Oncology Flashcards
What are the different grades of CIN
CIN 1 (low grade) – Mild dysplasia confined to lower 1/3 of epithelium
CIN 2 (high grade) – Moderate dysplasia affecting 2/3 of epithelial thickness
CIN 3 (high grade) – Severe dysplasia extending to upper 1/3 of epithelium
when is the peal incidence of CIN
25-29
what HPV types are associated with CIN
16 & 18
what is the timeline for smear invitations
25-50 = every 3y 50-65 = every 5y
What is the pathway following an abnormal smear result
CIN1 - HPV test, if +ve colposcopy, if -ve routine recall
CIN2 or 3 - urgent colposcopy
what is the management of CIN
CIN 1 - repeat smear in 12 mo
2/3 - LLETZ (lrg loop excision of transformation zone)
OR - core biopsy (for larger lesions - req GA)
follow up test of cure after 6 mo
what are some risks associated with LLETZ
inc risk mid trimester miscarriage or preterm delivery
what is the most common type of cervical cancer
80% = squamous 20% = adenocarcinoma
what is the staging system for cervical cancer
FIGO staging system
what are some RFs for cervical cancerf
Major = HPV
minor: smoking, inc sexual partners, early first intercourse, immunosupp
Signs/sympto of cervical cancer
IMB
post menoP bleed
offensive PV discharge (often bloodstained)
What is the best imaging inv for cervical cancer
MRI > CT-CAP
what is the best imaging for ovarian/endometrial C
CT-CAP > MRI
What is the management pathway for cervical cancer
if stage Ia1 (microinv - conservative, LETZ/cone biopsy
early stage - <4cm radical hysterectomy and lymphadenopathy
- > 4cm - chemo (cisplatin)
- fertility sparing - radical trachelectomy
Advanced - chemo + radiotherapy
What are some risk factors for endometrial hyperplasia
age, obesity smoking habit
inc oestrogen - early menarche, late menopause, nulliparous, COCP. tamoxifen, HRT
high insulin - T2DM, PCOS
what are the inv for suspected endometrial Hyperplasia
1st - TVUSS - be careful to watch over their ovulatory cycle
2 - diagnostic gold standard = hysteroscopy + pipelle biopsy
Whatr is the management of EH without atypia
1st = LNG-IUS 2nd = oral progesterone
what is the management of EH with atypia
total hysterectomy + bilat salpingo-oophrectomy
What is ther number one Ddx if post menopausal bleeding
Endometrial cancer
what is the treatment for the different stages of endometrial cancer
Stage 1 - total abdominal hysteroscopy + bilat salpingoophrectomy + peritoneal washings
stage 2 - Radical hysterectomy (inc cervix) + radiotherapy adjunct + lymph node assessment
3 - debulking + chemo + radio
4 - debulking + palliative
What are the red flags for ovarian caner
bloating in post menopausal women, irreg bleed, urinary distrbance
What is RMI and how is it calculated
Risk of malig index
RMI = U x M x CA125
U = USS findings (0, 1 (1 ft) or 2 (2+ features)
M = menopause status (1 = pre, 2 = post)
what are some RFs for ovarian cancer
age, FHx, obe3sity, HRT, endometriosis, diabetes
what are some protective factors for ovarian cancer
COCP, breast feeding, hysterectomy
