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Ovary & Endometrium Flashcards

1
Q

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

A

Thin, pale, atrophic cervix

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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
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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)

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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)

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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

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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

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7
Q

How is endometrial cancer staged?

A

Surgical/Pathological

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

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8
Q

What staging is used for endometrial cancer?

A

FIGO staging

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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

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10
Q

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

A

Eostrogen

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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

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12
Q

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

A

Progesterone

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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

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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

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15
Q

What are the symptoms of endometrial cancer?

A
  • Abnormal vaginal bleeding
  • PMB
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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
Q

What is CA125 used for in the context of ovarian cancer?

A

Used in detecting and monitoring epithelial ovarian tumours

26
Q

What is included in risk of malignancy index (RMI) for ovarian cancer?

A

RMI=U x M x CA 125

Ultra sound features
- multi-locular
- solid areas
- bilateral
- ascites
- intra-abdominal

Menopausal status

CA 125 level

27
Q

How is ovarian cancer treated?

A

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
Q

What is a laparotomy used for in ovarian cancer?

A

Obtain tissue diagnosis

Stage disease

Disease clearance

Debulk disease

29
Q

What is done for a recurrence of ovarian cancer?

A

Chemotherapy

Palliation
- symptomatic recurrence

Platinum if > 6months

?Surgery

Tamoxifen

30
Q

Who is screened for ovarian cancer?

A

Population screening NOT proven

High risk women
- cancer gene mutation carriers
- 2 or more relatives

Pelvic examination

US scanning of ovaries

CA 125

31
Q

With what stage disease does ovarian cancer usually present with?

A

Stage 3 or 4 disease

  • Poor prognosis
32
Q

What can surgery be used for in ovarian cancer?

A

To stage & to reduce disease bulk

Reproduction (17 decks)

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