Cancer

Question 1

cervical cancer epidemiology

Answer 1

younger women

peaks in reproductive years

Question 2

cervical cancer pathology

Answer 2

squamous cell carcinoma (80%)

adenocarcinoma

Question 3

cervical cancer aetiology

Answer 3

HPV (type 16 &18)

Question 4

cervical cancer risk factors

Answer 4

increased risk of catching HPV

• early sexual activity
• increased number of sexual partners
• not using condoms

non-engagement with cervical screening 
smoking 
HIV 
COCP for >5 years
Increased number of full-term pregnancies 
family history

Question 5

cervical cancer presentation

Answer 5

may be asymptomatic 
abnormal vaginal bleeding 
vaginal discharge
pelvic pain 
dyspareunia 

abnormal appearance of cervix: ulceration, inflammation, bleeding, visible tumour

Question 6

cervical intraepithelial neoplasia

Answer 6

grading system for level of dysphasia

CIN I: mild dysplasia, affecting ⅓ thickness of epithelial layer

CIN II: moderate dysplasia, affecting ⅔ thickness

CIN III: severe dysplasia (sometimes called cervical carcinoma in situ)

Question 7

Cervical Screening

Answer 7

Look for precancerous changes (dysskaryosis)

every 3 years aged 25-49
every 5 years aged 50-64

Question 8

cervical cancer investigation

Answer 8

Colposcopy

• Stains to differentiate abnormal areas (acetic acid, Schiller’s iodine test)
• Tissue sample (obtain through LLETZ or cone biopsy)

Question 9

Staging of cervical cancer

Answer 9

1: confined to cervix
2: invades to uterus or upper ⅔ of vagina
3: invades pelvic wall or lower ⅓ of vagina
4: invades bladder, rectum or beyond pelvis

Question 10

management of cervical cancer

Answer 10

CIN & Early-Stage 1: LLETZ or cone biopsy

Stage 1b-2A: radical hysterectomy & removal of local lymph nodes with chemo& radiotherapy

Stage 2B-4A: chemotherapy & radiotherapy

stage 4B: combination of surgery, radiotherapy, chemotherapy & palliative care

Benvacizumab (Avastin)

• monoclonal antibody can be used in combo with other chemo
• reduces development go new blood vessels

Question 11

endometrial cancer

Answer 11

cancer of the endometrium: lining of uterus

Question 12

endometrial cancer pathology

Answer 12

adenocarcinoma

oestrogen-dependent

Question 13

endometrial hyperplasia

Answer 13

precancerous condition involving thickening of endometrium

types

• hyperplasia without atypic
• Atypical hyperplasia

Treatment

• intrauterine system (Mirena coil)
• Continuous oral progestogens

Question 14

endometrial cancer risk factors

Answer 14

relate to patients exposure to unopposed oestrogen 
Increase age 
early onset of menstruation 
late menopause
oestrogen only HRT
no/fewer pregnancies
Obesity
PCOS
Tamoxifen

Additional (not related to oestrogen)
T2DM
HNPCC or Lynch syndrome

Question 15

Endometrial cancer protective factors

Answer 15

COCP
Mirena coil
increased pregnancies
smoking

Question 16

presentation of endometrial cancer

Answer 16

postmenopausal bleeding.

Postcoital bleeding 
intermenstrual bleeding 
unusually heavy menstrual bleeding 
abnormal vaginal discharge
haemaaturia
Anaemia
Raised platelet count

Question 17

endometrial cancer referral criteria

Answer 17

2-week-wait urgent cancer referral
- postmenopausal bleeding

Referral for Transvaginal US women >55years

• unexplained vaginal discharge
• visible haematuria + raised platelets, anaemia or elevated glucose levels

Question 18

endometrial cancer investigations

Answer 18

Transvaginal US
- endometrial thickness (normal <4cm post menopause)

Pipelle biopsy

hysteroscopy with endometrial biopsy

Question 19

Stages of endometrial cancer

Answer 19

Stage 1: confined to uterus
Stage 2: invades cervix
Stage 3; invades ovaries, Fallopian tubes, vagina or lymph nodes
Stage 4: invades, bladder, rectum or beyond pelvis

Question 20

Management of endometrial cancer

Answer 20

Stage 1& 2: total abdo hysterectomy with bilateral sapling-oophorectomy

Question 21

ovarian cancer types

Answer 21

epithelial cell tumours
dermoid cysts/germ cell tumours
sex cord-stomal tumours
metastasis

Question 22

krukenberg tumour

Answer 22

metastasis in the ovary, usually from GI cancer, particularly stomach

Characteristic ‘signet-ring’ cells on histology

Question 23

Risk factors of ovarian cancer

Answer 23

Age (peaks 60)
BRCA1 and BRCA2) 
Increased number of ovulations 
obesity 
Smoking 
Current use of Clomifene

Question 24

ovarian cancer protective factors

Answer 24

COCP
breastfeeding
pregnancy

Question 25

Ovarian cancer presentation

Answer 25

often non-specific ``` abdo bloating early satiety loss of appetite pelvic pain urinary symptoms weight loss abdo or pelvic mass ascites ``` Ovarian mass may press on obturator nerve-> referred hip/groin pain

Question 26

Ovarian cancer referral criteria

Answer 26

2-week-wait referral if exam reveals - ascites - pelvic mass - abdo mass

Question 27

ovarian cancer investigations

Answer 27

Initial - CA125 - Pelvic US Risk of malignancy index - menopausal status - US findings - CA125 levels CT scan Histology: CT guided biopsy, laparoscopy or laparotomy Paracentesis Women <40 with complex ovarian mass -Tumour markers

Question 28

tumour markers needed for women <40 with complex ovarian mass

Answer 28

Possible germ cell tumour - alpha-fetoprotein - HCG

Question 29

Causes of raised CA125

Answer 29

``` Epithelial cell ovarian cancer Endometriosis FIbroids Adenomyosis Pelvic infection Liver disease Pregnancy ```

Question 30

Staging. of ovarian cancer

Answer 30

1: confined to ovary 2: spread past ovary but inside pelvis 3: past pelvis but inside abdo 4: outside abdo (metastasis

Question 31

management of ovarian cancer

Answer 31

Requires MDT | Usually combo of surgery and chemotherapy

Question 32

vulval cancer pathology

Answer 32

Squamous cell carcinoma (90%) | Malignant melanomas

Question 33

vulval cancer risk factors

Answer 33

advanced age immunosuppression HPV infection Lichen sclerosus

Question 34

vulval intraepithelial neoplasia

Answer 34

premalignant condition affecting squamous epithelium of the skin High grade squamous VIN - associated with HPV infection - typically age 35-50 Differentiate VIN - Associated with lichen sclerosis - typically 50-60 Biopsy required for diagnosis

Question 35

vulval cancer presentation

Answer 35

``` vulval lump ulceration bleeding pain itching lymphadenopathy in groin ``` ``` frequently affects labia majora -rregular mass -fungating lesion ulceration bleeding ```

Question 36

investigation of vulval cancer

Answer 36

Establishing diagnosis and stage - biopsy - sentinel node biopsy for lymph node spread - further imaging. (CT abdo and pelvis) for staging

Question 37

management of vulval cancer

Answer 37

wide local excision to remove cancer groin lymph node dissection chemotherapy radiotherapy