Women's Health : Gynaecological Cancers

Question 1

What is the most common gynaecological cancer?

Answer 1

Endometrial cancer.

Question 2

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

Answer 2

8000 new cases.

Question 3

What is the median age of diagnosis for endometrial cancer?

Answer 3

63 years.

Question 4

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

Answer 4

Multiple cell types ● Endometrial hyperplasia

Question 5

What is the most common histological type of endometrial cancer?

Answer 5

Endometrioid adenocarcinoma (glandular secretory epithelium).

Question 6

What is endometrial hyperplasia?

Answer 6

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

Question 7

Describe the pathophysiology of endometrial cancer.

Answer 7

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.

Question 8

Where do endometrial cancers metastasise to?

Answer 8

pelvic and para-aortic lymph nodes

Question 9

What are the key risk factors for endometrial cancer?

Answer 9

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

Question 10

What is the classic symptom of endometrial cancer?

Answer 10

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

Question 11

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

Answer 11

transvaginal ultrasound ○ Endometrial thickness >5 mm is abnormal

Question 12

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

Answer 12

hysteroscopy with endometrial biopsy

Question 13

How is endometrial hyperplasia without atypia managed?

Answer 13

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

Question 14

How is endometrial hyperplasia with atypia managed?

Answer 14

total hysterectomy with bilateral salpingo-oophorectomy (BSO)

Question 15

What is the first-line treatment for endometrial cancer?

Answer 15

Hysterectomy with bilateral salpingo-oophorectomy (BSO).

Question 16

Other forms of management for endometrial cancer?

Answer 16

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

Question 17

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

Answer 17

7000 new cases.

Question 18

What is the median age of diagnosis for ovarian cancer?

Answer 18

63 years.

Question 19

What is the most common histological subtype of ovarian cancer?

Answer 19

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

Question 20

What percentage of ovarian cancers are epithelial in origin?

Answer 20

0.9

Question 21

Other subtypes originating from the cortex of the ovary include :

Answer 21

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

Question 22

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

Answer 22

BRCA1 and BRCA2 mutations.

Question 23

How does ovarian epithelial cancer commonly metastasise?

Answer 23

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

Question 24

Name three risk factors for ovarian cancer.

Answer 24

● BRCA1 / BRCA2 mutation ● Increasing age ● Family history

Question 25

Why is ovarian cancer often detected at an advanced stage?

Answer 25

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

Question 26

Symptoms present in ovarian cancer patients

Answer 26

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

Question 27

Signs present in ovarian cancer patients

Answer 27

palpable abdominal mass, ascites

Question 28

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

Answer 28

Abdominal and pelvic examination.

Question 29

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

Answer 29

CA-125 (tumour marker) level

Question 30

What is considered a highly suspicious CA-125 level?

Answer 30

> 35 IU/ml.

Question 31

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

Answer 31

transvaginal ultrasound

Question 32

First Line Managment for Ovarian Cancer

Answer 32

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

Question 33

Additional Managment for Ovarian Cancer

Answer 33

adjuvant chemo , bevacizumab (anti-VEGF monoclonal antibody)

Question 34

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

Answer 34

3000 new cases.

Question 35

What percentage of cervical cancers are detected through screening?

Answer 35

0.75

Question 36

What is the median age of diagnosis of Cervical Cancer?

Answer 36

50

Question 37

What is the most common histological type of cervical cancer?

Answer 37

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

Question 38

Another histological type of cervical cancer?

Answer 38

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

Question 39

What causes most cases of cervical cancer?

Answer 39

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

Question 40

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

Answer 40

0.9

Question 41

What is cervical intraepithelial neoplasia (CIN)?

Answer 41

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.

Question 42

Cervical Intraepithelial Neoplasia (CIN) : CIN1

Answer 42

- low grade, confined to lower third of epithelium.

Question 43

Cervical Intraepithelial Neoplasia (CIN) : CIN2

Answer 43

- moderate grade, confined to lower two thirds of epithelium

Question 44

Cervical Intraepithelial Neoplasia (CIN) : CIN3

Answer 44

- high grade, severely atypical cellular changes in more than two thirds of epithelium

Question 45

List three risk factors for cervical cancer.

Answer 45

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

Question 46

Symptoms of cervical cancer

Answer 46

: intermenstrual bleeding, postcoital bleeding, abnormal vaginal discharge.

Question 47

Signs of cervical cancer

Answer 47

mass, ulcerated lesion, bleeding on speculum exam

Question 48

First Line investigation of cervical cancer

Answer 48

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

Question 49

Additional testing for cervical cancer

Answer 49

HPV testing

Question 50

Stage 1 Cervical Cancer

Answer 50

- confined to cervix

Question 51

Stage 2 Cervical Cancer

Answer 51

extending beyond uterus

Question 52

Stage 3 Cervical Cancer

Answer 52

extending into lower third of the vagina or pelvic wall

Question 53

Stage 4 Cervical Cancer

Answer 53

spread beyond true pelvis or bladder / rectum involvement

Question 54

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

Answer 54

25–64 years.

Question 55

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

Answer 55

every 3 years

Question 56

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

Answer 56

every 5 years

Question 57

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

Answer 57

hrHPV

Question 58

If tested with Negative for hrHPV, what is next?

Answer 58

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

Question 59

1st positive hrHPV

Answer 59

- 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.

Question 60

2nd hrHPV

Answer 60

- 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).

Question 61

3rd hrHPV

Answer 61

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

Question 62

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

Answer 62

Cone biopsy if fertility preservation is desired or radical hysterectomy.

Question 63

What are advanced-stage cervical cancer treatment options?

Answer 63

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.