynaecology Oncology and Screening Flashcards

1
Q

Which demographic does cervical cancer tend to affect?

A

Younger women

Peaks in reproductive years

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2
Q

What type of cancer is cervical cancer?

A

80% squamous cell carcinomas

Adenocarcinomas next most common

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3
Q

How is the risk of cervical cancer mitigated?

A

Children 12-13 vaccinated against HPV due to its association with cervical cancer

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4
Q

Which types of HPV are associated with cervical cancer?

A

16 & 18

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5
Q

Risk factors for cervical cancer

A

Early sexual activity

Increased number of sexual partners

Sexual partners who have had more partners

Not using condoms

Non-engagement with cervical screening

Smoking

HIV

COCP >5 years

Increased number of full-term pregnancies

Family history

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6
Q

Presentation of cervical cancer

A

Abnormal vaginal bleeding (intermenstrual, postcoital or post-menopausal bleeding)

Vaginal discharge

Pelvic pain

Dyspareunia (pain or discomfort with sex)

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7
Q

Colposcopy findings in cervical cancer

A

Ulceration

Inflammation

Bleeding

Visible tumour

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8
Q

What is cervical intraepithelial neoplasia?

A

Grading system for level of dysplasia in cells of the cervix

CIN is diagnosed at colposcopy (not with cervical screening)

CIN I: mild dysplasia, affecting 1/3 the thickness of the epithelial layer, likely to return to normal without treatment

CIN II: moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, likely to progress to cancer if untreated

CIN III: severe dysplasia, very likely to progress to cancer if untreated (aka cervical carcinoma in situ)

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9
Q

Dysplasia vs. dyskaryosis

A

Dysplasia - premalignant change found during colposcopy

Dyskaryosis - precancerous changes found on smear

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10
Q

Cervical screening programme

A

Smear for women (and transgender men that still have a cervix):
Every three years aged 25 – 49
Every five years aged 50 – 64

Tested for high-risk HPV and dyskaryosis

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11
Q

Exceptions to cervical smear programme

A

Women with HIV are screened annually

Women over 65 may request a smear if they have not had one since aged 50

Women with previous CIN may require additional tests (e.g. test of cure after treatment)

Certain groups of immunocompromised women may have additional screening (e.g. women on dialysis, cytotoxic drugs or undergoing an organ transplant)

Pregnant women due a routine smear should wait until 12 weeks post-partum

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12
Q

Smear results and outcomes

A

Inadequate sample – repeat the smear after at least three months

HPV negative – continue routine screening

HPV positive with normal cytology – repeat the HPV test after 12 months

HPV positive with abnormal cytology – refer for colposcopy

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13
Q

What is colposcopy?

A

Magnified view of cervix

Punch biopsy or large loop excision of the transitional zone (LLETZ) can be used to get tissue sample

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14
Q

Cervical cancer staging

A

Stage 1: Confined to the cervix

Stage 2: Invades the uterus or upper 2/3 of the vagina

Stage 3: Invades the pelvic wall or lower 1/3 of the vagina

Stage 4: Invades the bladder, rectum or beyond the pelvis

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15
Q

Management of cervical cancer

A

Cervical intraepithelial neoplasia and early-stage 1A: LLETZ or cone biopsy

Stage 1B – 2A: Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy

Stage 2B – 4A: Chemotherapy and radiotherapy

Stage 4B: Management may involve a combination of surgery, radiotherapy, chemotherapy and palliative care

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16
Q

HPV vaccine

A

Protects against stains 6, 11, 16 and 18

6 + 11 - genital warts

16 + 18 - cervical cancer

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17
Q

Which type of cancer is endometrial cancer?

A

Adenocarcinoma (80%)

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18
Q

Postmenopausal bleeding spot diagnosis

A

Endometrial cancer until proven otherwise

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19
Q

What is endometrial hyperplasia?

A

Precancerous condition involving thickening of the endometrium

20
Q

Which types of endometrial hyperplasia can go on to become endometrial cancer?

A

Hyperplasia without atypic

Atypical hyperplasia

21
Q

Endometrial hyperplasia management

A

Progestogens e.g.

IUS (Mirena)

Continuous oral progestogens (e.g. medroxyprogesterone or levonorgestrel)

22
Q

Risk factors of endometrial cancer

A

Unopposed oestrogen:

Increased age

Earlier onset of menstruation

Late menopause

Oestrogen only hormone replacement therapy

No or fewer pregnancies

Obesity

Polycystic ovarian syndrome

Tamoxifen

23
Q

Why is obesity a risk factor for endometrial cancer?

