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Obstetrics and Gynaecology > Cancer > Flashcards

Cancer Flashcards

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1
Q

Common types of cervical cancer

A
  1. 80% squamous cell carcinoma
  2. Adenocarcinoma
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2
Q

What is the most common cause of cervical cancer?

A

HPV

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3
Q

How do we screen for cervical cancer?

A

Smear tests

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4
Q

How is HPV transmitted?

A

Sexually transmitted

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5
Q

Important strains of HPV

A

16 and 18

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6
Q

How do you treat HPV?

A

There is no treatment for HPV infection and most cases resolve spontaneously within 2 years but some may persist.

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7
Q

How does HPV cause cervical cancer?

A

HPV produces E6 and E7 which suppress P53 and pRb (tumour suppressor genes) which as a result promotes the development of cancer.

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8
Q

Risk factors for cervical cancer

A

Early sexual activity
Increased number of sexual partners
Sexual partners who have had more partners
Not using condoms
Smoking
HIV
COCP use for more than five years
Increased number of full term pregnancies
Family history

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9
Q

Presentation of cervical cancer

A

Abnormal vaginal bleeding
Vaginal discharge
Pelvic pain
Dyspareunia

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10
Q

What should be done if a cervix appears abnormal on speculum examination?

A

Urgent cancer referral for colposcopy

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11
Q

What grading system is used for level of dysplasia?

A

CIN grading ( Cervical intraepithelial neoplasia)
CIN 1 - mild - affects 1/3 thickness of epithelial layer and likely to return to normal
CIN 2 - moderate - affects 2/3 of thickness of epithelial layer and likely to progress to cancer if untreated
CIN 3 - severe - very likely to progress to cancer if untreated

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12
Q

Cervical cancer screening process

A

Small brush collects cells from the cervix using a speculum and cells are deposited and looked at under a microscope for dyskaryosis. Sample is tested for high risk HPV before the cells are examined. If HPV negative then the cells are not examined - considered negative and returned to normal screening programme.

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13
Q

Cervical screening programme timeline

A

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

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14
Q

Exceptions to cervical screening programme timeline

A

Women with HIV screened annually
Immunocompromised women may have additional screening
Pregnancy women should wait 12 weeks (3 months) postpartum for cervical screening

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15
Q

Management of smear results:
1. Inadequate sample
2. HPV negative
3. HPV positive with normal cytology
4. HPV positive with abnormal cytology

A
  1. Inadequate sample - repeat smear after at least 3 months
  2. HPV negative - continue routine screening
  3. HPV positive with normal cytology - repeat HPV test after 12 months
  4. HPV positive with abnormal cytology - refer for colposcopy
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16
Q

What is colposcopy?

A

Involves inserting speculum and using a colposcope to magnify the cervix and examine abnormal areas of epithelial lining of cervix.

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17
Q

Types of biopsies during colposcopy

A

LLETZ or cone biopsy

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18
Q

Main risks of a cone biopsy

A

Pain
Bleeding
infection
Scar formation with stenosis of cervix
Increased risk of miscarriage and premature labour

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19
Q

Staging of cervical cancer

A

FIGO staging:
1. Confined to cervix
2. invades the uterus or upper 2/3 of vagina
3. invades pelvic wall or lower 1/3 of vagina
4. invades the bladder, rectum or beyond the pelvis

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20
Q

Management of cervical cancer

A

CIN I - LLETZ or cone biopsy
Stage 1b-2a - radical hysterectomy and removal of lymph nodes with chemo and radio
Stage 2b-4a - chemo and radio
stage 4b - combination of surgery, radio, chemo and palliative care

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21
Q

Current NHS vaccine for HPV

A

Gardasil

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22
Q

Most common type of endometrial cancer

A

Adenocarcinoma

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23
Q

Types of endometrial hyperplasia

A

Hyperplasia without atypic
Atypical hyperplasia

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24
Q

How may endometrial hyperplasia be treated?

