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Y4 CBLs > Obs&Gyn: Gyn malignancies > Flashcards

Obs&Gyn: Gyn malignancies Flashcards

1
Q

Cervical screening programme

A
  • 25-49 years: 3-yearly screening
  • 50-64 years: 5-yearly screening

*cervical screening cannot be offered to women over 64

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2
Q

Cervical screening in pregnancy

A

Cervical screening in pregnancy is usually delayed until 3 months post-partum unless missed screening or previous abnormal smears

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3
Q

Possible results of the cervical screen

A
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4
Q

Grades of CIN

A

CIN is a precancerous lesion. They are graded histologically as:

  • CIN 1 – 1/3 thickness affected (can revert to normal in 10-23 months)
  • CIN 2 – 2/3 thickness
  • CIN 3 – Full thickness (carcinoma in situ)
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5
Q

Management of Cervical Intraepithelial Neoplasia (CIN)

A
  • Cold coagulation in CIN 1
  • Follow up according to NHS cervical screening

guidelines

•LLETZ (Large Loop Excision of Transformation zone → performed mostly under local anaesthesia

to confirm diagnosis and treat)

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6
Q

HPV vaccine

A

Gardasil → protects against HPV 6, 11, 16 & 18

  • all 12- and 13-year-olds (girls AND boys) in school Year 8 will be offered the human papillomavirus (HPV) vaccine
  • given as 2 doses - girls have the second dose between 6-24 months after the first, depending on local policy
  • HPV vaccination should also be offered to men who have sex with men under the age of 45 to protect against anal, throat and penile cancers
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7
Q

Common subtypes of HPV that are linked to a disease

A
  • 6 & 11: causes genital warts
  • 16 & 18: linked to a variety of cancers, most notably cervical cancer
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8
Q

Risk factors predisposing to cervical cancer

A
  • HPV serotypes 16,18 & 33
  • smoking
  • HIV
  • early first intercourse, many sexual partners
  • high parity
  • lower socioeconomic status
  • combined oral contraceptive pill
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9
Q

Symptoms of cervical cancer

A
  • Intermenstrual bleeding/post- coital bleeding
  • Vaginal discharge
  • Pelvic pain (advanced disease)
  • Abnormal looking cervix
  • Pelvic vein thrombosis causing a swollen leg
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10
Q

Types of cervical cancer

A
  • Squamous cell carcinoma (85%)
  • Adenocarcinoma
  • Rare forms: malignant melanoma, sarcoma
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11
Q

Investigations in cervical cancer

A
  • Colposcopy – cervical biopsy
  • Cystoscopy and sigmoidoscopy
  • Bloods: FBC, U&E, LFTs
  • MRI pelvis, CT abdomen and Chest
  • Clinical staging :FIGO
  • Cone biopsy
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12
Q

Management of cervical cancer

A
  • Wertheim’s Hysterectomy/ aka radical hysterectomy
  • Radiotherapy
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13
Q

Risk factors for endometrial cancer

A
  • obesity
  • nulliparity
  • early menarche
  • late menopause
  • unopposed oestrogen (addition of a progestogen to oestrogen reduces this risk)
  • diabetes mellitus
  • tamoxifen
  • polycystic ovarian syndrome
  • hereditary non-polyposis colorectal carcinoma
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14
Q

Symptoms of endometrial cancer

A
  • postmenopausal bleeding is the classic symptom
  • premenopausal women may have a change intermenstrual bleeding
  • pain and discharge are unusual features
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15
Q

Ix in endometrial cancer

A
  • Ultrasound (endometrial thickness)
  • Hysteroscopy / Dilatation & Curettage
  • MRI of abdomen and pelvis
  • Chest X ray
  • Bloods-FBC,U&E and LFT
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16
Q

Who should we investigate for endometrial cancer?

A
  • women >= 55 years who present with postmenopausal bleeding should be referred using the suspected cancer pathway
  • first-line investigation is trans-vaginal ultrasound - a normal endometrial thickness (< 4 mm) has a high negative predictive value
  • hysteroscopy with endometrial biopsy
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17
Q

Management of endometrial cancer

A
  • localised disease is treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy
  • Patients with high-risk disease may have post-operative radiotherapy
  • progestogen therapy is sometimes used in frail elderly women not consider suitable for surgery
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18
Q

Risk factors for ovarian cancer

A
  • family history: mutations of the BRCA1 or the BRCA2 gene or HPNCC
  • many ovulations: early menarche, late menopause, nulliparity
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19
Q

Symptoms of ovarian cancer

A

Clinical features are notoriously vague

  • abdominal distension and bloating
  • abdominal and pelvic pain
  • urinary symptoms e.g. Urgency
  • early satiety
  • diarrhoea
20
Q

