Uterine and Cervical Tumours Flashcards
What virus is one of the main causes of cervical cancer?
HPV – mainly 16 & 18
Is the OCP protective against or a risk factor for cervical cancer
A risk factor
What is the most common type of cervical cancer?
Squamous carcinoma
Where in the cervix does cervical cancer most commonly occur?
The transformation zone
How long does it take for a high grade CIN to become an invasive cancer?
5-20 years
Who is currently offered the HPV vaccine in Scotland
Girls S1-3 and MSM <45
What is the precursor to squamous carcinoma of the cervix?
Cervical intraepithelial neoplasia (CIN)
What is the difference between CIN I, CIN II & CIN III
- CIN I = Basal 1/3 of epithelium occupied by abnormal cells – unlikely to progress to cancer
- CIN II = Abnormal cells extend to middle 1/3 – may progress to cancer
- CIN III – Abnormal cells occupy full thickness of epithelium – likely to progress to cancer
What is the precursor to adenocarcinoma of the cervix?
Cervical glandular intraepithelial neoplasia (CGIN)
Who is most at risk of vulvar carcinoma?
Elderly women
What cancer classically presents with a crusting rash on the vulva?
Vulvar paget’s disease (cancer arising from the sweat glands)
What age range is most at risk for endometrial cancer?
50-60
What is the most common type of uterine cancer?
Adenocarcinoma
Which is the more common uterine cancer, endometrial carcinoma or serous carcinoma?
Endometrial carcinoma
What is the difference between a stage IA and IB uterine tumour?
IA = no or <50% myometrial invasion
IB = ≥50% myometrial invasion
What is a stage II uterine tumour?
Tumour invades cervical stroma
What is a stage III uterine tumour?
Local and/or regional tumour spread:
- IIIA = invading ovary
- IIIB = Invades vagina
- IIIC = pelvic mets and/or para-aortic lymph nodes
What is a stage IV uterine tumour?
Tumour invades bladder and/or bowel (IVA) and/or distant mets (IVB)
What is the most common reason a uterine cancer patient is unfit for surgery?
High BMI
What treatment should you offer in the case of uterine cancer to young women who still desire fertility?
Mirena coil for a year, then remove and they have a year to get pregnant
What is lynch syndrome?
A cancer predisposition syndrome that give high risk of colorectal and uterine cancers and an increased risk of ovarian
Who is most at risk for leiomyomas/fibroids?
Women >40 and afro-caribbean women
What hormone does the growth of leiomyomas/fibroids depend on?
Oestrogen
What is the most common diagnostic test for leiomyomas/fibroids?
Ultrasound
How is a fibroid seen on USS?
A smooth echogenic mass
What is the gold standard treatment for leiomyomas/fibroids?
Hysterectomy - only if family is complete
What is the name of the rare malignant tumour of smooth muscle that can occur in the uterus?
Leiomyosarcoma
Name some causes of unopposed oestrogen that increases the risk of uterine cancer
HRT, Tamoxifen,
PCOS, nulliparity, infertility
What thickness of endometrium in post-menopausal women is suspicious of endometrial cancer
> 3mm
What is the best treatment for a stage I uterine cancer?
Total abdominal hysterectomy + bilateral salpingo-oophorectomy
OR
Progesterone for fertility sparing treatment
What is the best treatment for a stage II uterine cancer?
Radical hysterectomy + adjuvant
radiotherapy
What is the best treatment for a stage III or IVA (nodes) uterine cancer?
Radical radiotherapy (external beam and brachytherapy)
What is the best treatment for a stage IVB (mets) uterine cancer?
Palliative – chemotherapy/
radiotherapy
What is the peak age for cervical cancer?
40-45
List some risk factors other than HPV for cervical cancer
Early age at first pregnancy
Multiparity
Multiple sexual partners
OCP
Smoking
DES exposure
HIV (AIDS defining condition)
Apart from EUA, what other technique can be used to obtain a biposy in suspected cervical cancer?
Colposcopy
Between what ages is cervical screening done in Scotland?
Between 25 and 64 years
What is the best treatment for early stage cervical cancer?
Surgery (radical hysterectomy/ trachelectomy)
+
Adjuvant radiotherapy if high risk features (+LN,
LVI, +ve margins)
What is the best treatment for locally advanced cervical cancer?
Chemoradiotherapy
What is the best treatment for metastatic cervical cancer?
Palliative chemoradiotherapy
