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Phase 3a - Women's Health > Women's Health : Gynaecological Cancers > Flashcards

Women's Health : Gynaecological Cancers Flashcards

1
Q

What is the most common gynaecological cancer?

A

Endometrial cancer.

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2
Q

How many new cases of endometrial cancer are diagnosed annually in the UK?

A

8000 new cases.

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3
Q

What is the median age of diagnosis for endometrial cancer?

A

63 years.

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4
Q

What are the 2 types of histological findings in endometrial cancer?

A

Multiple cell types ● Endometrial hyperplasia

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5
Q

What is the most common histological type of endometrial cancer?

A

Endometrioid adenocarcinoma (glandular secretory epithelium).

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6
Q

What is endometrial hyperplasia?

A

A condition with a raised gland ratio compared to normal endometrium on histology.

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7
Q

Describe the pathophysiology of endometrial cancer.

A

Hormonal stimulation leads to uninterrupted endometrial proliferation, causing endometrial hyperplasia. ● The hyperplastic endometrial tissue then evolves and mutates from simple to complex forms, to premalignant endometrial intraepithelial neoplasia and eventually invasive adenocarcinoma.

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8
Q

Where do endometrial cancers metastasise to?

A

pelvic and para-aortic lymph nodes

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9
Q

What are the key risk factors for endometrial cancer?

A

● Obesity ● Age > 50 ● Endometrial hyperplasia ● Unopposed endogenous oestrogen: ○ Early menarche, late menopause, nulliparity, anovulation leading to amenorrhea. ● Unopposed exogenous oestrogen: ○ HRT, hormonal contraception.

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10
Q

What is the classic symptom of endometrial cancer?

A

Post-menopausal bleeding. ( - this is considered endometrial cancer
until proven otherwise)

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11
Q

What is the 1st line investigation for suspected endometrial cancer?

A

transvaginal ultrasound ○ Endometrial thickness >5 mm is abnormal

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12
Q

What is the 2nd line investigation for suspected endometrial cancer?

A

hysteroscopy with endometrial biopsy

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13
Q

How is endometrial hyperplasia without atypia managed?

A

reversal of risk factors e.g. weight loss, stopping HRT +/- progesterone therapy e.g. LNG-IUS.

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14
Q

How is endometrial hyperplasia with atypia managed?

A

total hysterectomy with bilateral salpingo-oophorectomy (BSO)

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15
Q

What is the first-line treatment for endometrial cancer?

A

Hysterectomy with bilateral salpingo-oophorectomy (BSO).

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16
Q

Other forms of management for endometrial cancer?

A

○ +/- vaginal brachytherapy ○ +/- radiotherapy ○ +/- chemotherapy

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17
Q

How many new cases of ovarian cancer are diagnosed annually in the UK?

A

7000 new cases.

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18
Q

What is the median age of diagnosis for ovarian cancer?

A

63 years.

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19
Q

What is the most common histological subtype of ovarian cancer?

A

Serous epithelial carcinoma. - derived from epithelium overlying
the ovarian capsule and distal fallopian tube.

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20
Q

What percentage of ovarian cancers are epithelial in origin?

A

0.9

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21
Q

Other subtypes originating from the cortex of the ovary include :

A

○ Sex cord stromal ○ Germ cell (more prominent in pre-menopausal women).

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22
Q

The underlying cause of ovarian cancer is unclear, although there is an established relationship with __________________.

A

BRCA1 and BRCA2 mutations.

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23
Q

How does ovarian epithelial cancer commonly metastasise?

A

Via transcoelomic (Across a body cavity) so spread to the liver, bowel, and associated mesentery.

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24
Q

Name three risk factors for ovarian cancer.

A

● BRCA1 / BRCA2 mutation ● Increasing age ● Family history

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25
Q

Why is ovarian cancer often detected at an advanced stage?

A

Symptoms are vague and non-specific (e.g., bloating, early satiety, altered bowel habit).

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26
Q

Symptoms present in ovarian cancer patients

A

vague gastrointestinal symptoms (bloating, early satiety, nausea, altered bowel habit), urinary frequency

27
Q

Signs present in ovarian cancer patients

A

palpable abdominal mass, ascites

28
Q

What is the first-line investigation for suspected ovarian cancer?

A

Abdominal and pelvic examination.

29
Q

What is the 2nd line investigation for suspected ovarian cancer?

A

CA-125 (tumour marker) level

30
Q

What is considered a highly suspicious CA-125 level?

A

> 35 IU/ml.

31
Q

What is the 3rd line investigation for suspected ovarian cancer?

