Screening for and Management of Gynaecological Cancers

Question 1

Which cancers are Pap smears most effective at detecting?

Answer 1

Squamous cell cancers

Question 2

Who are Pap smears provided to? What will change in 2017?

Answer 2

• Females aged 12-17, with catch-up programs for those 18-26, 2-yearly
• Females aged 25-74, 5-yearly

Question 3

Why is there no screening test for ovarian cancer?

Answer 3

No known pre-malignant lesion. Asymptomatic until very advanced

Question 4

What are the best tests for early detection of ovarian cancer and which populations are they used in?

Answer 4

• Combined TVUS and Ca125
• Used in BRCA and HNPCC positive families
  
  • Require yearly combined test
  • +/- bilateral mastectomy/oophorectomy/salpingectomy

Question 5

What are the main possible results for a Pap smear and how can these be managed?

Answer 5

• Unsatisfactory smear
  
  • Repeat 12 months
• LGIL
  
  • Repeat in 12 months unless last smear the same
• HGSIL
  
  • Colposcopy within 4-6 weeks, earlier if symptomatic
• Negative smear
  
  • Repeat 5 yearly

Question 6

What are some possible reasons for a falsele elevated Ca125?

Answer 6

• Cardiac/liver failure
• Peritonitis
• Menstruation
• Fibroids
• Endometriosis
• PID
• Pregnancy

Question 7

How is the risk of an ovarian mass being malignant determined?

Answer 7

• Risk malignancy index (RMI = U x M x C)
  
  • U = ultrasound score out of 3
  • M = menopausal status out of 3
  • C = Ca125 level in IU/mL
• Over 200 = high risk of malignancy

Question 8

What are the symptoms a woman with endometrial cancer might present with? How is it diagnosed?

Answer 8

• Abnormal uterine bleeding, from cervical cytology findings, or incidental findings at hysteroscopy/CT/MRI
• Histologic diagnosis

Question 9

What is the treatment for endometrial carcinoma?

Answer 9

• Total extrafascial hysterectomy with bilateral salpingo-oophorectomy with pelvic and para-aortic lymph node dissection

Question 10

Which populations do vulval and vaginal cancers tend to occur in? What’s the presentation and how is it managed?

Answer 10

• Generally in older populations +/- lichen sclerosis, immunosuppression
• Itch or lump, pain, discharge
• Excision +/- lymphadenectomy, radiotherapy

Question 11

What are the likely clinical findings in someone with a gestation trophoblast tumour? How might you manage them?

Answer 11

• Irregular bleeding, thecal luteal cysts, uterine sub involution, increasing bHCG
• Educate, multidisciplinary team
  • Decide if high risk or low risk
  • Low risk; methotrexate until BhCG back to normal
  • High risk; EMACO (chemotherapy regime)

Question 12

The risk factors for ovarian and endometrial cancer are similar. List some

Answer 12

• Age, obesity, diabetic, HT, alcohol
• Oestrogen exposure; HRT, PCOS, nulliparous, early menarche, late menopause
• FHx