Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What type of cancer is cervical cancer?

A

80% squamous cell carcinomas

Adenocarcinomas next most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is the risk of cervical cancer mitigated?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which types of HPV are associated with cervical cancer?

A

16 & 18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Colposcopy findings in cervical cancer

A

Ulceration

Inflammation

Bleeding

Visible tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dysplasia vs. dyskaryosis

A

Dysplasia - premalignant change found during colposcopy

Dyskaryosis - precancerous changes found on smear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

HPV vaccine

A

Protects against stains 6, 11, 16 and 18

6 + 11 - genital warts

16 + 18 - cervical cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which type of cancer is endometrial cancer?

A

Adenocarcinoma (80%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Postmenopausal bleeding spot diagnosis

A

Endometrial cancer until proven otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
Q

Presentation of endometrial cancer

A

POSTMENOPAUSAL BLEEDING

Postcoital bleeding

Intermenstrual bleeding

Unusually heavy menstrual bleeding

Abnormal vaginal discharge

Haematuria

Anaemia

Raised platelet count

26
Q

2-week wait referral criteria for endometrial cancer

A

Postmenopausal bleeding

TVUSS in >55 wit unexplained vaginal discharge or visible haematuria

27
Q

Investigations in endometrial cancer

A

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
Q

Staging of endometrial cancer

A

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
Q

Management of endometrial cancer

A

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
Q

Ovarian cancer presentation

A

Tends to present late due to non-specific symptoms

More than 70% of patients present after it has spread beyond the pelvis

31
Q

Types of ovarian cancer

A

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
Q

Risk factors for ovarian cancer

A

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
Q

Protective factors against ovarian cancer

A

(Factors that stop ovulation)

Combined contraceptive pill

Breastfeeding

Pregnancy

34
Q

Presentation of ovarian cancer

A

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
Q

2-week-wait referral criteria in ovarian cancer

A

Ascites

Pelvic mass (unless clearly due to fibroids)

Abdominal mass

36
Q

Investigations in ovarian cancer

A

CA125 blood test (>35 IU/mL is significant)

Pelvic ultrasound

37
Q

Further investigations in ovarian cancer

A

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
Q

Investigations in women under 40 with complex ovarian mass

A

Alpha-fetoprotein (α-FP)

Human chorionic gonadotropin (HCG)

39
Q

Causes of raised CA125

A

Endometriosis

Fibroids

Adenomyosis

Pelvic infection

Liver disease

Pregnancy

40
Q

Staging of ovarian cancer

A

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
Q

Management of ovarian cancer

A

Gynaecology-oncology MDT

Combination of surgery and chemotherapy

42
Q

What type of cancer is vulval cancer

A

Squamous cell carcinoma

Less commonly malignant melanoma

43
Q

Risk factors for vulval cancer

A

Advanced age (particularly over 75 years)

Immunosuppression

Human papillomavirus (HPV) infection

Lichen sclerosus

44
Q

What is vulval intraepithelial neoplasia

A

Premalignant condition affecting squamous epithelium that can precede vulval cancer

45
Q

Presentation of vulval cancer

A

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
Q

Investigations in vulval cancer

A

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
Q

Management of vulval cancer

A

Wide local excision to remove the cancer

Groin lymph node dissection

Chemotherapy

Radiotherapy

Obstetrics & Gynaecology (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions