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RACGP AFP/KFP > Womans Health > Flashcards

Womans Health Flashcards

1
Q

Risk cancer risk indicators based on family history?

A
  • Two 1st degree or 2nd degree relatives on one side of family with Ca
  • Individuals with age of onset of ca < 50
  • Individuals with bilateral or multifocal breast ca
  • Individuals w/ ovarian ca
  • Breast Ca in male relative
  • Jewish ancestry
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2
Q

Breast cancer screening recs for an asymptomatic low risk woman?

A
  • Asymptomatic, low-risk woman
    • Screen recommended every 2 yrs between 50-74
    • Screening mammography optional for women 40-49
      • Better diagnostic tool in older woman due to less dense/glandular breast tissue
      • Specificity approx. 90%
  • Use FRA-BOC (Familial Risk Assessment – Breast and Ovarian Cancer) tool to guide screening for women at increased risk
    • Cat 1 – at (or slightly above) average risk, option 2nd yrly mammograms for 40, routinely recommended from 50
    • Cat 2 – moderately increased risk, annual mammograms from 40 if woman has 1st-degree relative <50yrs diagnosed with breast cancer; otherwise routine 2 yrly mammograms recommended
    • Cat 3 – potentially high risk – referral to family cancer clinic recommended for possible genetic testing, increased surveillance determined on individual basis
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3
Q

Risk factors for cervical cancer?

A
  • Being sexually active (due to HPV exposure)
  • Smoking
  • COCP use >5yrs
  • Immunosuppression
  • Exposure to diethylstilboestrol in utero (old drug taken during pregnancy no longer used)
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4
Q

Who should have cervical screening?

A
  • All women sexually active from age 25, OR 2 yrs after 1st sexual intercourse (whichever is later)
  • Includes woman who:
    • Have had intimate sexual skin on skin contact
    • Have sex with woman
    • Are no longer sexually active
    • Have been HPV vaccinated
    • Are in monogamous relationship
  • Should continue every 5 years to age 74
    • -ve HPV after age 70 → discontinue screening (i.e. exit test 70-74)
    • Consider >75 if never screened or not done in past 5 yrs, if requested
  • Consider earlier testing (20-24) if sexually active <14 OR before receiving HPV vaccine
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5
Q

Speculum exam - diagnosis?

A

Nulliparous cervix

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6
Q

Speculum exam - diagnosis?

A

Eversion / ecropion. Nil further investigation if asymptomatic.

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7
Q

Speculum exam - diagnosis?

A

Nabothian follicles. Nil further investigation if asymptomatic.

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8
Q

Speculum exam - diagnosis?

A

Multiparous. No further ix needed if asymptomatic.

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9
Q

Speculum exam - diagnosis?

A

Atrophy - no further Ix needed if asymptomatic

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10
Q

Speculum exam - diagnosis?

A

Cervical polyp - requires further Ix

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11
Q

Speculum exam - diagnosis?

A

Cervical wart - consider further ix

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12
Q

Speculum exam - diagnosis?

A

Mucopurulent discharge - needs further Ix

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13
Q

Speculum exam - diagnosis?

A

Cervical cancer - needs further Ix

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14
Q

Speculum exam - diagnosis?

A

IUD

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15
Q

Speculum exam - diagnosis?

A

Cervical stenosis - if asymptomatic doesnt need Ix

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16
Q

Speculum exam - diagnosis?

A

Cervix post treatment for ca - no intervention if asymptomatic

17
Q

Information to include on CST request?

A
  • symptomatic?
  • age
  • hormonal state (i.e. pregnancy, post partum period, post menopausal)
  • presence of IUD
  • prev abnormal results
  • clinical findings
18
Q

Things to consider during CST consult? (also practical things)

A
  • Think about contraception, STI screening, family planning, breast awareness/screening
  • Ask about prev CST results, discomfort (i.e. atrophy) etc
  • Sample → needs sufficient mature + metaplastic squamous cells to indicate sampling from whole transformation zone, as well as sufficient endocervical cells to indicate upper limit of transformation zone was sampled (to screen for adenocarcinoma)
  • Timing → avoid during menstruation, during obvious vaginal infection, within 48 hrs of vaginal creams, pessaries or douching
19
Q

CST result: HPV Not 16/18 detected - further Ix/Mx?

20
Q

CST result: HPV 16/18 - Further management?

A

All cytology results - refer for colp

21
Q

Post treatment assessment of HSIL?

A
  • After treatment should complete test of cure surveillance to confirm successful
  • Co-test (HPV + LBC) 12 months post treatment, and annually until pt receives negative cotest on 2 consecutive occasions → return to 5 yrly screening
22
Q

Risk factors for endometrial cancer/hyperplasia?

A
  • Note: Identifies women at risk for Type I cancer
  • Endogenous oestrogen
    • ↑ cumulative Oe exposure
      • ↑ age
      • Early menarche / Late menopause (>55)
      • Nulliparity → ? linked to anovulation
      • Chronic anovulation
        • PCOS
        • Perimenopausal period
    • Other endogenous Oe source
      • Obesity
      • Oe-secreting tumour
  • Exogenous oestrogen
    • Unopposed Oe HRT
    • Tamoxifen therapy
  • Other
    • HNPCC
    • FmHx of endometrial / ovarian / breast / colon cancer
    • DM
    • HTN
  • Protective Factors
    • COC
    • Combined HRT
  • Essentially unopposed oestrogen stimulation of endometrium
23
Q

Symptoms of endometrial cancer or hyperplasia?

A
  • Abnormal uterine bleeding → >90%!, ESP perimenopausal
    • Irregular
    • Menorrhagia
  • Vaginal discharge (leucorrhoea)
24
Q

Investigations for suspected endometrial cancer/hyperplasia?

A
  • US -> determine endometrial thickness, however won’t necessarily detect hyperplasia
  • Requires biopsy
    • Pipelle (endometrial sampling), can miss due to not seeing lesions
    • Hysteroscopy, D&C -> required to fully evaluate any abnormalities on sampling
25
Q

Risk factors for ovarian cancer?

A
  • Increase no. of ovulations
    • nulligravidity/infertility
    • Early menarche/late menopause
  • Endometriosis
  • PCOS
  • Obesity
  • SMoking
  • Family hx of breast/ovarian/colorectal ca
    • BRCA1&2 -> 10-15% of ovarian ca
    • HNPCC -> ~1% ovarian ca
  • Protective factors
    • OCP
    • Multiparity
    • Tubal ligation/hysterectomy
    • Breast feeding
    • Progesterone
26
Q

Clinical features of ovarian cancer?

A
  • Symptoms usually vague
    • Abdo distension
    • Nausea
    • Anorexia
    • Early satiety -> ascites, bowel mets
    • Dyspnoea -> pleural effusion
    • Pressure Sx (mass effect?)
      • Feeling of pelvic pressure
      • GI complaints - constipation etc
      • Urinary frequency
      • Lower limb oedema
  • Examination
    • Distended abdomen
    • Adnexal/pelvic mass
    • Ascites
27
Q

Where does ovarian ca metastasize to?

A
  • Peritoneal cavity / surfaces
  • Lymphatics → pleural cavity, nodes
  • Organs → lung, liver, GI, brain (uncommon)
28
Q

Investigations for suspected ovarian cancer/tumour?

A
  • USS → adnexal mass
    • USS features suggestive of malignancy:
      • Solid component → nodular, papillary
        • Doppler flow in the solid compartment
      • Septations
      • Presence of ascites
      • Peritoneal masses, enlarged nodes etc.
    • More accurate in postmenopausal age group: have higher incidence of malignancy.
  • Bloods
    • CA 125 → not specific for epithelial tumour(endometrial Ca, pancreatic Ca, endometriosis, fibroids, PID, 1% normal women! etc. etc.)
      • More useful in postmenopausal women: high incidence of malignancy
      • Indications:
        • Suspicious features on US
        • Postmenopausal woman
        • Persistent ovarian cyst on 2 pelvic US 6 weeks apart AND
          • Simple cyst >5cm (premenopausal)
          • Cyst <5cm if complex (haemorrhagic, endometrial, dermoid, cystadenoma
          • Pelvic pain
    • AFP → largely germ cell tumours
    • Β-hCG → largely germ cell tumours
    • Indications for AFP, LDH, B-hCG, HE4 (Human epididymis protein 4)
      • Pre-pubertal pts w/ ovarian cyst or mass
        • Pt aged <40 with complex cyst
          • >3cm at diagnosis
          • <3cm persistent at 6 wk US f/u
  • Other imaging:
    • abdo / pelvic CT → look for sites of metastasis
    • look at endometrium → 10% have synchronous primaries!
    • Gastroscopy / colonoscopy if suspected GI primary
    • Breast imaging if suspected breast primary
  • Surgery → histology = definitive Dx
29
Q

Post treatment surveillance for ovarian ca?

A
  • Posttreatment Surveillance
    • Every 3/12 for 2 years, then 6/12 for 3 years, then annually
      • Tumour markers every visit
      • Pelvic examination as clinically indicated
      • Imaging as clinically indicated
30
Q

Risk factors for breast cancer?

A
  • Age >40
  • Western
  • Pre-existing benign lumps
  • Alcohol intake >2SDs/day
  • Use of MHT >5 yrs (combined)
  • PHx of breast ca
  • FHx in 1st degree relative (x3 rr)
  • Genetic mutation BRCA1 or BRCA2
  • Nulliparity
  • Late menopause (>53)
  • Obesity
  • Childless >30 yrs
  • Early menarche
  • Ionising radiation exposure
  • Ashkenazi Jewish Ancestry
31
Q

Symptoms/signs of breast ca?

A
  • Clinical features
    • 75% present w/ a lump
    • Usually painless, hard & irregular
    • Nipple changes, discharge, retraction, or distortion
    • Rarely -> Paget disease of breast (nipple eczema) or inflammatory B.C.
    • Rarely bone secondaries (i.e. back pain, dyspnoea, weight loss, headache)
  • Symptoms/red flags
    • Lump
    • Skin dimpling
    • Peau d’orange
    • Nipple inversion
    • Bloodstained nipple discharge
    • Eczema of nipple
32
Q

DDx of breast lump?

A
  • High probability
    • Fibrocystic disease (32%)
    • Fibroadenoma (23%)
    • Cancer (22%)
    • Cysts (10%)
    • Breast abscess/periareolar inflammation
    • Lactation cyst (galactocele)
  • Serious disorders (don’t miss)
    • Vascular -> thrombophlebitis (mondors disease)
    • Infection -> mastitis, breast abscess, tuberculosis
    • Cancer
      • Carcinoma
      • DCIS
      • Pagets disease of nipple
      • Sarcoma
      • Lymphoma
      • Mastitis carcinomatosa
    • Other -> phyllodes tumour
  • Pitfalls (often missed)
    • Duct papilloma
    • Lipoma
    • Mammary duct ectasia
    • Fat necrosis/fibrosis

RACGP AFP/KFP (2 decks)

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