Ovary & Endometrium Flashcards

1
Q

What does a normal cervical examination show in a post menopausal woman?

A

Thin, pale, atrophic cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is looked at in a transvaginal USS of the endometrium

A
  • Measure endometrial thickness
  • Looks at the endometrial contour
  • Biopsy if >4mm or irregular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What can you do with a hysteroscopy?

A

With this can inspect the whole of the uterine cavity & endocervical canal-target area of abnormality when taking biopsy

(Outpatient with LA & inpatient with GA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How are the pathological prognostic factors of endometrial cancer assessed?

A
  1. Histological type - Based on microscopy +/- ancillary tests
  2. Histological grade - Microscopy
  3. Stage - How far tumour has spread, based on surgical resection with assessment of entire uterus and adjacent organs
  4. Lymphovascular space invasion (LVSI) - Microscopy of resection specimen

(MRI maybe before surgery which can give a radiological staging & Do pathological staging only when have the surgical resection specimen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the two Distinct Categories of Endometrial Cancer?

A

TYPE 1
- Endometrioid adenocarcinoma
- Commonest
- Unopposed oestrogen
- Hyperplasia with atypia precursor

TYPE 2
- Uterine serous & clear cell carcinoma
- High grade, more aggressive, worse prognosis
- Generally older women
- Serous intraepithelial carcinoma precursor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

..?.. is a risk factor for Type 1 endometrial cancer

A

OBESITY

Obesity=peripheral conversion of androgens in body fat into a weak oestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is endometrial cancer staged?

A

Surgical/Pathological

MRI
- depth of myometrial invasion
- cervical involvement
- lymph node involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What staging is used for endometrial cancer?

A

FIGO staging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the treatment for endometrial cancer depending on stage?

A

Early Stage=Surgery TAH/BSO/washings

High risk histology=Chemotherapy

Advanced Stage=Radiotherapy

Palliation=Progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Endometrium is ..?.. sensitive so high levels is a risk factor for endometrial cancer

A

Eostrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the risk factors for endometrial cancer?

A

Post-menopausal women

High circulating oestrogen levels
- obesity
- unopposed E2 therapy/Tamoxifen
- PCOS
- early menarche/late menopause

Endometrial hyperplasia with atypia

HNPCC/Lynch type II familial cancer syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Must combine HRT with ..?.. to protect uterus

A

Progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Tamoxifen although it acts as an anti oestrogen in breast tissue it actually acts as what in the uterus?

A

An oestrogen and is associated with an increased risk of endometrial hyperplasia, endometrial adenocarcinoma and endometrial sarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In women <45 with endometrial cancer what is it important to check for?

A

Test for Lynch also important to check this in a FH of a woman with a new onset of heavy, irregular bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the symptoms of endometrial cancer?

A
  • Abnormal vaginal bleeding
  • PMB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are causes of PMB (post menopausal bleeding)?

A

8% of women with PMB will have endometrial cancer

Hormone Replacement Therapy (HRT)

Peri-menopausal bleeding

Atrophic vaginitis

Polyps cervical/endometrial

Other cancer eg cervix, vulva, bladder,anal

17
Q

Endometrial cancer is diagnosed by what?

A

Histology of the endometrium

18
Q

What is the main treatment for endometrial cancer?

A

Total abdominal hysterectomy with removal of tubes & ovaries & peritoneal washings

19
Q

Who does ovarian cancer present in?

A

Rare < 30 years

High risk families 5-10% of cases
- HNPCC/Lynch type II familial cancer syndrome
- BRCA1
- BRCA2

‘Incessant ovulation’
OCP protective

20
Q

Where do most cases of ovarian cancer probably originate from?

A

Most cases probably actually originate from the fallopian tube

Some derive from pre-existing benign ovarian cysts (often low grade cancers)

21
Q

What genes are linked to high grade ovarian serous carcinoma?

A

p53

BRCA 1

BRCA 2

22
Q

What are the symptoms of ovarian cancer?

A

Vague!

Indigestion/early satiety/poor appetite

Altered bowel habit/pain

Bloating/discomfort/weight gain

Pelvic mass
- asymptomatic
- pressure symptoms

23
Q

How is ovarian cancer diagnosed?

A

Surgical/Pathological
US Scan abdomen and pelvis
CT Scan

CA 125 (enzyme which can be measured)

Surgery

24
Q

What conditions can CA125 be associated with?

A

Malignancy
- ovary
- colon/pancreas
- breast

Benign conditions
- menstruation/endometriosis/PID
- liver disease/recent surgery/effusions

25
What is CA125 used for in the context of ovarian cancer?
Used in detecting and monitoring epithelial ovarian tumours
26
What is included in risk of malignancy index (RMI) for ovarian cancer?
RMI=U x M x CA 125 Ultra sound features - multi-locular - solid areas - bilateral - ascites - intra-abdominal Menopausal status CA 125 level
27
How is ovarian cancer treated?
Surgery +/- Chemo (adjuvant or neoadjuvant) - within 8 weeks of surgery - First line Platinum and taxane (Taxol) - Complete/partial response - Cure unlikely - Average response 2 years
28
What is a laparotomy used for in ovarian cancer?
Obtain tissue diagnosis Stage disease Disease clearance Debulk disease
29
What is done for a recurrence of ovarian cancer?
Chemotherapy Palliation - symptomatic recurrence Platinum if > 6months ?Surgery Tamoxifen
30
Who is screened for ovarian cancer?
Population screening NOT proven High risk women - cancer gene mutation carriers - 2 or more relatives Pelvic examination US scanning of ovaries CA 125
31
With what stage disease does ovarian cancer usually present with?
Stage 3 or 4 disease - Poor prognosis
32
What can surgery be used for in ovarian cancer?
To stage & to reduce disease bulk