Week 220 - Gynaecologocal Cancers Flashcards by Hannah Gregson

What method of smear is used more frequently now and why?

Liquid-based cytology; more efficient processing and fewer inadequate smears (as opposed to spatula and glass slide)

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How regularly should women receive cervical smears in Wales?

25-49 = every 3 yrs
50-65 = every 5 yrs

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Where about on the cervix do you take the smear from?

The transformation zone (where the columnar and squamous epithelium meet)

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What is the most common type of vulval cancer?

90% squamous cell carcinoma

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How common is vulval cancer?

Rare (3-4%) or all gynae cancers

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What does VIN stand for and what is it?

Vulval Intraepithelial Neoplasia - VIN2 and 3 assoc with precancerous vulval States, VIN1 abnormal cells covering <1/3 of vulva and often clear up spontaneously. Associate with HPV unlike carcinoma of the vulva

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What is vulval carcinoma often assoc with?

Older women (65-75) often with a PMH of Lichen Sclerosus

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List some symptoms of vulval cancer?

Itching; bleeding; discharge; skin colour changes / sores; lumps; pain

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How is VIN usually managed?

Surgery or medical e.g. Imiquimod cream

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How is vulval carcinoma managed?

Surgically, depending on depth - WLE or total vulvectomy

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Describe the different results you can get with a smear and the following management accordingly.

High Grade Dyskaryosis (mod or severe) > colposcopy
Low Grade Dyskaryosis > repeat 6/12 or colposcopy
Borderline change > repeat 6/12
Glandular Dyskaryosis > Colposcopy

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What is the most common toe of cervical cancer?

SCC

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Describe briefly the FIGO staging of cervical cancer and what is means for 5yr survival prognosis and treatment

I - confined to cervix, 70-90%, local excision
II - confined to uterus, 60%, TAH/radio/chemo/brachy
III - involves pelvic wall / lower vagina, 40%, radical/radio/chemo
IV - beyond pelvis/bladder/rectal mucosa, 15%, radical/radio/chemo

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What is the most common cause form cervical cancer?

HPV (human papilloma virus)

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What is by far the most common cause of malignant uterine tumours?

Adenocarcinomas

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What is the gold standard for diagnosis of endometrial cancer?

Hysteroscopy/transvaginal US and biopsy

MRI then used for staging

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What is the usual management for endometrial (uterine) cancers?

TAH + BSO + removal of omentum (often involved/spread to) +/- LNs

What is the commonest gynaecological malignancy?

Ovarian Cancer

What are the different types of ovarian cancer and respective incidences?

Epithelial 70%
Germ cell 20%
Sex cord / stromal 10%
Mets (from breast or uterus commonly)

For what reasons is it likely that ovarian cancers present late?

The symptoms are quite nonspecific : abdo/back pain, abnormal bleeding or discharge, pelvic pressure, toilet habit changes, bloating

What is the tumour marker for ovarian cancer?

Ca125 (non specific but together with an ovarian mass on USS meaningful)

What are the principle treatment options for ovarian cancer?

Debulking surgery and adjuvant / neo-adjuvant chemo

What do adjuvant and new-adjuvant mean?

Adjuvant means ‘in addition to primary therapy’

Neo-adjuvant means ‘given before primary therapy’

What treatment is NOT commonly used for ovarian cancer?

Radiotherapy - palliative maybe to reduce pain or bleeding

What are the options available for cervical Intraepithelial neoplasia removal?

``` Large loop excision of transitional zone (LLETZ) Diathermy Cryotherapy Laser vaporisation Cold coagulation Cone biopsy ```

What surgical options are available for removal of cervical cancers?

Radical Tracelectomy Total Hysterectomy Radical hysterectomy

Name 3 non- surgical approaches to treatment of cervical cancers

Radiotherapy Brachytherapy Chemo

What 3 surgical options are frequently used in the treatment of endometrial cancer?

TAH BSO Lymph node clearance (if nec)

What treatment option is rarely used in endometrial cancer?

Chemo - only if advanced | If so carboplatin or Doxorubicin + Carboplatin/Cisplatin used

What two forms of treatment are used most commonly to treat vivo all cancer?

Surgery - wide local excision or total vulvectomy | Radiotherapy - shrink prep; post op if clear margin not achieved; nodes; palliative

What treatment is only used in advanced vulval cancer?

Chemotherapy (Cisplatin)

What is the second commonest gynae cancer?

Uterine cancer

What is the most likely patient-type to present with uterine/endometrial cancer?

Postmenopausal women, presenting with postmenopausal bleeding

What type of lesion is most common in uterine cancer?

Adenocarcinoma of the endometrial glands

What are the two most common symptoms of endometrial cancer?

Abnormal bleeding | Pain/pressure in pelvis

What is endometrial cancer often associated with?

High levels of oestrogen (low parity, late menopause, obesity, oestrogen only HRT)

Is endometrial cancer HPV related?

What is associated with ovarian cancer?

High number of ovulations: nulliparity, late menopause, early menarche

Is ovarian cancer associated with HPV?

Is vulval cancer associated with HPV?

In younger women with VIN yes | In older with differentiated hyperplasia no it's assoc with Lichen Sclerosus

What is cervical cancer most associate with?

Smoking and HPV | CIN with those and sexual practices