W06: Uterus Path.; Vulval Cancer; Ovary Pathology Flashcards
History and investigations of post menopausal bleeding
often presents as spotting
PMB investigations
> pelvic and speculum examination
> transvaginal ultrasound = endometrial thickness
> biopsy if >4mm or irregular
- pipelle
- hysteroscopy
Principles of management of endometrial cancer
> total lap. hysterectomy
> bilateral salpingoophorectomy
Relevance and significance of histological diagnosis
used for prognostic features as well as TYPING
TYPE 1
endometrioid adenocarcinoma
commonest
unopposed oestrogen = RF: obesity
hyperplasia with atypia precursor
TYPE 2
uterine serous & clear cell carcinoma
older women, highly aggressive
serous intraepithelial carcinoma precursor
Endometrial Cancer Staging
-sx/pathologicaal
- MRI: depth of myometrial invasion
- cervical involvement
- LN involvement
1 - contained to myometrium
2 - cervix invasion
3 - serosa/adnexa/vagina/parametrium/ pelvic
4 - bladder/bowel/ inguinal nodes etc.
Endometrial Cancer Tx
Early
>sx: tot. hysterectomy / bilateral salpingoo. +washings
High risk
> chemoT
Advanced
>RT
Palliation
> progesterone
Endometrial Ca RF
PMB
oesgtrogen
- obesity
- unopposed E2 tx / tamoxifen
- PCOS
- early menarche / late menopause
endometrial hyperplasia with atypia
HNPCC familial cancer syndrome
DDx of PMB
~8% will have endometrial ca.
*HRT
* peri-menopausal bleeding
*atrophic vaginitis
*polyps cervical
*other cancers
Explain the risk factors, causes, diagnosis of vulval cancer
RF
- intraepithelial neoplasia or ca. at lower genital tract
- lichen sclerosus
- smoking
- immunosuppression
Dx
- surgical-patho = staging; biopsy
*micro-invasion <1mm
(1) HPV RELATED
usual VINeoplasia
younger
multifocal and multizonal
imm suppr.
hx of intraepithelial neoplasia
*classical/warty
(2) NON-HPV RELATED
differentiated VIN
older women
lichen sclerosus
presents as cancer; v high grade
maalignant = squamous cell carcinoma
Explain the management of vulval cancer
> sx: individualised sx, local excision
+unilateral or bilateral node dissection
of inguinal OR upper femoral nodes
* node dissection carries significant morbidity
> RT/ChemoT
squamous cell carcinoma
highly invasive; metastatic
History and investigations of pelvic mass
OCP = protective
* pre-existing ovarian cysts may develop into ovarian ca.
vague symptoms: indigestion, poor appetite, altered bowels/pain, bloating, wt gain, PELVIC MASS; pressure symptoms/asympt.
- surgical/pathological dx
- USS abdo and pelvis
- CT scan
- Ca 125 = glycoprotein antigen
- Sx
Principles of management of ovarian cancer
> core biopsy of omentum etc. = cytology
> sx
- LAPOROTOMY: tissue dx, staging, clearance, or debulking
> ChemoT
- Taxol within 8w of sx = complete / partial response (2yrs avg)
- unlikely curative
RECURRENCE
> ChemoT
> Palliation
> Platinum if 6mos+
> Tamoxifen
- PROPHYLACTIC SALPINGO-OOPHRECTOMY for HIGH RISK WOMEN
Relevance and significance of histological diagnosis
Staging:
1) limited to ovaries with capsule in tact
2) ovaries with pelvic extension
3) ovaries with peritoneal implants outside pelvis or +ve nodes
4) distant mets
genetic predisposition to ovarian cancer
HNPCC/Lynch type II familial cancer syndrome
BRCA1
BRCA2
Ca 125
Glycoprotein antigen present in malignancies of
ovary
colon/pancreas
breast
as well as BENIGN:
- menstruation/endometriosis/PID
- liver disease/ effusions/ sx
