Ovarian, Endometrial and Cervical Cancers Flashcards
What’s the most common ovarian cancer?
Serous carcinoma
What is a follicular cyst?
Benign ovarian cyst
Most common ovarian cyst
Due to non-rupture of dominant follicle
Commonly regress after several menstrual cycles
What is the epidemiology of endometrial cancer?
Seen in post menopausal women mostly (though about 25% occur before)
Most common of all the gynae cancers
Risk factors:
Obesity - fat cells synthesis free circulating androgens into estrone - increased unopposed oestrogen
Nulliparity
Early menarche
Late menopause
Unopposed oestrogen - reduced with combined progesterone
T2DM
Tamoxifen (blocks oestrogen in breast tissue but acts like oestrogen on endometrial tissue)
Polycystic ovaries
Oestrogen only HRT
Combined oral contraceptive pill + parity are protective
Most common is adenocarcinoma
How does endometrial cancer present?
Post menopausal bleeding is the classic sign - even 1x episode
If premenopausal - may have change in bleeding
Possible pain and discharge
How do you investigate post menopausal bleeding?
In women >55yrs - suspected cancer pathway/2wk wait
1st line investigation is transvaginal USS:
Normal endometrial thickness (<4mm) has a good negative predictive value, if increased - increased risk of Ca
Pipelle biopsy +/- hysteroscopy is diagnostic
May do CT/MRI to check for mets
How do you manage endometrial cancer?
If localised - total hysterectomy + bilateral salpingo-oophorectomy +/- local lymph node removal +/- post op radiotherapy or chemotherapy (depending on spread to vagina and other structures
Progesterone e.g. Mirena coil as a palliative agent to shrink endometrial lining and reduce symptoms may be suitable for those not eligible for surgery; may even be curative in some patients
For patients on palliative treatment (including for precancerous cells) - review with biopsy every 6/12
What is a dermoid cyst/cystic teratoma?
Most common benign ovarian tumour in women under 30yrs
Median age of Dx = 30yrs
Bilateral in 10-20%
Usually asymptomatic but most likely of all ovarian rumours to present with torsion
What is the epidemiology of ovarian cancer?
5th most common malignancy in females
Leak incidence is 60yrs
Risk factors:
Mutations in BRCA1 or BRCA2 genes
Many ovulations - early menarche, late menopause, nulliparity
Obesity
Oral contraceptive is protective
Prognosis often poor because of late Dx - high percentage have advanced disease, 5yr survival is 46%
What is the pathophysiology of ovarian cancer?
C.90% are epithelial in origins = 70-80% due to serous carcinomas
How does ovarian cancer present?
Vague
Abdominal distension, bloating, pain
Pelvic pain
Urinary symptoms e.g. urgency
Anorexia, weight loss, night sweats, diarrhoea
How do you investigate ovarian cancer?
CA125 bloods:
Raised - >35IU/ml = urgent USS of abdo + pelvis
(Also raised in endometriosis, menstruation, benign ovarian cysts)
CA125 is sensitive but not specific - can be raised in other conditions that irritate the adnexa (e.g. endometriosis, even some liver diseases) but levels in cancer tend to be >100IU/ml
USS
Dx laparotomy
How do you manage ovarian cancer?
Surgery
Chemo- cisplatin (?)
How is ovarian cancer graded?
Stage 1
Tumour in ovary
Stage 2
Tumour outside ovary but in pelvis
Stage 3
Tumour outside pelvis but in abdomen
Stage 4
Distant mets
How does cervical cancer screening work?
Smears offered to all women 25-64:
i) 25-49 = 3yrly (attendance in this age group is not high enough)
ii) 50-64 = 5yrly
Checks for:
Cervical intraepithelial neoplasia (CIN)
Human papilloma virus (HPV)
If worrying looking results (moderate dyskaryosis/CIN II-III), will have a 2wk colposcopy in clinic with acetic acid stains +/- biopsy of any suspicious looking tissues which will then go to histology for Dx confirmation then return to colposcopy for treatment by large loop excision of the transformation zone (LLETZ) (this is curative in stage 1a which is usually what usually presents to clinic)
Borderline dyskaryosis with -ve HPV - repeat in 3yrs; with +ve - refer to colp
900 woman die a year in the UK; 900 women a day worldwide
Why is HPV important?
Is an agent often responsible for stimulating the dyskaryosis process where cervical cells in the transformation zone of the cervix (junction between columnar epithelium and squamous) start to have larger nuclei relative to their cytoplasm - the first noticeable change in precancerous states (though progression to cancer takes many years)
Persistent HPV is what increases this risk
HPV is found in 95% of the squamous cell cervical carcinomas (the most common type) and 60% of the adenocarcinomas (c.15%); also linked to squamous cell vulval cancer
High risk HPV subtypes = 16, 18, (31, 33)
