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Pete 3 > Time of the month > Flashcards

Time of the month Flashcards

1
Q

What are the 3 layers of the uterus

A

Serosa- outermost layer, thin,

Myometrium – smooth muscle, thickest layer, contracts during menstruation

Endometrium – the layer that is shed

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2
Q

What are the lymph nodes that drain the the female pelvis

A 
paracervical
parametrial 
presacral & sacral
external illiac
common illiac
hypogastric (obturator)
internal illiac
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3
Q

What age group does endometrial cancer mostly effect.

A

It is most common in MENOPAUSAL women

55-85 years old

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4
Q

What are the risk factors of endometrial cancer?

A
  • Early menarche
  • Late menopause
  • Obesity – too much adipose tissue can secrete -
    hormones
  • Nulliparity (having no children)
  • Infertility
  • Oestrogen-producing ovarian tumours
  • The use of tamoxifen for breast cancer
  • Family history (immediate family gets disease before 50)
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5
Q

What are the symptoms for endometrial cancer?

A
  • vaginal discharge (90%)
  • bleeding

Not common in post-menopausal therefore is picked up earlier

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6
Q

What is the common pathology of Endometrial Cancer

A
  • Adenocarcinoma
  • Adenocanthoma
  • Adenosquamous carcinoma
  • Leiomyosarcoma – muscle
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7
Q

What are the patterns of spread for endometrial cancer

A
  • Blood borne spread is uncommon
  • Cervix, myometrium, serosa to the bladder, colon, abdominal cavity and Fallopian Tubes
  • Lymph drainage from the fundus empties into the para‐aortic nodes.
  • From the middle and lower portions of the uterus lymph passes through the broad ligament to the pelvic nodes.
  • Some lymphatics course through the round ligament to the inguinal nodes.
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8
Q

What level do the paraaoritc nodes finish

A

T12

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9
Q

What are the prognostic indicators for endometrial cancer?

A

Spread to the regional nodes is the most important prognostic.

Pelvic or paraaortic LN spread

Tumour grade or cell type

Depth of myometrial invasion
Tumour extension to the cervix

Tumour vascularity

LVSI (Lymphovascular space invasion)

Peritoneal metastases

Distant organ metastases

Low grade tumours have a better prognosis

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10
Q

Why is prognosis not always good in younger women (endometrial cancer)?

A

Prognosis is not always good in younger women because it is not picked up early (bleeding from the uterus is normal).

In older women who are post-menopausal it is usually diagnosed earlier (bleeding is abnormal).

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11
Q

What are the recurrence rates of deep and superficial invasion (endometrial cancer)?

A

Patients with superficial invasion have a 10% recurrence risk.

Patients with deep invasion have a 25% recurrence rate.

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12
Q

What is stage 1 of endometrial cancer?

A

Stage 1 – the tumour is confined to the uterine fundus (body of uterus)

  • A: Tumour limited to endometrium
  • IB: Invasion to no more than half the myometrial thickness.
  • IC: Invasion to more than half the myometrial thickness
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13
Q

What is stage 2 of endometrial cancer?

A

Stage 2- The tumour extends to the cervix (lower part of uterus)

IIA: Invasion to the mucosa of the cervix.

IIB: Invasion to cervical stroma

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14
Q

What is stage 3 of endometrial cancer?

A

There is regional tumour spread

  • IIIA: Tumour invades serosa and/or adnexa, and/or positive peritoneal cytology
  • IIIB: Vaginal metastases
  • IIIC: Metastases to pelvic and/or para‐aortic lymph nodes.
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15
Q

What are the staging method for Endometrial cancer?

A

• Cancer of the Endometrium staged surgically
o Pathology review
o EUA (Examination Under Anesthesia)
o Chest X ray
• CT/MRI may be used to define extent of disease

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16
Q

What is the clinical management of Endometrial cancer?

A

Primary therapy is surgery
- Abdominal hysterectomy
- bilateral salpingo-oophorectomy
(removal of the ovaries and Fallopian tubes)

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17
Q

What is the treatment for each stage of cancer? (Endometrial)

A

Stage 1A – surgery alone
Stage 1B – surgery + brachytherapy
Stage 1C – surgery + EBRT + BT
Stage II‐III – surgery + EBRT + BT

Role of RT in early stages is questionable

18
Q

What are the pre-treatment steps for endometrial cancer?

A 
Full bladder ( pushes small bowel superior)
Mostly supine
19
Q

What are the pre-treatment steps for endometrial cancer?

A 
Full bladder ( pushes small bowel superior)
Mostly supine 
Are fiducial markers required 
Oral contrast - for lymph nodes 
Daily verification
20
Q

What are the doses for endometrial cancer?

A

Brachytherapy alone:
16Gy in 4# or 22Gy in 4#

EBRT: 45Gy in 25# + 8Gy in 2# brachytherapy
Pelvic EBRT usually given for Stage 3 and above.

21
Q

Acute side Effects of Endometrial cancer (RT treatment)?

A

Acute:
Diarrohoea

Nausea and vomiting para-aortics involved

Abdominal pain and cramping

Erythema and Desquamation in the inguinal folds

Rectal dysfunction

Urinary frequency and dysuria (less common)

22
Q

Late Side effects of endometrial cancer (RT treatment)?

