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Medicine Year 2 > Week 220 - Gynaecologocal Cancers > Flashcards

Week 220 - Gynaecologocal Cancers Flashcards

0
Q

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

A

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

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1
Q

How regularly should women receive cervical smears in Wales?

A 
25-49 = every 3 yrs
50-65 = every 5 yrs
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2
Q

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

A

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

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3
Q

What is the most common type of vulval cancer?

A

90% squamous cell carcinoma

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4
Q

How common is vulval cancer?

A

Rare (3-4%) or all gynae cancers

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5
Q

What does VIN stand for and what is it?

A

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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6
Q

What is vulval carcinoma often assoc with?

A

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

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7
Q

List some symptoms of vulval cancer?

A

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

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8
Q

How is VIN usually managed?

A

Surgery or medical e.g. Imiquimod cream

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9
Q

How is vulval carcinoma managed?

A

Surgically, depending on depth - WLE or total vulvectomy

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10
Q

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

A

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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11
Q

What is the most common toe of cervical cancer?

A

SCC

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12
Q

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

A

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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13
Q

What is the most common cause form cervical cancer?

A

HPV (human papilloma virus)

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14
Q

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

A

Adenocarcinomas

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15
Q

What is the gold standard for diagnosis of endometrial cancer?

A

Hysteroscopy/transvaginal US and biopsy

MRI then used for staging

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16
Q

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

A

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

17
Q

What is the commonest gynaecological malignancy?

A

Ovarian Cancer

18
Q

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

A

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

19
Q

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

A

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

20
Q

What is the tumour marker for ovarian cancer?

A

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

21
Q

What are the principle treatment options for ovarian cancer?

A

Debulking surgery and adjuvant / neo-adjuvant chemo

22
Q

What do adjuvant and new-adjuvant mean?

A

Adjuvant means ‘in addition to primary therapy’

Neo-adjuvant means ‘given before primary therapy’

23
Q

What treatment is NOT commonly used for ovarian cancer?

A

Radiotherapy - palliative maybe to reduce pain or bleeding

24
Q

What are the options available for cervical Intraepithelial neoplasia removal?

A 
Large loop excision of transitional zone (LLETZ)
Diathermy 
Cryotherapy
Laser vaporisation
Cold coagulation
Cone biopsy
25
Q

What surgical options are available for removal of cervical cancers?

A

Radical Tracelectomy
Total Hysterectomy
Radical hysterectomy

26
Q

Name 3 non- surgical approaches to treatment of cervical cancers

A

Radiotherapy
Brachytherapy
Chemo

27
Q

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

A

TAH
BSO
Lymph node clearance (if nec)

28
Q

What treatment option is rarely used in endometrial cancer?

A

Chemo - only if advanced

If so carboplatin or Doxorubicin + Carboplatin/Cisplatin used

29
Q

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

A

Surgery - wide local excision or total vulvectomy

Radiotherapy - shrink prep; post op if clear margin not achieved; nodes; palliative

30
Q

What treatment is only used in advanced vulval cancer?

A

Chemotherapy (Cisplatin)

31
Q

What is the second commonest gynae cancer?

A

Uterine cancer

32
Q

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

A

Postmenopausal women, presenting with postmenopausal bleeding

33
Q

What type of lesion is most common in uterine cancer?

A

Adenocarcinoma of the endometrial glands

34
Q

What are the two most common symptoms of endometrial cancer?

A

Abnormal bleeding

Pain/pressure in pelvis

35
Q

What is endometrial cancer often associated with?

A

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

36
Q

Is endometrial cancer HPV related?

A

No

37
Q

What is associated with ovarian cancer?

A

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

38
Q

Is ovarian cancer associated with HPV?

A

No

39
Q

Is vulval cancer associated with HPV?

A

In younger women with VIN yes

In older with differentiated hyperplasia no it’s assoc with Lichen Sclerosus

40
Q

What is cervical cancer most associate with?

A

Smoking and HPV

CIN with those and sexual practices

Medicine Year 2 (28 decks)

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