220 Gynea cancers Flashcards by Jess Godfrey

Which cell type is involved in carcinoma?

Epithelial cells

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Which tissue type is involved in adenocarcinoma?

Glandular epithelial tissue

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What is dysplasia?

Disordered growth with cells showing abnormalities

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What is pleomorphism?

2 or more species existing at the same time which suggests rapid growth

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What is neoplasia?

Abnormal, uncontrolled cell growth

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In which group of patients is endometrial cancer most common in?

Post menopausal women

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Name 4 risk factors for endometrial cancer (7 listed)

Obesity
Nulliparous
Long fertile period
Unopposed oestrogen
Hx of other Ca
HNPCC gene carriers
Tamoxifen / oestrogen only OCP

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How does increased exposure to oestrogen and decreased progesterone cause endometrial Ca?

Oestrogen causes proliferation of the endometrium while progesterone softens the endometrium for implantation & withdrawal and causes shedding - unopposed oestrogen therefore causes uncontrolled proliferation and increased risk of cancerous mutation

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Why is obesity a risk factor for endometial cancer?

Fat converts steroids to oestrogen leading to increased oestrogen

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Name 3 types of endometrial cancer

Endometrioid carcinoma
Papillary serous & clear cell carcinomas
Secretory carcinomas

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What is the most common type of endometrial cancer?

Endometrioid carcinoma - contains glands which resemble normal endometrium

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Why is the presentation of endometrial cancer normally quite early?

Post menopausal bleeding = symptom

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What percentage of post menopausal bleeding is due to endometrial Ca?

20%

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What is the PC in pre menopausal women with endometrial cancer?

Irregular or heavy bleeding

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Name 3 Ddx for post menopausal bleeding

4 listed

HRT
Atrophic vaginitis
Endometrial hyperplasia
Cervical Ca

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What investigations should be performed in post menopausal bleeding? (3 listed)

Trans-vaginal USS
Endometrial Bx
MRI for staging

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What is the treatment for endometrial Ca?

TAH with bilateral salpingoophrectomy

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What should be added in to the treatment of high grade endometrial Ca along with TAH?

Chemo and RTx

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What is the 5 year survival rate in limited endometrioid adenocarcinoma?

94%

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What is the 5 year survival rate in endometrioid andenocarcinoma grade 4?

25%

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What type of ovarian cancer makes up >90% of primary tumours?

Epithelial ovarian carcinoma

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Which gynea cancer causes the highest rates of mortality in the UK?

Ovarian Ca

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Which genes are related to an increased risk of developing ovarian Ca?

BRCA 1
BRCA 2
HNPCC

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What is HNPCC?

Hereditary non-polyposis colorectal cancer

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Which cancers does HNPCC cause? | 3 listed

Ovarian Edometrial Colorectal

Name 4 risk factors for the development of ovarian cancer | 5 listed

``` Oestrogen only HRT Tamoxifen Nulliparity Obesity Endometriosis ```

Name 3 protective factors for ovarian cancer

OCP Sterilisation Breast feeding

What is the mechanism of spread of ovarian epithelial carcinoma?

Intraperitoneal dissemination ? cells floating in ascites

Where does ovarian cancer tend to spread to first?

Greater omentum creating an omental cake

What causes ascites in ovarian cancer?

Breakdown of the peritoneal barrier to ECF, lymph blockage and protein loss into ascites causing increased oncotoc pressure

At which stage does ovarian cancer commonly present and why?

Stage 3 - this is when the Ca has spread to abdominal organs

What may cause an early presentation of ovarian Ca?

Ovarian torsion

What are the symptoms of ovarian Ca?

Abdo/pelvic pain (organ involvelment) Bloating and feeling full (due to pressure of ascites) Urinary - frequency/urgency (ascites pressure on bladder) Fatigue W/L

What are the signs of ovarian Ca? | 4 listed

Abdo distension Palpable mass Shifting dullness Pleural effusion (ascits passing into pleural cavity/pleural mets)

Which tumour marker is useful for tracking the progression of ovarian Ca?

CA-125

What is the treatment of ovarian Ca?

Surgery - of benefit even if disease is not fully resectable | + chemo (carboplatin)

Why is cervical Ca the most common gynea Ca in the world but only 3rd most common in the UK?

Screening

What are the risk factors for cervical Ca? (4 listed)

No of sexual partners due to HPV Smoking OCP Immunosuppression

What is the cervical transformation zone?

Where the (stratified squamous) epithelium of the ectocervix meets the (columnar) epithelium of the endocervix

What is ectropion?

Where the transfromational zone is visible surrounding the cervical os

When does part of the external os evert outwards onto the cervical surface?

Puberty

What happens to the part of the external cervical os during puberty?

Squamous metaplasia

Which HPV viruses are thought to cause 70% of cervical cancers?

16 + 18

What is CIN?

Cervical intraepithelial neoplasia

What is Stage 1 cervical dysplasia?

Mild dysplasia (may exist for 20 years before progressing)

What is Stage 3 cervical dysplasia?

Severe dysplasia/carcinoma in situ - i.e. the neoplasia is developing but not yet invasive

Which type of cervical cancer is the most common?

Squamous cell carcinoma (80%)

What is the presentation of cervical cancer which has not been picked up by screening?

Irregular bleeding - intermenstrual or post coital in pre menopausal or post menopausal bleeding Vaginal discharge Cervical lesion

What investigation/treatment should be performed for CIS?

Colposcopy +/- loop excision

What is the treatment for a resectable cervical tumour?

TAH +/- vaginal excision

What is the treatment for a non resectable cervical tumour?

Chemotherapy RTx Brachytherapy

What is FIGO used for?

International federation of obs and gynea - staging of cervical cancer

What is FIGO stage 0 cervical cancer?

CIS - carcinoma confined to the epithelial lining of the cervix

What is FIGO stage 1 cervical cancer?

Cancer has spread further into the cervix

What is FIGO stage 2 cervical cancer?

Cancer has spread into the upper 2/3rds of vagina and or part of the uterus

What is FIGO stage 3 cervical cancer?

Cancer spread into lower third of vagina and into ureter causing one non-functioning kidney

What is FIGO stage 4 cervical cancer?

Cancer spread into the true pelvis involving multiple surrounding organs +/- mets

What is the 5 year survival for cervical cancer?

67%

Which 2 gynea cancers are the most rare?

Vulval and vaginal

What type of cancer causes 90% of vulval Ca?

Squamous cell

Which cancer causes 5% of vulval Ca and has a high risk of mets?

Melanoma

Which type of vulval cancer rarely invades deeply or metastases?

Basal cell

Which HPV virus is present in the majority of vaginal cancers?

HPV 16

In which group of patients is squamous cell carcinoma of the vagina most common?

>65 yr olds

In which group of patients is adenocarcinoma of the vagina most common?

Children/young women

220 Gynea cancers Flashcards

(65 cards)