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CCC > Gynaecological Cancers > Flashcards

Gynaecological Cancers Flashcards

1
Q

Where is ovarian cancer usually found? and Where does it spread to?

A

Attaches to the surface of the organ rather than invading the parenchyma
Peritoneal cavity
Bowel mesentery
Liver capsule

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2
Q

What are the causes of ovarian cancer?

A

BRCA mutation
Precursor lesion
p53 mutation

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3
Q

What is the most common cause of gynaecological cancer death?

A

Ovarian

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4
Q

What are the signs & symptoms of ovarian cancer?

A 
Asymptomatic
Weight loss
Fatigue
Pressure effects on bowel & bladder
Bloating/feeling full/loss of appetite
Pelvic/abdo pain
Dragging sensation
Urinary frequency/urgency (pressure effects)
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5
Q

What are the risk factors for ovarian cancer?

A 
Nulliparity/continuous ovulation
Early menarche/late menopause
HRT
Endometriosis
Difficulty conceiving
Genetics: BRCA 1-2, Lynch II Syndrome

COCP-Protective

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6
Q

When is a 2week wait appropriate for query ovarian cancer?

A

Ascites

Abdo/pelvic mass NOT fibroids

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7
Q

What markers can be considered for ovarian cancer?

A

Ca125: Serous, endometrioid
Ca19.9: Mucinous
CEA

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8
Q

How specific is Ca125?

A

Not very

Also elevated in inflammation & during periods

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9
Q

What other investigations can be done for ovarian cancer?

A 
Abdo exam, palpate supraclavicular lymph nodes, breast/chest/vaginal/rectal exam 
Staged at time of laparotomy 
Pelvic USS
Biopsy
Staging: CT & MRI
Ascites: Paracentesis
Peritoneal biopsy & washing
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10
Q

How is ovarian cancer treated?

A

Stage 1: TAH & bilateral S-O
OR unilateral S-O without TAH
Retroperitoneal lymph node assessment
Stage 2-4: TAH, lymph node dissection, bilateral S-O
Adj: Omentectomy & platinum based chemo

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11
Q

What are the stages of ovarian cancer and which stage do most ovarian cancers present?

A
  1. Macroscopically confined to ovaries
  2. Beyond ovaries confined to pelvis
  3. Beyond pelvis confined to abdomen
  4. Disease beyond abdomen
    MOST PRESENT: Stage 3 or 4
    Most common gynaecologist cancer causing death
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12
Q

What are the malignant types of ovarian cancer?

A

Adenocarcinoma
Adenocarcinofibroma
SCC
Transitional cell carcinoma

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13
Q

What are the benign types of ovarian cancer?

A

Cystadenoma
Epiermoid cyst
Adenofibroma

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14
Q

What type of cancer makes up the majority of vulval cancers?

A

SCC

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15
Q

What is a pre-cancerous sign of vulval cancer?

A 
Lichen Sclerosus (autoimmune loss of collagen leading to thin epithelium)
Progresses to differentiated VIN
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16
Q

How is vulval cancer investigated?

A

Incisional biopsy >1mm

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17
Q

How is vulval cancer treated?

A

1a: WLE 15mm margin
1b: Triple incision, WLE & dissect groin nodes
2: Neo RT/chemo & reconstruction (flap coverage/ skin graft)
3-4: Radical vulvectomy

18
Q

How is endometrial cancer defined?

A

An epithelial malignancy of the uterine corpus mucosa

19
Q

What is the most common type of endometrial cancer?

A

Adenocarcinoma

20
Q

How common is endometrial cancer?

A

Common

Most common gynaecologist tumour in the developed world

21
Q

What is the pathophysiology of endometrial cancer?

A

OE affects expression of genes leading to altered regulation of cellular signals= endometrial hyperplasia.

22
Q

What stage is precancerous in endometrial cancer?

A

Atypical hyperplasia

23
Q

What are the causes of endometrial cancer?

A

Endometrial hyperplasia
Familial cancer syndromes
Endogenous OE stimulation of the endometrium (obesity, PCOS)
Exogenous OE stimulation of the endometrium (HRT)

24
Q

What are the signs & symptoms of endometrial cancer?

A 
PMB!!! (1year after cessation of periods)
Discharge (pyometra-pus in uterus)
Irregular menstrual cycle in older women
Uterine/adnexal mass
Fixed uterus
25
Q

What are the RFs of endometrial cancer?

A 
Mostly OE dependent = linked to unopposed OE
Obesity
Nulliparity
Late menopause
>50
PCOS
Endometrial hyperplasia
Tamoxifen
Fhx
26
Q

How is endometrial cancer investigated?

A 
Urgent TVUS: Endometrial thickening >5mm
Biopsy
Histopathology
Hysteroscopy
MRI
27
Q

How is endometrial cancer managed?

A

1: TAH & bilateral S-O
2: TAH, bilateral S-O, lymph node sampling
3: Radical RT +/- TAH OR Progesterone OR combined chemo
4: Internal/external brachy OR Progesterone

28
Q

How is endometrial cancer staged?

A

Locally invasive cancer

1: Confined to uterus
2: Spread to cervix
3: Spread outside of the uterus
4: Spread to bowel & surrounding organs

29
Q

What is the cause of cervical cancer?

A

HPV 16 & 18

30
Q

What is the most common type of cervical cancer?

A

SCC

31
Q

How does cervical cancer spread?

A

Spreads along the embryological development pattern

32
Q

What are the signs & symptoms of cervical cancer?

A

Abnormal vaginal bleeding- PCB/IMB/PMB
Chronic mucoid/purulent/blood stained discharge
Pelvic pain
Dyspareunia
Cervical mass/bleed
Advanced: Malaise, weight loss, pain, haematuria

33
Q

What RFs are associated with cervical cancer?

A 
HPV infection 16 & 18
HIV/immunoS
Early onset of sexual activity <18
Multiple sexual partners
Smoking
34
Q

What investigations are done in suspected cervical cancer?

A 
VE/Speculum
Smear test
Colposcopy: Punch biopsy w/ acetic acid
HPV testing
Staging: MRI &amp; CT
35
Q

In Cervical cancer what will a smear test show?

A

Dyskaryosis

36
Q

How is cervical cancer managed?

A

1a1: LLETZ/ cone biopsy
1b1 WANTING FERTILITY: Radical trachelectomy
1-2a: Radical AH & lymph node dissection & upper 1/3 of vagina, adjuvant chemo
2b-4: RT/Chemo

37
Q

What are the stages of cervical cancer?

A

0: Carcinoma in situ
1: Confined to cervix, only surgically treatable stage
a1= <3mm deep
a2= <5mm deep
b1= <4cm
b2= >4cm
2: Upper vagina NOT pelvic wall
a= not parametrium
b= invasion of parametrium
3: Pelvic wall or 1/3 lower vagina or ureteric obstruction
4: Bowel wall, bladder, distal mets

38
Q

What does CIN mean?

A

Cervical intraepithelial neoplasm
1: Low grade, can regress back to normal
2-3: Full thickness

39
Q

In what cancer are signet cells seen?

A

Krukenberg’s tumour
Mucin secretion
Secondary ovarian Ca
Primary usually Gastric/colon

40
Q

What are the types of epithelial ovarian cancer?

A 
SEROUS
Mucinous
Endometrioid
Clear cell
Transitional cell
Mixed
Undifferentiated
41
Q

What are the components of Meig’s syndrome?

A 
Ovarian fibroma
Ascites
Pleural effusion (R sided most common)

CCC (21 decks)

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