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5 - Obstetrics and Gynaecology > Gynaeoncology > Flashcards

Gynaeoncology Flashcards

1
Q

What is the different pathology of ovarian tumours?

A

Epithelial
Germ cell tumours
Ovarian stromal tumours
Mets eg, Krukenberg tumours.
Tumours are either invasive or borderline.

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2
Q

Two types of epithelial ovarian cancer

A
  1. High grade serous
  2. Arises from surface epithelium of ovary and mullerian inclusion cysts (low grade serous, endometroid, clear cell)
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3
Q

How does ovarian cancer spread?

A

Direct extension (transcoelemic),
Exfoliation into peritoneal cavity,
Lymphatic invasion

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4
Q

Risk factors for ovarian CA?

A

Smoking,
Low parity,
Oral contracpetive,
Infertility,
Tubal ligation,
Early menarche,
Late menopause

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5
Q

What genes are linked to ovarian cancer?

A

BRCA1
BRCA2
Lynch syndrome
Other undiscovered genes

BRCA genes have a 30% lifetime risk of ovarian cancer.

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6
Q

What are features which suggest genetic mutations?

A

Early onset of breast CA (<50y),
Male breast cancer,
Ashkenazi jews,
Bilateral breast cancers,
Multiple genetically related family memebrs with cancer

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7
Q

What is the risk reducing surgery for ovarian cancer?

A

Prophylactic bilateral salpingo-oopherectomy. Important to remove entire ovary and fallopian tube!

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8
Q

What is the presentation of ovarian cancer?

A

Vague and non specific
Altered bowel habit,
Abdominal pain/bloating,
Early setiaty,
Difficulty eating,
Urinary/pelvic symptoms

Signs - Abdo distention, upper abdo mass, pleural effusion, nodules on PV examination and paraneoplastic syndrome

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9
Q

What are the investigations for ovarian cancer?

A

Initial: Ultrasound and CA125. Then calculate the risk of malignancy index.
If RMI is high then do CT. Used to determine initial treatment plan

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10
Q

How do you calculate RMI?

A

Ultrasound score,
Menopausal status,
CA125 level
If RMI > 200 then high suspicion so get CT and referral to MDT

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11
Q

How can you confirm diagnosis of ovarian cancer?

A

Cytology of pleural effusion or ascitic fluid.
Histology from biopsy either percutaneous under guidence or laparoscopic

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12
Q

Staging

A

Stage 1 - confined to ovaries.
Stage 2 - On surface of pelvic orgnans.
Stage 3 - Mets out of pelvis + retroperitoneal nodes.
Stage 4 - distant mets

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13
Q

Treatment of ovarian cancer?

A

All ovarian cancer will come back at some stage.
Surgery - midline laparotomy with total abdominal hysterectomy, BSO, washings, omentectomy +/- any other abdominal organs containing disease.
Chemotherapy - either neo/adjuvant.
Fertility conserving surgery

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14
Q

Describe features of chemotherapy used in ovarian cancer and other treatments used.

A
  1. IV chemo either NACT or adjuvant. 1st line is carboplatin with paclitaxel.
  2. Intraperitoneal chemotherapy
  3. Biological agents - bevacizumab (in patients with residual disease)
  4. Hormonal therapy - tamoxifen/aromatase inhibitors
  5. PARPi inhibitors - for BRCA
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15
Q

What is the presentation of endometrial cancers

A

PMB,
PCB,
IMB,
Altered menstrual pattern,
Persistent vaginal discharge.

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16
Q

what are the different pathological types of endometrial cancer?

A

Adenocarcinoma is the most common. Type 1 associated with oestrogen excess, type 2 is not associated with oestrogen excess.
Sarcomas - derived from muscle layer. Leiomyosarcoma is most common
Uterine carcinosarcoma

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17
Q

What is the precursor for endometrial cancer?

A

Atypical endometrial hyperplasia

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18
Q

What are the risk factors for endometrial cancer?

A

Obesity,
Physical inactivity,
HRT,
Diabetes,
Metabolic syndrome,
Tamoxifen,
Nullparity,
Longer menstrual lifespan,
Lynch syndrome type II.

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19
Q

How do you diagnose Lynch syndrome?

A

Amsterdam criteria:
Colorectal CA in 3+ relatives,
Involves at least two generations,
One case above age 50,
FAP excluded

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20
Q

How can you reduce the risk of endometrial cancer?

A

Reduce BMI
Avoid diabetes,
Parity and COCP use protective,
TVS and biopsy,
Progesterone prophylaxis?

21
Q

What is the staging of ovarian cancer?

A

Stage 1 - Tumour confined to uterus
2 - Cervical stromal invasion but not beyond uterus.
3 - Tumour invasion outside of uterus
Stage 4 - Metastasis.

22
Q

What are the investigations for endometrial cancer?

A

Bloods
Imaging - Transvaginal scan to measure endometrial thickness, if thick then biopsy (pipelle or hysteroscopy)

23
Q

When to biopsy endometrial tissue?

