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Year 4 - Cancer Care > Gynae cancers > Flashcards

Gynae cancers Flashcards

1
Q

A 60yo lady (LMP 8yrs ago) presents to the PMB clinic with a 2/52 history of spotting.
What is your differential diagnosis for PMB?

A
  1. vaginal atrophy
  2. endometrial/cervical polyps
  3. endometrial hyperplasia
  4. HRT
  5. endometrial carcinoma - until proven otherwise
  6. cervical or ovarian carcinoma
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2
Q

A 60yo lady (LMP 8yrs ago) presents to the PMB clinic with a 2/52 history of spotting.

How will you investigate her?

A
  1. TVUS to look at endometrial thickness
  2. if >5 mm: hysteroscopy + endometrial biopsy for diagnosis + histology
  3. FBC
  4. CT chest/abdo/pelvis +/- MRI pelvis: for staging
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3
Q

What is the most common type of endometrial carcinoma?

A

80% adenocarcinomas (oestrogen-dependent)

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4
Q

Suggest possible risk factors for endometrial carcinomas

A

Prolonged periods of unopposed oestrogen:

  1. early menarche, late menopause, nulliparity, 1st child >30yo
  2. obesity + DM
  3. PCOS
  4. tamoxifen
  5. previous breast/ovarian cancer
  6. BRCA1/2 and HNPCC
  7. endometrial polyps/hyperplasia
  8. Parkinson’s disease
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5
Q

Which staging system is used for endometrial cancer?

A

FIGO staging:
I. limited to myometrium
II. cervical spread
III. uterine serosa, ovaries/tubes or vagina, pelvis/para-aortic LNs
IV. bladder/bowel involvement or distant mets e.g. lung, liver, bone

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6
Q

What are the management options for endometrial cancer?

A
  1. hysterectomy + bilateral salpingo-oophorectomy: 1st line for most pts
  2. +/- adjuvant RT: if high recurrence risk or stage III-IV
  3. non-surgical alternatives:
    - progestogens e.g. for stage IA without myometrial invasion in women who wish to preserve fertility
    - primary RT
    - chemo
    - palliative care
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7
Q

What is endometrial hyperplasia? What are the 2 types?

A

Abnormal proliferation of endometrium:

  1. hyperplasia without atypia: <5% risk of progression to carcinoma within 20yrs
  2. atypical hyperplasia (cytological change present): pre-malignant condition with 28% risk of progression
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8
Q

What treatment would you offer a woman with endometrial hyperplasia (without atypia + atypical)?

A

Without atypia:

  • reassurance (most return to normal) + watchful waiting
  • progestogen Tx e.g. levonorgestrel IUD
  • 6-monthly biopsies until 2 consecutive ones are negative (annual biopsy thereafter for high-risk women e.g. BMI >35)
  • hysterectomy: may be required if no regression after 1yr of Tx or woman’s preference

Atypical:

  • total hysterectomy + bilateral salpingo-oophorectomy for post-menopausal women
  • progestogen Tx as above for women wishing to preserve fertility with 3 monthly biopsies + hysterectomy as soon as potential fertility no longer required
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9
Q

A 27yo woman is referred to gynae OP due to an abnormal cervical smear result.
How should she be investigated?

A
  1. colposcopy + biopsy
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10
Q

What are the main types of cervical cancer?

A
  1. squamous cell cancer (80%)

2. adenocarcinoma (20%)

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11
Q

What are the main risk factors for cervical cancer?

A
  1. HPV 16, 18 and 33 infection
  2. early 1st intercourse, many sexual partners
  3. smoking
  4. low SES
  5. HIV
  6. high parity
  7. COCP
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12
Q

How does HPV cause cervical cancer?

A

HPV 16 produces E6: inhibits p53 tumour suppressor gene

HPV 18 produces E7: inhibits Rb suppressor gene

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13
Q

What are the management options for cervical cancer according to stage?

A

Stage IA (confined to cervix, <7mm wide)

  1. hysterectomy +/- LN clearance OR
  2. cone biopsy with -ve margins + close f/u

Stage IB (confined to cervix, >7mm wide)

  1. RT + CISPLATIN chemo OR
  2. radical hysterectomy + pelvic LN dissection (if >4cm)

Stage II and III

  1. RT + chemo
  2. +/- nephrostomy if hydronephrosis

Stage IV

  1. RT and/or chemo
  2. palliative chemo if stage IV B
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14
Q

How often should women be screened for cervical cancer?

A
  • age 25-49: every 3yrs
  • age 50-64: every 5yrs

in pregnancy, usually delayed 3/12 post-partum unless missed screening or previous abnormal smears

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15
Q

A 55yo woman presents to the GP with a 3/12 history of abdo. discomfort + bloating, as well as fatigue + 6kg weight loss. No PMH of note. O/E: NAD.

How should she be investigated/managed by the GP?

A
  1. measure CA-125
  2. if raised (35 IU/mL): urgent abdo/pelvis USS
  3. if abnormal: urgent 2ww gynae referral
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16
Q

Suggest possible causes for a raised CA 125.

A
  1. ovarian cancer
  2. endometriosis
  3. PID
  4. pregnancy
  5. ovarian cyst torsion, rupture or haemorrhage
  6. other cancer e.g. peritoneal, lung, pancreatic
  7. other peritoneal pathology (trauma, irritation)
  8. HF
17
Q

A 55yo woman presents to the GP with a 3/12 history of abdo. discomfort + bloating, as well as fatigue + 6kg weight loss. She has a raised CA-125 and abnormal pelvic USS.
How should she be assessed in secondary care?

A
  1. measure Risk Malignancy Index 1 score

2. CT abdo/pelvis +/- chest: to confirm Dx + extent

18
Q

How is RMI 1 calculated?

A

USS score x menopausal score x CA 125 (IU/ml)

USS score: multilocular cyst, solid areas, bilateral lesions, ascites, intra-abdominal mets (1 = 1 abnormality, 3 = 2+ abnormalities)

Menopausal score: 1 = premenopausal, 3 = postmenopausal

19
Q

What are the main types of ovarian cancer? Which subtype is most common?

A
  1. epithelial ovarian cancers (90%): most common subtype = serous cystadenoma (characterised by Psamomma bodies)
  2. germ cell tumours (5-10%)
  3. sex-cord stromal tumours (<5%)
20
Q

Which blood tests should be performed in a woman <40yrs with ovarian cancer?

A
  • AFP: to exclude endodermal sinus tumours
  • B-hCG: to exclude dysgerminomas, embryonal carcinomas or choriocarcinomas
  • LDH
21
Q

What are the main risk factors for development of ovarian cancer?

A
  1. smoking
    2, obesity + DM
  2. asbestos or RT exposure
  3. FHx
  4. BRCA1/2 genes
  5. previous ovarian, breast or bowel cancer
  6. endometriosis
  7. infertility + use of fertility drugs e.g. clomifene
  8. nulliparity, early menarche, late menopause
  9. HRT use >5yrs
22
Q

What are the treatment options for a woman with ovarian cancer?

A
  1. total abdominal hysterectomy
    OR unilateral salpingo-oophorectomy (if early ovarian cancer in young woman who desires fertility)

Further Mx depends on stage + histology of tumour:

  1. adjuvant chemo: if stage II-!V
  2. interval debulking
  3. palliative care

Year 4 - Cancer Care (13 decks)

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