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Finals > O&G: Gynae cancers > Flashcards

O&G: Gynae cancers Flashcards

1
Q

Cervical cancer

who does it tend to affect

A

younger women, peaking in the reproductive years

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2
Q

Cervical cancer

what is the most common type

A
  • squamous cell carcinoma

- then adenocarcinoma

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3
Q

Cervical cancer

what is is strongly associated with

A

human papillomavirus

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4
Q

Cervical cancer

at what age are people vaccinated against certain strains of HPV to reduce risk of cervical cancer

A

children aged 12-13y

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5
Q

Cervical cancer

how is HPV transmitted

A

primarily a STI

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6
Q

Cervical cancer

what types of HPV are responsible for around 70% of cervical cancers

A

type 16 and 18

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7
Q

Cervical cancer

what is the trx for infection with HPV

A

none, most cases resolve spontaneously within 2y

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8
Q

Cervical cancer

how does HPV promote the development of cancer

A

HPV produces proteins E6 and E7

which inhibit P53 and pRb tumour suppressor genes respectively

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9
Q

Cervical cancer

risk factors

A

increased risk of catching HPV:

  • early sexual activity
  • increased number of sexual partners
  • sexual partners who have more partners
  • not using condoms

non-engagement with cervical screening

  • smoking
  • HIV
  • COCP use>5y
  • increased number of full term pregnancies
  • FH
  • Exposure to diethylstilbestrol during fetal development (was previously used to prevent miscarriages before 1971)
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10
Q

Cervical cancer

presentation

A
  • asymptomatic
  • abnormal vaginal bleeding
  • vaginal discharge
  • pelvic pain
  • dyspareunia
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11
Q

Cervical cancer

appearances on speculum exam that may suggest cervical cancer

A
  • ulceration
  • inflammation
  • bleeding
  • visible tumour
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12
Q

Cervical cancer

speculum exam may suggest cervical cancer. What next?

A

urgent cancer referral for colposcopy

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13
Q

Cervical cancer

what is Cervical intraepithelial neoplasia (CIN)

A

a grading system for the level of dysplasia (premalignant change) in the cells of the cervix

CIN is diagnosed at colposcopy (not with cervical screening)

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14
Q

Cervical cancer

CIN I grade

A
  • mild dysplasia
  • affecting 1/3 the thickness of the epithelial layer
  • likely to return to normal without treatment
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15
Q

Cervical cancer

CIN II grade

A
  • moderate dysplasia
  • affecting 2/3 the thickness of the epithelial layer
  • likely to progress to cancer if untreated
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16
Q

Cervical cancer

CIN III grade

A
  • severe dysplasia
  • very likely to progress to cancer if untreated
  • aka cervical carcinoma in situ
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17
Q

Cervical cancer

screening: what does microscope examination look for

A

precancerous changes (dyskaryosis)

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18
Q

Cervical cancer

screening: what are samples initially tested for before cells are examined

A

high-risk HPV

if HPV test is -ve, the cells are not examined, the smear is considered negative, and the woman is returned to the routine screening program.

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19
Q

Cervical cancer

how often are women screened

A
  • every 3y aged 25-49

- every 5y aged 50-64

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20
Q

Cervical cancer

how often are women with HIV screened

A

annually

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21
Q

Cervical cancer

can women over 65 request a smear if they have not had one since aged 50

A

yes

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22
Q

Cervical cancer

if pregnant and due a routine smear, what should they do

A

wait until 12 weeks post-partum

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23
Q

Cervical cancer

what organisms are often discovered in women with an intrauterine device (coil).

A

Actinomyces-like organisms

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24
Q

Cervical cancer

smear result: inadequate sample

what next

A

repeat the smear after at least three months

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25
Q

Cervical cancer

smear result: HPV negative

what next

A

continue routine screening

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26
Q

Cervical cancer

smear result: HPV positive with normal cytology

what next

A

repeat the HPV test after 12 months

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27
Q

Cervical cancer

smear result: HPV positive with abnormal cytology

what next

A

refer for colposcopy

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28
Q

Cervical cancer

what does colposcopy involve

A

inserting speculum and using colposcope to magnify cervix

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29
Q

Cervical cancer

colposcopy: what does the stain, acetic acid do

A

causes abnormal cells to appear white: acetowhite

because CIN and cervical cancer cells have more nuclear material

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30
Q

Cervical cancer

colposcopy: what does the stain, Schiller’s iodine test do

A

Iodine will stain healthy cells a brown colour. Abnormal areas will not stain.

