Gynaecology Oncology 2

Question 1

What is an epithelial tumours of the ovary?

Answer 1

derived from epithelium covering the ovary

most common in postmenopausal women

Question 2

What are the different types of epithelial tumours of the ovary?

Answer 2

from most common to least common

• serious cyst adenoma or adenocarcinoma
• endometroid carcinoma
• mutinous cystadenoma
• clear cell carcinoma
• brenner tumour

Question 3

What are the germ call tumours of the ovary?

Answer 3

teratoma or dermoid cyst

• common benign tumour in young premenopausal women
• may contain hair and teeth
• common bilateral

dysgerminoma - rare but most common ovarian malignancy in younger women

Question 4

What is premalignant vulval cancer?

Answer 4

vulval intraepithelial neoplasia (VIN), presence of atypical cells in vulval epithelium
more common in women 35-55
associated with HPV, CIN, cigarette smoking, chronic immunosuppression

Question 5

What is differentiated type VIN?

Answer 5

rare
associated with lichen sclerosis
seen in older women
risk of progression to cancer

Question 6

What are the RFs for vulval cancer?

Answer 6

normally arise de novo
VIN premalignant
associated with lichen sclerosis, immunosuppression, smoking, paget’s disease of the vulva

Question 7

What are the symptoms of vulval cancer?

Answer 7

pruritus, bleeding or discharge
malignancy often presents late
ulcer or mass most commonly on labia major or clitoris
inguinal lymph nodes may be enlarged, hard and immobile

Question 8

How does vulval cancer spread?

Answer 8

Vulval carcinoma spreads locally

Spreads via lymph drainage of vulva

Question 9

What are investigations for vulval cancer?

Answer 9

biopsy to establish diagnosis and histyological

assess fitness for surgery - CXR, ECG, FBC, UEs, cross match blood

Question 10

How is vulval cancer managed?

Answer 10

Biopsy then wide local excision with separate groin node dissection, bilateral unless tumour >2cm from midline

Radiotherapy if lymph node involvement

Question 11

What can be used for pain relief in cancer?

Answer 11

analgesic ladder
co-analgeics - antidepressants, steroids, cytotoxic may be used
opioid analgesia can be patient controlled
alternative therapies

Question 12

What can be used N+V in cancer treatment?

Answer 12

Poss opiates, metabolic causes (e.g. uraemia), vagal stimulation (e.g. bowel
distension) or psychological factors

Antiemetics = anticholinergics, antihistamines, dopamine antagonists or 5HT-
3 antagonists

Question 13

What can be done for high vaginal bleeding in cancer treatment?

Answer 13

High dose progesterones may be useful

Radiotherapy used if not used before

Question 14

What is ascites and bowel obstruction a sign of?

Answer 14

advanced ovarian carcinoma

Question 15

How is ascites and bowel obstruction managed?

Answer 15

• ascites best drained slowly by repeated paracentesis
• obstruction managed at home
• partial obstruction –> metaclopramide used with stool softeners with enemas for constipation and trial of dexamethasone to reduce tissue oedema
• complete obstruction –> cyclizine and ondansetron for N&V, hyoscine for spasm
• encourage eating and drinking small amount
• stents can be inserted in acute obstruction
• terminal distress - manage sensitively

Question 16

What is the purpose of hospice care?

Answer 16

Only 30% cured of gynaecological carcinoma

Palliative care – ‘active total care of the patient whose disease is incurable’

Increase QoL for patient + family

Address symptoms

Meeting patient’s social, psychological + spiritual needs

Care needs to be individualised

Problems of prolongation of poor-quality life, euthanasia, symptom control vs drug SEs, making transition from curative to palliative care + resource allocation