Investigation of ovarian cancer

A
  • CA125
    • CA125 test is done initially → endometriosis, menstruation, benign ovarian cysts and other conditions may also raise the CA125 level
  • if the CA125 is raised (35 IU/mL or greater) → urgent ultrasound scan of the abdomen and pelvis should be ordered

*a CA125 should not be used for screening for ovarian cancer in asymptomatic women

  • ultrasound
  • Diagnosis is difficult and usually involves diagnostic laparotomy
21
Q

Types of ovarian cancers

A
  • Epithelial → serous, mucinous, endometrioid
  • Sex cord stromal →granulosa cell
  • Malignant germ cell tumours → dysgerminoma, immature teratoma
  • Metastatic tumours
22
Q

Management of ovarian cancer

A
  • MDT discussion for plan of management including calculation of risk of malignancy index (risk of malignancy of a cyst)
  • Surgery (Hysterectomy and bilateral salpingo-ophorectomy , omentectomy) and surgical FIGO staging
  • Chemotherapy ( i.e. Carboplatin)
  • Monitor response clinically with regular follow up; tumour marker (CA125, CEA, CA19-9 )
  • Palliative: drainage of ascites
23
Q

Vulval intraepithelial neoplasia

  • what’s that
  • presentation
  • Ix
  • management
A
  • Premalignant lesion of the vulva
  • Presents as visible lesion, pain or pruritus
  • Investigations : vulvoscopy and biopsy
  • Treatment is local excision
  • Long term follow up
24
Q

Presentation of vulval carcinoma

A

Vulval:

  • itching
  • irritation
  • pain
  • bleeding
25
Q

Development of vulval carcinoma

A
  • Can develop from lichen schlerosus, VIN ,lichen planus and Paget`s disease
  • Lesions can be exophytic mass or ulcerative
  • Spreads locally and can embolise to the inguinal lymph nodes
26
Q

Treatment of vulval cell carcinoma

A
  • Wide local excision (early disease)
  • Radiotherapy to protect sphincter function
  • Radical vulvectomy with inguinal node dissection
27
Q

Types of vaginal carcinoma

A
  • Usually secondary from malignancies elsewhere (endometrium, cervix, vulva, colon, rectum)
  • Usually squamous cell carcinomas
  • Adenocarcinoma (9%)
28
Q

Treatment of vaginal carcinoma

A

Most treated with chemo and radiotherapy

29
Q

What’s uterine sarcoma?

A

Aggressive tumours arising from the myometrium of the uterus

30
Q

Types of uterine sarcomas

A
  1. Leiomyosarcoma
  2. Endometrial stromal sarcoma
  3. Mixed mullerian tumours
31
Q

Investigations and management of uterine sarcomas

A
  • Staging is surgico-pathological
  • Ultrasound scan shows vascular mass in the myometrium
  • MRI and CT Chest
  • Surgery is the mainstay of treatment
32
Q

Origin of fallopian tube cancer

A
  • 90% papillary serous adenocarcinoma
  • Arise from the endosalpinx
  • Transition from benign to malignant of tubal mucosa
  • Ovaries and endometrium are normal or contain smaller tumours
33
Q

Presentation of fallopian tube cancer

A
  • vaginal bleeding
  • pain
  • discharge
34
Q

Investigations of fallopian tube cancers

A
  • Tubal cystic mass on ultrasound
  • Diagnosed at laparotomy-FIGO staging
35
Q

Management of fallopian tube cancers

A
  • Surgical TAH and BSO along with omentectomy and removal of lymph nodes
  • Chemotherapy
36
Q

Risk of malignancy index

A
37
Q

What’s HPV triage?

A
  1. Smear
  2. Tested for HPV

a. If negative → not anything else, routine smear in 3 years
b. If positive → test for dyskariosis: - if borderline/mild → smear in 1 year; if severe → colposcopy
* After 1 year → if negative routine recall if still positive →see for dyscariosis and so on

If 3 positive HPV smears → colposcopy anyway (regardless of grade of dyscariosis)

38
Q

Total abdominal hysterectomy vs radical

A
  • radical take out also the top part of vagina + part of abdominal wall
39
Q

Figo staging for gyn cancers

A
40
Q

What’s a omental cake?

A

Omentum is full of cancer (usually from ovarian ca)

41
Q

What value on the Risk of Malignancy Index do we worry about?

A

250 and over → high risk of ovarian ca

42
Q

Possible causes of post-coital bleed

A
  • infection
  • ectropion
  • cancer
  • trauma
43
Q

Triple swap

A
  • endocervical for chlamydia and gonorrhoea
  • high vaginal swab → general infection e.g. trush
44
Q

Management of endometrial hyperplasia

A
  • simple endometrial hyperplasia without atypia: high dose progestogens with repeat sampling in 3-4 months. The levonorgestrel intra-uterine system may be used
  • atypia: hysterectomy is usually advised
45
Q
A

Y4 CBLs (32 decks)

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