A

Chronic fatigue

Vaginal Stenosis

Rectal and urinary frequency

23
Q

What is epidemiology of the cervix?

A
  • Seventh most common cancer overall worldwide
  • Second most common cancer in women worldwide
  • Incidence is highest in developing countries
  • Regular screening has reduced the incidence in developed countries
  • Vaccination = Gardasil
24
Q

What is the aetiology of of cervical cancer?

A

HPV 16 –Squamous Cell carcinoma
HPV 18–Adenocarcinoma (associated with a worse prognosis)
- HPV 11 (associated with benign) malignancies

25
Q

What are early detection methods of cervical cancer?

A

Pap testing/ cytology testing

HPV DNA testing

26
Q

What is the lymphatic spread of cervical cancer?

A

Tumor spreads from the primary lesion sequentially to the pelvic lymph nodes, para-aortic lymph nodes (PAN) and supraclavicular lymph nodes

paracervical
parametrial
presacral
sacral
external iliac
common iliac
hypogastric (obturator)
internal iliac
27
Q

What are the staging methods for cervical cancer?

A

Cutterage of the cervix to examine abnormal cells

  • Pathology review
  • EUA (Examination under Anaesthesia)
  • Chest X-Ray
  • IVP (intravenous pyelogram)
  • MRI useful for determining the extent of the tumour in the cervix and parametrial extension
28
Q

What is the clinical management of cervical cancer?

A

Stage 1A1 and 1A2 – surgery alone can be curative

1A1 – cone biopsy may achieve clear margins but simple hysterectomy is indicated if fertility not an issue

1A2 – radical trachelectomy and node dissection if required may help to maintain fertility, but simple hysterectomy is indicated if this is not an issue

Trachelectomy – surgical remove of lower part of the uterus and the cervix

1B1 – fertility may still be preserved if tumour <2cm, otherwise patient has a choice between hysterectomy or chemo radiation

1B2 – IVa – primary treatment is radiation therapy with concurrent chemo (cisplatin)

IVb – treated palliatively with chemo and radiation

Chemotherapy – might be possible for the patient to preserve fertility

29
Q

What are the CT scan considerations?

A
  • L1 to 5cm beyond the vaginal introitus

- IV contrast to outline the pelvic blood vessels and nodes

30
Q

What is the dose for cervical cancer?

A

50.4Gy in 28# over 5.5 weeks

14Gy in 2# Brachytherapy

31
Q

What is the Aetiology Vaginal cancer?

A
  • Occurs mainly in post-menopausal women
  • HPV infection
  • previous hysterectomy
  • prolapsed uterus
32
Q

What are the symptoms of Vaginal Cancer

A
  • A watery, bloody or malodourous discharge

- Bleeding and pain during intercourse

33
Q

What is the clinical management of vaginal cancer?

A

Surgery

  • Useful in early superficial disease
  • Radical surgery may cause loss of function of the bladder and rectum

EBRT and brachytherapy is the main option
45 Gy in 25# EBRT
21-28Gy in 3- 4# of brachytherapy

34
Q

What is the aeitology of Vulval cancer?

A
  • Uncommon in women under 50 – mean age of 70
  • Increased risk associated with HPV and smoking
  • Although often seen in post-menopausal women there is an increasing number of young women with the disease
35
Q

What are the symptoms of Vulval cancer?

A

Bleeding
Pain
Dysuria
Pruritus - pus filled lesion

36
Q

How is vulval cancer staged?

A

Surgical staging - biopsy performed

Depth of invasion important indicator of nodal involvement and prognosis

  • 1% nodal involvement in invasion of less than 1mm
  • 28% nodal involvement in invasion 1-5mm
37
Q

What is the clinical management of vulval cancer (Surgery)?

A

Surgery is the primary intervention
Early invasion – tumours < 2cm + ≤ 1mm invasion = WLE (wide local excision)

  • Stage I with > 1mm invasion = WLE + lymph node assessment
  • Larger stage I and II tumours > 2cm = WLE + partial or complete vulvectomy + node dissection
38
Q

What is the clinical management of vulval cancer (RT)?

A

Can also be used for those who are unfit for surgery

Bolus brings dose to the skin

Treated with large fields, (Ideally, treated in lithotomy position, but not all patients can do this )

Concurrent chemo being investigated

45Gy in 25# to vulva alone and an electron boost of 15Gy in 8# to the perineum and to the nodal sites involved

39
Q

What is the patient care (Vulval cancer)?

A

Very painful skin reactions for the vulva

RT side effects are similar for all gynae patients

Patients diagnosed with vulva cancer may experience psychosocial issues before RT

Vaginal Dilators (for stenosis)

40
Q

What are the signs and symptoms of ovarian cancer?

A
  • Anorexia
  • Urinary frequency
  • Sensation of heaviness
  • Growth into peritoneal cavity leads to abdominal pain
41
Q

What is the clinical management of ovarian cancer?

A

Surgery is treatment of choice

  • In early stages 5-year survival is 95% for surgery alone
  • Later stage disease – Debulking based surgery followed by platimum based chemo

Chemotherapy

  • Used after surgery
  • Carboplatin
  • Paclitaxel
  • Cisplatin

Pete 3 (11 decks)

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