A

Adipose tussle is a source of oestrogen

24
Q

Protective factors against endometrial cancer

A

Combined contraceptive pill

Mirena coil

Increased pregnancies

Cigarette smoking

25
Presentation of endometrial cancer
POSTMENOPAUSAL BLEEDING Postcoital bleeding Intermenstrual bleeding Unusually heavy menstrual bleeding Abnormal vaginal discharge Haematuria Anaemia Raised platelet count
26
2-week wait referral criteria for endometrial cancer
Postmenopausal bleeding TVUSS in >55 wit unexplained vaginal discharge or visible haematuria
27
Investigations in endometrial cancer
TVUSS for endometrial thickness (normal is less than 4mm post-menopause) Pipelle biopsy, which is highly sensitive for endometrial cancer making it useful for excluding cancer Hysteroscopy with endometrial biopsy
28
Staging of endometrial cancer
Stage 1: Confined to the uterus Stage 2: Invades the cervix Stage 3: Invades the ovaries, fallopian tubes, vagina or lymph nodes Stage 4: Invades bladder, rectum or beyond the pelvis
29
Management of endometrial cancer
Total abdominal hysterectomy with bilateral salpingo-oophorectomy Radical hysterectomy involves also removing pelvic lymph nodes, surrounding tissues top of vagina Radiotherapy Chemotherapy Progesterone may slow the progression of the cancer
30
Ovarian cancer presentation
Tends to present late due to non-specific symptoms More than 70% of patients present after it has spread beyond the pelvis
31
Types of ovarian cancer
Epithelial cell tumour (most common) Dermoid cycle/germ cell tumours (teratomas, associated with ovarian torsion) Sex-cord-stromal tumours Krukenberg tumour (metastasis from GI cancer - signet ring cells on histology)
32
Risk factors for ovarian cancer
Age (peaks age 60) BRCA1 and BRCA2 genes (consider the family history) Increased number of ovulations Obesity Smoking Recurrent use of clomifene (Factors that increase number of ovulations) Early-onset of periods Late menopause No pregnancies
33
Protective factors against ovarian cancer
(Factors that stop ovulation) Combined contraceptive pill Breastfeeding Pregnancy
34
Presentation of ovarian cancer
Abdominal bloating Early satiety (feeling full after eating) Loss of appetite Pelvic pain Urinary symptoms (frequency/urgency) Weight loss Abdominal or pelvic mass Ascites May compress obturator nerve and cause hip/groin pain
35
2-week-wait referral criteria in ovarian cancer
Ascites Pelvic mass (unless clearly due to fibroids) Abdominal mass
36
Investigations in ovarian cancer
CA125 blood test (>35 IU/mL is significant) Pelvic ultrasound
37
Further investigations in ovarian cancer
CT scan to establish the diagnosis and stage the cancer Histology (tissue sample) using a CT guided biopsy, laparoscopy or laparotomy Paracentesis (ascitic tap) can be used to test the ascitic fluid for cancer cells
38
Investigations in women under 40 with complex ovarian mass
Alpha-fetoprotein (α-FP) Human chorionic gonadotropin (HCG)
39
Causes of raised CA125
Endometriosis Fibroids Adenomyosis Pelvic infection Liver disease Pregnancy
40
Staging of ovarian cancer
Stage 1: Confined to the ovary Stage 2: Spread past the ovary but inside the pelvis Stage 3: Spread past the pelvis but inside the abdomen Stage 4: Spread outside the abdomen (distant metastasis)
41
Management of ovarian cancer
Gynaecology-oncology MDT Combination of surgery and chemotherapy
42
What type of cancer is vulval cancer
Squamous cell carcinoma Less commonly malignant melanoma
43
Risk factors for vulval cancer
Advanced age (particularly over 75 years) Immunosuppression Human papillomavirus (HPV) infection Lichen sclerosus
44
What is vulval intraepithelial neoplasia
Premalignant condition affecting squamous epithelium that can precede vulval cancer
45
Presentation of vulval cancer
May be incidental finding in older women e.g. during catheterisation Vulval lump Ulceration Bleeding Pain Itching Lymphadenopathy in the groin ``` Most frequently affects labia majora, giving an appearance of: Irregular mass Fungating lesion Ulceration Bleeding ```
46
Investigations in vulval cancer
2-week-wait referral Biopsy of the lesion Sentinel node biopsy to demonstrate lymph node spread Further imaging for staging (e.g. CT abdomen and pelvis)
47
Management of vulval cancer
Wide local excision to remove the cancer Groin lymph node dissection Chemotherapy Radiotherapy

Obstetrics & Gynaecology (13 decks)

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