Women's Health : Gynaecological Cancers Flashcards
What is the most common gynaecological cancer?
Endometrial cancer.
How many new cases of endometrial cancer are diagnosed annually in the UK?
8000 new cases.
What is the median age of diagnosis for endometrial cancer?
63 years.
What are the 2 types of histological findings in endometrial cancer?
Multiple cell types ● Endometrial hyperplasia
What is the most common histological type of endometrial cancer?
Endometrioid adenocarcinoma (glandular secretory epithelium).
What is endometrial hyperplasia?
A condition with a raised gland ratio compared to normal endometrium on histology.
Describe the pathophysiology of endometrial cancer.
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.
Where do endometrial cancers metastasise to?
pelvic and para-aortic lymph nodes
What are the key risk factors for endometrial cancer?
● Obesity ● Age > 50 ● Endometrial hyperplasia ● Unopposed endogenous oestrogen: ○ Early menarche, late menopause, nulliparity, anovulation leading to amenorrhea. ● Unopposed exogenous oestrogen: ○ HRT, hormonal contraception.
What is the classic symptom of endometrial cancer?
Post-menopausal bleeding. ( - this is considered endometrial cancer
until proven otherwise)
What is the 1st line investigation for suspected endometrial cancer?
transvaginal ultrasound ○ Endometrial thickness >5 mm is abnormal
What is the 2nd line investigation for suspected endometrial cancer?
hysteroscopy with endometrial biopsy
How is endometrial hyperplasia without atypia managed?
reversal of risk factors e.g. weight loss, stopping HRT +/- progesterone therapy e.g. LNG-IUS.
How is endometrial hyperplasia with atypia managed?
total hysterectomy with bilateral salpingo-oophorectomy (BSO)
What is the first-line treatment for endometrial cancer?
Hysterectomy with bilateral salpingo-oophorectomy (BSO).
Other forms of management for endometrial cancer?
○ +/- vaginal brachytherapy ○ +/- radiotherapy ○ +/- chemotherapy
How many new cases of ovarian cancer are diagnosed annually in the UK?
7000 new cases.
What is the median age of diagnosis for ovarian cancer?
63 years.
What is the most common histological subtype of ovarian cancer?
Serous epithelial carcinoma. - derived from epithelium overlying
the ovarian capsule and distal fallopian tube.
What percentage of ovarian cancers are epithelial in origin?
0.9
Other subtypes originating from the cortex of the ovary include :
○ Sex cord stromal ○ Germ cell (more prominent in pre-menopausal women).
The underlying cause of ovarian cancer is unclear, although there is an established relationship with __________________.
BRCA1 and BRCA2 mutations.
How does ovarian epithelial cancer commonly metastasise?
Via transcoelomic (Across a body cavity) so spread to the liver, bowel, and associated mesentery.
Name three risk factors for ovarian cancer.
● BRCA1 / BRCA2 mutation ● Increasing age ● Family history
Why is ovarian cancer often detected at an advanced stage?
Symptoms are vague and non-specific (e.g., bloating, early satiety, altered bowel habit).
Symptoms present in ovarian cancer patients
vague gastrointestinal symptoms (bloating, early satiety, nausea, altered bowel habit), urinary frequency
Signs present in ovarian cancer patients
palpable abdominal mass, ascites
What is the first-line investigation for suspected ovarian cancer?
Abdominal and pelvic examination.
What is the 2nd line investigation for suspected ovarian cancer?
CA-125 (tumour marker) level
What is considered a highly suspicious CA-125 level?
> 35 IU/ml.
What is the 3rd line investigation for suspected ovarian cancer?
transvaginal ultrasound
First Line Managment for Ovarian Cancer
surgical staging with radical hysterectomy, BSO, appendectomy, omentectomy, lymph node dissection, pelvic washout. ○ Fertility-sparing surgery can be used in some specific cases.
Additional Managment for Ovarian Cancer
adjuvant chemo , bevacizumab (anti-VEGF monoclonal antibody)
How many new cases of cervical cancer are diagnosed annually in the UK?
3000 new cases.
What percentage of cervical cancers are detected through screening?
0.75
What is the median age of diagnosis of Cervical Cancer?
50
What is the most common histological type of cervical cancer?
Squamous cell carcinoma of the ectocervix. (part of the cervix
projecting into the vagina).
Another histological type of cervical cancer?
adenocarcinoma of the endocervix (part of the cervix lining the cervical canal)
What causes most cases of cervical cancer?
Infection with high-risk HPV strains (HPV-16 and HPV-18).
HPV infection spontaneously resolves within 2 years in ____of women - at this point, risk returns to baseline
0.9
What is cervical intraepithelial neoplasia (CIN)?
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.
Cervical Intraepithelial Neoplasia (CIN) : CIN1
- low grade, confined to lower third of epithelium.
Cervical Intraepithelial Neoplasia (CIN) : CIN2
- moderate grade, confined to lower two thirds of epithelium
Cervical Intraepithelial Neoplasia (CIN) : CIN3
- high grade, severely atypical cellular changes in more than two thirds of epithelium
List three risk factors for cervical cancer.
● High-risk HPV (hrHPV) infection ● Cigarette smoking ● Immunosuppression
Symptoms of cervical cancer
: intermenstrual bleeding, postcoital bleeding, abnormal vaginal discharge.
Signs of cervical cancer
mass, ulcerated lesion, bleeding on speculum exam
First Line investigation of cervical cancer
colposcopy with biopsy - suspicious features seen on colposcopy are abnormal vascularity, white change with acetic acid and exophytic lesions.
Additional testing for cervical cancer
HPV testing
Stage 1 Cervical Cancer
- confined to cervix
Stage 2 Cervical Cancer
extending beyond uterus
Stage 3 Cervical Cancer
extending into lower third of the vagina or pelvic wall
Stage 4 Cervical Cancer
spread beyond true pelvis or bladder / rectum involvement
What is the age range for cervical cancer screening in the UK?
25–64 years.
How often are cervical screening tests conducted for women aged 25-49?
every 3 years
How often are cervical screening tests conducted for women aged 50-64?
every 5 years
The first test is for ______; if this is positive, further testing is indicated.
hrHPV
If tested with Negative for hrHPV, what is next?
Return to normal recall (age-based) without further testing at the time.
1st positive hrHPV
- 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.
2nd hrHPV
- 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).
3rd hrHPV
If negative, return to normal recall - If positive, refer to colposcopy
What is the management for stage 1A1 (<3mm) cervical cancer?
Cone biopsy if fertility preservation is desired or radical hysterectomy.
What are advanced-stage cervical cancer treatment options?
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.
