Gynae-oncology

Question 1

2ww - rapid access gynaecology centre

Answer 1

Hx 
Examination 
USS
Colposcopy / vulvoscopy / hysteroscopy
Biopsy
Bloods

Question 2

Histology look at

Answer 2

Histological dx
Grading
Receptor status

Question 3

Ovarian Cancers

Answer 3

Peak age - 60

RF - FH, BRCA1/2 mutations, many ovulations (early menarche, late menopause, nulliparity, subfertility)

Protective - childbearing, breast feeding, early menopause, the OCP

Question 4

Ovarian cancer symptoms

Answer 4

NUTORIOUSLY VAGUE

Abdominal distention and bloating
Abdominal and pelvic pain 
Urinary symptoms 
Early satiety
Diarrhoea

Question 5

OC Investigations and Tx

Answer 5

CA125 - if > 35 then urgent ultrasound of abdo and pelvis

Diagnosis difficult and usually involves diagnostic laparotomy

Management usually a combination of surgery and platinum based chemo (taxol and carboplatin)

Question 6

Risk of Malignancy Index

Answer 6

Combines serum Ca125, menopausal status and ultrasound score

Question 7

Other causes for raised CA125

Answer 7

Endometriosis
PID
Pregnancy
Torsion, rupture or haemorrhage of ovarian cyst
Other cancer
Other peritoneal pathology (trauma, irritation)
Heart failure

Question 8

Endometrial cancer

Answer 8

Most common gynae malignancy, mean age 54

RF - tamoxifen, diabetes, HNPCC, obesity, late menopause, HRT
OCP reduces risk

Features - abnormal bleeding, blood stained discharge, lower abdo pain, dyspareunia

> 4mm - hysteroscopy and biopsy. FIGO staging. Total hysterectomy and bilateral salpingo-oophorectomy is the tx of choice.

Question 9

Cervical Ca

Answer 9

Clinical presentation - post coital bleeding, intermenstrual bleeding, post menopausal bleeding, blood stained vaginal discharge

MRI to assess staging

Management - surgery, radiotherapy (sometimes chemo in conjunction)