A

If thickness > 3mm and not HRT useres.
If thickness > 5mm and HRT user.
Hyseroscopy/biopsy if using tamoxifen

24
Q

Endometrialcancer: What is the treatment for early disease?

A

Total hysterectomy, BSO and washings.
Examine all peritoneal surfaces,
Lymphadenectomy
May need additional chemorads

25
Q

What is the treatment for advanced disease?

A

Surgery, chemo, radiotherapy, hormonal treatment.
If inoperable then chemo/rads and/or hormonal therapy.

26
Q

Describe features of radiotherapy in endometrial cancer

A

Either external beam, or brachytherapy.
Side effects - Proctitis, cystitis, lethargy and skin changes.

27
Q

What are the risk factors for cervical cancer?

A

HPV,
Smoking,
Early first episode of sexual intercourse,
COCP use,
Multiple sexual partners,
Immunosuppression

28
Q

What strains does the Gardisal vaccine protect against?

A

HPV 6, 11, 16 and 18.

29
Q

What is the cervical screening programme?

A

Smears every 3 years for women aged 25-49
Smears > 50y is every 5 years
More based on HPV status now

30
Q

Describe anatomy of cervix

A

Endocervix is columnar epithelium and ectocervix is squamous cell. Where this change happens is called the transformation zone.

31
Q

What are the ix for an abnormal looking cervix?

A

Do not do smear. Do biopsy!
Either punch biopsy or large loop excision of transformation zone (LLETZ). A LLETZ is both treatment and biopsy

32
Q

Describe features of colposcopy

A

Done if abnormal smear result of suspicious symptoms/appearance.
Uses a binocular microscope and examination with acetic acid and/or lugols iodine.
If abnormal on colposcopy then either do biopsy or go ahead and treat first.

33
Q

Describe features of cervical intraepithelial neoplasia

A

CIN 1 - low grade and should resolve on their own.
CIN2 or 3 - High grade and therefore treatment is offered.
Treatment - excisional. most commonly via LLETZ.
Then continue to follow up, if + for HPV then more follow up

34
Q

What are the most common types of cervical cancer types?

A

Adenocarcinoma
Adenosquamous carcinoma

35
Q

What is the presentation of cervical cancer?

A

Unschedualed vaginal bleeding,
Offensive vaginal discharge,
Obstructive renal failure,
Supraclavicular node
Can also be asymptomatic

36
Q

Staging of cervical cancer

A

Stage 1 - confined to cervix
Stage 2 - Spread to vagina and parametrium
Stage 3 - SPread within pelvis,
Stage 4 - Mets

37
Q

What is the management of cervical cancer?

A

Surgery - fertility sparing, simple or radical surgery
Chemotherapy - cisplatin
Radiotherapy
If advanced disease then pallative care, chemorads

38
Q

Fertility conserving surgery for cervical ca

A

LLETZ,
Trachelectomy - will probably need IVF and then C-section

39
Q

simple vs total hysterectomy

A

Simple - only uterus and cervix. Used for 1A1 and 1A2 staging.
Radicle - Uterus, cervix and parts of vagina. Used in 1B1 and 2A staging

40
Q

RFs for vulva cancer?

A

Smoking,
HPV,
Immunosuppression,
Lichen sclerosis

41
Q

Pathological types of vulval cancers?

A

90% squamous cell carcinoma,
Others: Adenocarcinoma, melanoma, BCC, sarcoma

42
Q

What is the precursors to vulval cacner?

A

Vulval intraepithelial neoplasia 1,2 and 3
VIN 2/3 - Usual, warty, basaloid.

43
Q

What is the presentation of VIN?

A

Pruritis,
Pain,
Ulceration,
Thickened white areas,
Lump/wart,
Asymptomatic

44
Q

Where is the commonest sites of VIN?

A

Labia majora, labia minora, posterior courchette

45
Q

How do you diagnose and manage high grade VIN?

A

Biopsy - incisional or exision.
Management - Observation or excision, ablation either with laser or chemical (imiquimod)

46
Q

Signs and symptoms of vulvar cancer?

A

Symptoms - lump, pain, bleeding, discharge, swollen leg, groin lump.

Signs - Mass, ulceration, colour changes, elevation and irregular surface, inguinal lymphadenopathy and lower limb lymphoedema

47
Q

How do you diagnose vulval cancer?

A

Biopsy - incisional (prefered) or excisional.
Investigate locoregional lymphnodes with US, CT or MRI

48
Q

What is the management of vulval cancer?

A

Surgical - WLE or vulvectomy (triple excision). Do sentinal lymph node biopsy, if negative then no need to preform lymphadenectomy

49
Q

What are the complications of lemphadenectomy?

A

Delayed wound healing, infection, wound breakdown, lymphoedema, recurrent infection.

5 - Obstetrics and Gynaecology (22 decks)

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