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31
Q

Cervical cancer

colposcopy: how to get a tissue sample

A

punch biopsy or large loop excision of the transformational zone

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32
Q

Cervical cancer

what is the large loop excision of the transformation zone (LLETZ) procedure aka

A

a loop biopsy

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33
Q

Cervical cancer

what does a LLETZ involve

A

single diathermy to remove abnormal epithelial tissue on the cervix

The electrical current cauterises the tissue and stops bleeding.

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34
Q

Cervical cancer

what may LLETZ increase the risk of

A

preterm labour

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35
Q

Cervical cancer

what is a cone biopsy for

A

trx for cervical intraepithelial neoplasia (CIN)

and very early-stage cervical cancer.

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36
Q

Cervical cancer

what is involved in a cone biopsy

A

Surgeon removes a cone-shaped piece of the cervix using a scalpel.

This sample is sent for histology to assess for malignancy.

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37
Q

Cervical cancer

main risks of cone biopsy

A
  • pain
  • bleeding
  • infection
  • scar formation with stenosis of the cervix
  • increased risk of miscarriage and premature labour
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38
Q

Cervical cancer

stage 1

A

Confined to the cervix

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39
Q

Cervical cancer

stage 2

A

Invades the uterus or upper 2/3 of the vagina

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40
Q

Cervical cancer

stage 3

A

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

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41
Q

Cervical cancer

stage 4

A

Invades the bladder, rectum or beyond the pelvis

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42
Q

Cervical cancer

mnx for CIN and early-stage 1A

A

LLETZ or cone biopsy

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43
Q

Cervical cancer

mnx for stage 1B-2A

A
  • radical hysterectomy

- removal of local lymph nodes with chemo and radio

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44
Q

Cervical cancer

mnx for stage 2B - 4A

A

Chemotherapy and radiotherapy

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45
Q

Cervical cancer

mnx for stage 4B

A

combination of surgery, radiotherapy, chemotherapy and palliative care

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46
Q

Cervical cancer

what is pelvic exenteration

A

used in advanced cervical cancer

removing most or all of the pelvic organs, including the vagina, cervix, uterus, fallopian tubes, ovaries, bladder and rectum

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47
Q

Cervical cancer

what is Bevacizumab (Avastin)

A

a monoclonal antibody that may be used in combination with other chemotherapies in the treatment of metastatic or recurrent cervical cancer

48
Q

Cervical cancer

how does Bevacizumab (Avastin) work

A

It targets vascular endothelial growth factor A (VEGF-A), which is responsible for the development of new blood vessels.

Therefore, it reduces the development of new blood vessels.

49
Q

Cervical cancer

what is the current NHS HPV vaccine

A

gardaso;

50
Q

Cervical cancer

which strains does the HPV vaccine protect against

A

6 + 11: genital warts

16 + 18: cervical cancer

51
Q

Endometrial Cancer

what type is the most common

A

adenocarcioma

52
Q

Endometrial Cancer

what does it mean by oestrogen-dependent cancer

A

oestrogen stimulates the growth of endometrial cancer cells.

53
Q

Endometrial Cancer

woman presenting with postmenopausal bleeding. What is it

A

endometrial cancer until proven otherwise

54
Q

Endometrial Cancer

key RFs

A

obesity + diabetes

55
Q

Endometrial Cancer

what is endometrial hyperplasia

A

a precancerous condition involving thickening of the endometrium.

56
Q

Endometrial Cancer

what are 2 types of endometrial hyperplasia to be aware of

A
  • Hyperplasia without atypia

- Atypical hyperplasia

57
Q

Endometrial Cancer

how may endometrial hyperplasia be treated

A

by a specialist using progestogens, with either:

  • IU system (mirena)
  • Continuous oral progestogens (e.g. medroxyprogesterone or levonorgestrel)
58
Q

Endometrial Cancer

RFs

A

exposure to unopposed oestrogen:

  • increased age
  • earlier onset menstruation
  • late menopause
  • oestrogen only HRT
  • no or fewer pregnancies
  • obesity
  • PCOS
  • tamoxifen
59
Q

Endometrial Cancer

why do women with PCOS have more exposure to unopposed oestrogen

A

less likely to ovulate and form a corpus luteum.

so progesterone not produced and the endometrial lining has more exposure to unopposed oestrogen.

60
Q

Endometrial Cancer

why do obese women have more exposure to unopposed oestrogen

A

adipose tissue contains aromatase which converts testosterone into oestrogen

61
Q

Endometrial Cancer

what effect does tamoxifen have on breast tissue and the endometrium

A

an anti-oestrogenic effect on breast tissue

but an oestrogenic effect on the endometrium

62
Q

Endometrial Cancer

why may T2 DM increase the risk

A

increased production of insulin.