Study These Flashcards
A

Using progestogens : IUS or continuous oral progestogens

25
Risk factors for endometrial cancer
Related to patient's exposure to unopposed oestrogen so: - increased age - early onset of menstruation - late menopause - oestrogen only hormone replacement therapy - no or few pregnancies - obesity - PCOS - Tamoxifen
26
How does PCOS lead to increased risk of endometrial cancer?
Increased exposure to unopposed oestrogen due to lack of ovulation. Women with PCOS are less likely to ovulate and for a corpus luteum and without the corpus luteum, progesterone is not produced -> unopposed oestrogen. For endometrial protection, women with PCOS should have either COCP, IUS, or cyclical progestogens.
27
How does obesity lead to increased risk of endometrial cancer?
Adipose tissue contains aromatase which converts androgens such as testosterone to oestrogen. The extra oestrogen is unopposed in women who are not ovulating.
28
How does tamoxifen lead to increased risk of endometrial cancer?
Tamoxifen is an anti-oestrogenic effect on breast tissue but an oestrogen effect on the endometrium -> increased risk of endometrial cancer.
29
How does T2DM lead to increased risk of endometrial cancer?
Increased production of insulin may stimulate the endometrial cells and increase the risk of endometrial hyperplasia and cancer.
30
Protective factors against endometrial cancer examples.
COCP Mirena coil Increased pregnancies Cigarette smoking
31
How is smoking protective against endometrial cancer?
Smoking in post menstrual women is protective by being anti-oestrogenic, for example: Oestrogen is thought to be metabolised differently in smokers. Smokers tend to be leaner - so less adipose tissue and less aromatase Smoking destroys oocytes resulting in earlier menopause
32
How does endometrial cancer present?
Main symptom is post-menstrual bleeding. - unusually heavy menstrual bleeding - postcoital bleeding - intermittent bleeding - haematuria - anaemia - raised platelet count
33
What should you do if you suspect endometrial cancer?
2-week wait referral for post menstrual bleeding (more than 12 months after last menstrual period)
34
For whom does NICE recommend a transvaginal USS?
Women over 55 with: Unexplained vaginal discharge Visible haematuria plus raised platelets, anaemia or elevated glucose levels
35
Endometrial cancer investigations
Transvaginal USS, Pipelle biopsy (highly sensitive for endometrial cancer) Hysteroscopy with endometrial biopsy
36
Staging of endometrial cancer
FIGO Stage 1: confined to uterus Stage 2: invades the cervix Stage 3: invades the ovaries, Fallopian tubes, vagina or lymph nodes Stage 4: invades bladder, rectum or beyond the pelvis
37
Endometrial cancer management
Usual treatment for stage 1 and 2 endometrial cancer is a total abdominal hysterectomy with bilateral sapling-ooophorectomy Other treatment options: - Radio - Chemo - Progesterone can be used as hormonal treatment to slow the progression of the cancer - radical hysterectomy with lymph node, surrounding tissue and top of vagina removal
38
Ovarian cancer presentation
Often presents late due to non-specific symptoms and usually has a bad prognosis
39
Types of ovarian cancer
Epithelial cell tumours (most common) Dermoid cysts/ Germ cell tumours Sex cord-stomal tumours Metastasis
40
Dermoid cysts/ Germ cell tumours
Benign ovarian tumours. They are teratomas meaning they come from the germ cells. They contain various tissue types such as skin, teeth, hair and bone. They are particularly associated with ovarian torsions. This protuberance is referred to as the Rokitansky protuberance. Germ cell tumours may cause raised alpha-fetoprotein and hCG.
41
Sex cord-stomal tumours
Rare tumours that can be benign or malignant. They arise from the storm or sex cords. Either from sertoli-leydig cell tumours and granulose cell tumours
42
Krukenberg tumour
metastasis in the ovary from a gastrointestinal tract cancer - most commonly the stomach.
43
Risk factors for ovarian cancer
Age >60 BRCA 1 and BRCA 2 genes Increased number of ovulations Obesity Smoking Recurrent use of clomifene
44
Protective factors of ovarian cancer
COCP Breastfeeding Pregnancy
45
Ovarian cancer presentation
Abdominal bloating Loss of appetite Pelvic pain Weight loss Abdominal or pelvic mass Ascites
46
Referral criteria for ovarian cancer
Refer directly for 2 week wait referral if physical examination reveals: Ascites Pelvic mass Abdominal mass
47
Ovarian cancer investigations
CA125 blood test >35 Pelvic USS
48
What is RMI?
Risk of malignancy index which is based on: Menopausal status USS findings CA125 level
49
Causes of raised CA125
Endometriosis Fibroids Adenomyosis Pelvic inflammation Liver disease Pregnancy
50
Staging of ovarian cancer
FIGO Stage 1: confined to ovary Stage 2: spreads past the ovary but inside the pelvis Stage 3: past the pelvis but inside the abdomen Stage 4: spread outside the abdomen
51
Management of ovarian cancer
Managed by specialist with combination of surgery and chemo
52
Vulval cancer types
Squamous cell carcinomas most common
53
Risk factors for vulval cancer
Advanced age >75 Immunosuppression HPV Lichen Sclerosis
54
What is vulval intraepithelial neoplasia?
Premalignant condition affecting the squamous epithelium that can precede vulval cancer.
55
Types of vulval intraepithelial neoplasia
High grade VIN - VIN with HPV infection and occurs in younger women Differentiated VIN - VIN with lichen sclerosis and occurs in older women
56
How to diagnose and manage VIN?
Diagnose via biopsy and management includes: - Watch and wait - Wide local excision - Imiquimod cream - Laser ablation
57
Presentation of vulval cancer
Vulval lump Ulceration Bleeding Pain Itching Lymphadenopathy in groin
58
Management of vulval cancer
Wide local excision Groin lymph node dissection Chemotherapy Radiotherapy

Obstetrics and Gynaecology (9 decks)

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