A

transvaginal ultrasound

32
Q

First Line Managment for Ovarian Cancer

A

surgical staging with radical hysterectomy, BSO, appendectomy, omentectomy, lymph node dissection, pelvic washout. ○ Fertility-sparing surgery can be used in some specific cases.

33
Q

Additional Managment for Ovarian Cancer

A

adjuvant chemo , bevacizumab (anti-VEGF monoclonal antibody)

34
Q

How many new cases of cervical cancer are diagnosed annually in the UK?

A

3000 new cases.

35
Q

What percentage of cervical cancers are detected through screening?

A

0.75

36
Q

What is the median age of diagnosis of Cervical Cancer?

A

50

37
Q

What is the most common histological type of cervical cancer?

A

Squamous cell carcinoma of the ectocervix. (part of the cervix
projecting into the vagina).

38
Q

Another histological type of cervical cancer?

A

adenocarcinoma of the endocervix (part of the cervix lining the cervical canal)

39
Q

What causes most cases of cervical cancer?

A

Infection with high-risk HPV strains (HPV-16 and HPV-18).

40
Q

HPV infection spontaneously resolves within 2 years in ____of women - at this point, risk returns to baseline

A

0.9

41
Q

What is cervical intraepithelial neoplasia (CIN)?

A

HPV causes dysregulated cell cycle regulation, leading to formation of a pre-malignant monoclonal cell population referred to as cervical intraepithelial neoplasia (CIN), which subsequently mutates further to become an invasive carcinoma.

42
Q

Cervical Intraepithelial Neoplasia (CIN) : CIN1

A
  • low grade, confined to lower third of epithelium.
43
Q

Cervical Intraepithelial Neoplasia (CIN) : CIN2

A
  • moderate grade, confined to lower two thirds of epithelium
44
Q

Cervical Intraepithelial Neoplasia (CIN) : CIN3

A
  • high grade, severely atypical cellular changes in more than two thirds of epithelium
45
Q

List three risk factors for cervical cancer.

A

● High-risk HPV (hrHPV) infection ● Cigarette smoking ● Immunosuppression

46
Q

Symptoms of cervical cancer

A

: intermenstrual bleeding, postcoital bleeding, abnormal vaginal discharge.

47
Q

Signs of cervical cancer

A

mass, ulcerated lesion, bleeding on speculum exam

48
Q

First Line investigation of cervical cancer

A

colposcopy with biopsy - suspicious features seen on colposcopy are abnormal vascularity, white change with acetic acid and exophytic lesions.

49
Q

Additional testing for cervical cancer

A

HPV testing

50
Q

Stage 1 Cervical Cancer

A
  • confined to cervix
51
Q

Stage 2 Cervical Cancer

A

extending beyond uterus

52
Q

Stage 3 Cervical Cancer

A

extending into lower third of the vagina or pelvic wall

53
Q

Stage 4 Cervical Cancer

A

spread beyond true pelvis or bladder / rectum involvement

54
Q

What is the age range for cervical cancer screening in the UK?

A

25–64 years.

55
Q

How often are cervical screening tests conducted for women aged 25-49?

A

every 3 years

56
Q

How often are cervical screening tests conducted for women aged 50-64?

A

every 5 years

57
Q

The first test is for ______; if this is positive, further testing is indicated.

A

hrHPV

58
Q

If tested with Negative for hrHPV, what is next?

A

Return to normal recall (age-based) without further testing at the time.

59
Q

1st positive hrHPV

A
  • Use liquid-based cytology (LBC) to detect cellular atypia. - If cytology is positive, colposcopy is indicated. - If cytology is inadequate, cytology is repeated in 3 months. - If repeat cytology is inadequate, refer for colposcopy. - If colposcopy is normal, test hrHPV in 12 months. - If cytology is negative, perform the 2nd hrHPV test in 12 months.
60
Q

2nd hrHPV

A
  • If negative, return to normal recall - If positive, offer a 3rd hrHPV test in a further 12 months (i.e. 24 months after the first positive test).
61
Q

3rd hrHPV

A

If negative, return to normal recall - If positive, refer to colposcopy

62
Q

What is the management for stage 1A1 (<3mm) cervical cancer?

A

Cone biopsy if fertility preservation is desired or radical hysterectomy.

63
Q

What are advanced-stage cervical cancer treatment options?

A

Radical hysterectomy with lymph node removal, plus adjuvant therapy (chemotherapy / radiotherapy) ■ Radical trachelectomy (removal of cervix) with lymph node removal, plus adjuvant therapy. ■ Neoadjuvant chemotherapy, immunotherapy e.g. bevacizumab.

Phase 3a - Women's Health (21 decks)

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