Insulin may stimulate the endometrial cells and increase the risk of endometrial hyperplasia and cancer.

63
Q

Endometrial Cancer

protective factors

A
  • COCP
  • mirena coil
  • increased pregnancies
  • cigarette smoking
64
Q

Endometrial Cancer

why is smoking a protective factor

A
  • Oestrogen may be metabolised differently in smokers
  • Smokers tend to have less adipose tissue and aromatase enzyme
  • Smoking destroys oocytes (eggs), resulting in an earlier menopause
65
Q

Endometrial Cancer

the number 1 presenting sx

A

postmenopausal bleeding

66
Q

Endometrial Cancer

presentation

A
  • postmenopausal bleeding
  • Postcoital bleeding
  • Intermenstrual bleeding
  • Unusually heavy menstrual bleeding
  • Abnormal vaginal discharge
  • Haematuria
  • Anaemia
  • Raised platelet count
67
Q

Endometrial Cancer

what is the
referral criteria for a 2-week-wait urgent cancer referral for endometrial cancer

A

Postmenopausal bleeding (more than 12 months after the last menstrual period)

68
Q

Endometrial Cancer

NICE recommends referral for a transvaginal ultrasound in women over 55 years with?

A
  • Unexplained vaginal discharge
  • Visible haematuria
  • plus raised platelets, anaemia or elevated glucose levels
69
Q

Endometrial Cancer

3 inx to diagnose and exclude endometrial cancer

A
  • TVUS for endometrial thickness
  • pipelle biopsy
  • hysteroscopy
70
Q

Endometrial Cancer

what is a normal endometrial thickness

A

<4mm

71
Q

Endometrial Cancer

when may you discharge pt following inx

A
  • endometrial thickness <4mm

- normal pipette biopsy

72
Q

Endometrial Cancer

stage 1

A

Confined to the uterus

73
Q

Endometrial Cancer

stage 2

A

Invades the cervix

74
Q

Endometrial Cancer

stage 3

A

Invades the ovaries, fallopian tubes, vagina or lymph nodes

75
Q

Endometrial Cancer

stage 4

A

Invades bladder, rectum or beyond the pelvis

76
Q

Endometrial Cancer

mnx for stage 1 and 2

A

total abdominal hysterectomy with bilateral salpingo-oophorectomy

aka TAH and BSO

(removal of uterus, cervix and adnexa).

77
Q

Endometrial Cancer

mnx stage 3 and 4

A
  • radical hysterectomy involves also removing the pelvic lymph nodes, surrounding tissues and top of the vagina
  • radio and chemotherapy
  • Progesterone may be used as a hormonal treatment to slow the progression of the cancer
78
Q

Ovarian Cancer

types

A
  • Epithelial Cell Tumours
  • Dermoid Cysts / Germ Cell Tumours
  • Sex Cord-Stromal Tumours
  • Metastasis
79
Q

Ovarian Cancer

which is the most common type

A

Epithelial Cell Tumours

80
Q

Ovarian Cancer

what are the subtypes of epithelial cell tumours

A
  • serous tumours (most common)
  • endometrioid carcinomas
  • clear cell tumours
  • mucinous tumours
  • undifferentiated tumours
81
Q

Ovarian Cancer

what are Dermoid Cysts / Germ Cell Tumours

A

benign ovarian tumours.

They are teratomas, meaning they come from the germ cells.

may contain various tissue types, such as skin, teeth, hair and bone.

82
Q

Ovarian Cancer

what are Dermoid Cysts / Germ Cell Tumours associated with

A

ovarian torsion

83
Q

Ovarian Cancer

what may Dermoid Cysts / Germ Cell Tumours cause

A

raised α-FP and hCG

84
Q

Ovarian Cancer

what are sex cord-stromal tumours

A

rare tumours, that can be benign or malignant.

They arise from the stroma (connective tissue) or sex cords (embryonic structures associated with the follicles)

85
Q

Ovarian Cancer

types of Sex Cord-Stromal Tumours

A

Sertoli–Leydig cell tumours

granulosa cell tumours.

