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Gynaecology > Gynaecological oncology > Flashcards

Gynaecological oncology Flashcards

1
Q

Which types of HPV are responsible for cervical cancer?

A

Types 16 and 18

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2
Q

What types of HPV cause genital warts?

A

Types 6 and 11

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3
Q

What types of HPV does the current Gardasil vaccine protect against?

A

Types 6, 11, 16 and 18

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4
Q

Describe how the cervical screening programme is triaged?

A
  1. Intial screening for HPV
  2. If HPV+ve, cytology
  3. If abnormal cells: send for colposcopy
  4. If cells normal but HPV+ve, then repeat smear in 12/12
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5
Q

What ages are included in the cervical screening programme and how often should they have a smear?

A

25-49: every 3 years

50-64: every 5 years

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6
Q

If cytology returns an ‘inadequate’ result, how should the screening proceed?

A

Repeat in 3 months

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7
Q

What is the appropriate course of action:
Initially: HPV+ve, cytology normal
12/12 later: HPV-ve

A

Return to normal screening i.e. retest in 3yrs

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8
Q

What is the appropriate course of action:
Initially: HPV+ve, cytology normal
12/12 later: HPV+ve, cytology normal

A

Repeat in 12/12

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9
Q

What is the appropriate course of action:
Initially: HPV+ve, cytology normal
12/12 later: HPV+ve, cytology normal
12/12 later: HPV+ve, vytology normal

A

After 24 months with remaining HPV positive, refer to colposcopy

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10
Q

What is the appropriate course of action:
Initially: HPV+ve, cytology normal
12/12 later: HPV+ve, cytology normal
12/12 later: HPV-ve

A

Return to routine screening (e.g. next smear in 3 years)

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11
Q

How is CIN1 managed?

A

Nil required. Will likely spontaneously resolve.

Repeat screening in 12/12

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12
Q

How is CIN2 managed?

A

LLETZ

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13
Q

How is CIN3 managed?

A

LLETZ

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14
Q

How is CGIN managed?

A

LLETZ

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15
Q

How is cervical cancer staged?

A

FIGO staging

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16
Q

How might cervical cancer present?

A 
Most are picked up on screening. 
Symptoms may include:
PCB
IMB 
Persistent and offensive discharge
PMB
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17
Q

How is FIGO 1a1 cervical cancer managed?

A

Loop excision

18
Q

How is FIGO stage 1a2-1b2 managed?

A

Hysterectomy + BSO + pelvic node clearance

19
Q

What is the treatment for a woman with cervical cancer who wishes to preserve her fertility?

A

Cone biopsy OR radical trachelectomy

20
Q

What type of endometrial hyperplasia is a precursor to endometrial cancer?

A

Complex atypical endometrial hyperplasia

21
Q

How is endometrial hyperplasia treated?

A

Hysterectomy as it is likely that a cancer is already present.

22
Q

How is endometrial hyperplasia managed if a hysterectomy is refused?

A

Progesterone given to thin the endometrium and endometrial biopsies to follow up.

23
Q

Who gets endometrial cancer (generally)?

A

Post-menopausal women aged 50y/o+

24
Q

What risk factor is most likely to blame for rising incidences of endometrial cancer?

A

Obesity

25
Q

What are the types of endometrial cancer?

A

Oestrogen dependent - usually endometrioid adenocarcinomas

Non-oestrogen dependent - serous papillary carcinoma, clear cell carcinoma

26
Q

What is the most important risk factor for endometrial cancer?

A

Tamoxifen use

27
Q

How might endometrial cancer present?

A

PMB: typically heavy vaginal bleeding 1 year after the menopause

28
Q

How is endometrial cancer investigated?

A

Transvaginal ultrasound - 4.5mm+ requires a pipelle endometrial biopsy or hysteroscopy wiht biopsy

29
Q

How is endometrial cancer treated?

A

Hysterectomy + BSO +/- pelvic node clearance +/- omentectomy

30
Q

What is the most common type of pvarian cancer?

A

Serous carcinoma

31
Q

What is the most important risk factor for ovarian cancer?

A

BRCA1 gene

32
Q

How might ovarian cancer present?

A

Weight loss
Abdominal pain
Bloating
Vague symptoms

33
Q

What findings might be present on examination in ovarian cancer?

A

Pelvic mass
Omental cake
Ascites

34
Q

What tumour markers shoudl be measured when concerned about ovarian cancers?

A

CA125
CEA
CA153
CA199

35
Q

What additional tumour markers should be taken in a woman under 40 with symptoms of ovarian cancer and why?

A

AFP
hCG
LDH
To exclude a germ cell tumour

36
Q

What tool is used to stratify risk in ovarian cancer and how is it used?

A

Risk of Malignancy Index (RMI)

Menopausal status x USS findings x CA125 level

37
Q

How is ovarian cancer managed?

A

TAH + BSO + omentectomy + pelvic node clearance

38
Q

How is ovarian cancer managed in a woman who wishes to get pregnant?

A

Only if early stage: remove affected ovary and Fallopian tube (+/- node clearance on affected side)

39
Q

What is the most common vulval cancer?

A

Squamous cell carcinoma

40
Q

What are the two most important risk factors for vulval cancer?

A

Lichen sclerosus

HPV

41
Q

How might vulval cancer present?

A 
Persistent itching
Ulceration on the vulva 
Lump or lesion 
Thickened red or white skin patch
Change in mole
42
Q

How is vulval cancer treated?

A

Wide local excision +/- pelvic node clearanec +/- chemotherapy

Gynaecology (7 decks)

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