86
Q

Ovarian Cancer

what is a Krukenberg tumour

A

a metastasis in the ovary

usually from a GI tract cancer, particularly the stomach

87
Q

Ovarian Cancer

on histology, what will Krukenberg tumours show

A

“signet-ring’’

88
Q

Ovarian Cancer

RFs

A
  • Age (peaks age 60)
  • BRCA1 and BRCA2 genes
  • Increased number of ovulations
  • Obesity
  • Smoking
  • Recurrent use of clomifene

increased ovulations:

  • Early-onset of periods
  • Late menopause
  • No pregnancies
89
Q

Ovarian Cancer

protective factors

A

less lifetime ovulations:

  • COCP
  • breastfeeding
  • pregnancy
90
Q

Ovarian Cancer

presentation

A

non specific:

  • Abdo bloating
  • Early satiety
  • Loss of appetite
  • Pelvic pain
  • Urinary symptoms (frequency / urgency)
  • Weight loss
  • Abdominal or pelvic mass
  • Ascites
91
Q

Ovarian Cancer

why may it present with hip or groin pain

A

ovarian mass may press on the obturator nerve and cause referred hip or groin pain.

92
Q

Ovarian Cancer

when should you refer directly on a 2 week wait referral

A

if a physical examination reveals:

  • Ascites
  • Pelvic mass (unless clearly due to fibroids)
  • Abdominal mass
93
Q

Ovarian Cancer

inital investigations

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

- Pelvic ultrasound

94
Q

Ovarian Cancer

what is the risk of malignancy index (RMI)

A

estimates the risk of an ovarian mass being malignant, taking account of three things:

  • Menopausal status
  • Ultrasound findings
  • CA125 level
95
Q

Ovarian Cancer

secondary care inx

A
  • CT
  • histology
  • paracentesis (ascitic tap)
96
Q

Ovarian Cancer

which women need tumour markers for a possible germ cell tumour (α-FP + HCG)

A

women <40y with a complex ovarian mass

97
Q

Ovarian Cancer

causes of a raised CA125

A
  • Endometriosis
  • Fibroids
  • Adenomyosis
  • Pelvic infection
  • Liver disease
  • Pregnancy
98
Q

Ovarian Cancer

stage 1

A

Confined to the ovary

99
Q

Ovarian Cancer

stage 2

A

Spread past the ovary but inside the pelvis

100
Q

Ovarian Cancer

stage 3

A

Spread past the pelvis but inside the abdomen

101
Q

Ovarian Cancer

stage 4

A

Spread outside the abdomen (distant metastasis)

102
Q

Ovarian Cancer

mnx

A

surgery + chemo

103
Q

Vulval Cancer

what is the most common

A

squamous cell carcinoma

less common: malignant melanomas

104
Q

Vulval Cancer

RFs

A
  • > 75y
  • immunosuppression
  • HPV
  • Lichen sclerosus
105
Q

Vulval Cancer

what is Vulval intraepithelial neoplasia (VIN)

A

a premalignant condition affecting the squamous epithelium of the skin that can precede vulval cancer

106
Q

Vulval Cancer

what is High grade squamous intraepithelial lesion

A

a type of VIN associated with HPV infection that typically occurs in younger women aged 35 – 50 years.

107
Q

Vulval Cancer

what is Differentiated VIN

A

an alternative type of VIN associated with lichen sclerosus and typically occurs in older women (aged 50 – 60 years).

108
Q

Vulval Cancer

what is required to diagnose VIN

A

a biopsy

109
Q

Vulval Cancer

trx options

A
  • Watch and wait with close follow up
  • Wide local excision (surgery) to remove the lesion
  • Imiquimod cream
  • Laser ablation
110
Q

Vulval Cancer

presentation

A
  • Vulval lump
  • Ulceration
  • Bleeding
  • Pain
  • Itching
  • Lymphadenopathy in the groin
111
Q

Vulval Cancer

which part of the vulva does it typically affect

A

labia majora, giving an appearance of:

  • Irregular mass
  • Fungating lesion
  • Ulceration
  • Bleeding
112
Q

Vulval Cancer

Establishing the diagnosis and staging involves:

A
  • Biopsy of the lesion
  • Sentinel node biopsy to demonstrate lymph node spread
  • Further imaging for staging (e.g. CT abdomen and pelvis)
113
Q

Vulval Cancer

mnx

A
  • wide local excision to remove the cancer
  • Groin lymph node dissection
  • Chemotherapy
  • Radiotherapy
114
Q

Ovarian cancer

features to look out for on the USS (as part of the RMI)

A

1 point for each:

  • multiocular cysts
  • solid area
  • metastases
  • ascites
  • bilateral lesions
115
Q

To what regional lymph nodes is her ovarian tumour most likely to spread initially?

A

para-aortic nodes

The main lymphatic drainage of the ovary is to the para-aortic nodes.

Finals (47 decks)

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