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O&G > Cancer > Flashcards

Cancer Flashcards

1
Q

WHat are the main causes of cervical cancer

A
  • human papilloma virus (type 16, 18, 33)
  • Early sexual activity with many partners (greater chance of contracting HPV)
  • Smoking
  • HIV
  • COCP
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2
Q

What typ of cancer is cervical cancer

A

Occurs in younger women in peak reproductive years.

80% are squamous cell, 20% are adenocarcinoma

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3
Q

What is the main presentation of cervical cancer

A 
Abnormal bleeding (intermenstrual, postcoital, post-menopause)
Vaginal discharge
Pelvic pain
Urinary symptoms (dysuria, frequency)
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4
Q

How is cervical cancer staged

A

Stage 1: Confined to cervix
Stage 2: Invades uterus / upper 2/3 of vagina
Stage 3: Invades pelvic wall / lower 1/3 of vagina
Stage 4: Invades bladder / rectum / beyond pelvis

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5
Q

What does Cervical Intraepithelial Neoplasia 1 (CIN) mean

A

mild dysplasia, likely to return to normal without treatment

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6
Q

What does Cervical Intraepithelial Neoplasia 2 (CIN) mean

A

moderate dysplasia, likely to progress to cancer without treatment

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7
Q

What does Cervical Intraepithelial Neoplasia 3 (CIN) mean

A

severe dysplasia, will progress to cancer if untreated. Sometimes called “cervical carcinoma in situ”

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8
Q

What is the aim of cervical screening

A
  • Involves a cervical smear test that picks up cells from the cervix that are then looked at under a microscopy to assess for any cancerous changes.
  • Smears are tested for HPV, if negative, they are not further analysed
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9
Q

At what ages do you get screened for cervical cancer

A

Aged 25-49 every 3 years

Aged 50-64 every 5 years

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10
Q

Which strain of HPV are responsible for cervical cancer and genital warts

A

6 and 11: genital warts

16 and 18: cervical cancer

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11
Q

What is HPV (Human Papilloma Virus)

A

The most common cause of cervical cancer.
Also linked to anal, vulval, vaginal, penis, mouth and throat cancers
Invades cells and interrupts the normal replication process, inhibiting tumour suppressor genes p53 and pRb.
Sexually transmitted.

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12
Q

What are the risk factors for endometrial cancer

A 
Age
Exposure to oestrogen:
Early onset of menstruation
Late menopause
Hormone replacement therapy (particularly oestrogen without progesterone)
No pregnancies
Obesity
Tamoxifen
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13
Q

What is the presentation of endometrial cancer

A

Post-menopausal bleeding

Inter-menstrual bleeding

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14
Q

How do we investigate for endometrial cancer

A

Transvaginal ultrasound for endometrial thickness (normal is <4mm)
Hysteroscopy with endometrial biopsy

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15
Q

What is the management of endometrial cancer

A
  • Total abdominal hysterectomy with bilateral salpingo-oophorectomy (removal of uterus and adnexa)
  • Wertheim’s Hysterectomy involves also removing the pelvic lymph nodes
  • Radiotherapy
  • Progesterone can be used as a hormonal treatment to slow progression of the cancer where surgery is inappropriate
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16
Q

What are the risk factors for ovarian cancer

A 
Age (peaks age 60)
BRCA1 and BRCA2 genes (family history)
More ovulations = greater risk:
Early onset of periods
Late menopause
No pregnancies
Obesity
Hormone replacement therapy (greater in oestrogen only therapy)
Smoking
17
Q

What are protective factors for ovarian cancer

A

breast feeding

18
Q

What is the presentation of ovarian cancer

A 
Bloating
Pelvic pain
Urinary symptoms
Weight loss
Abdominal mass
19
Q

Which marker is raised in ovarian cancer

A

Ca125

20
Q

What other conditions is Ca125 raised in

A 
Ovarian cancer
During menstruation
Endometriosis
Liver cirrhosis
Benign ovarian cysts
Fibroids
21
Q

What investigations should you complete for suspected ovarian cancer

A

CA125 blood test
Abdominal/pelvic ultrasound
Diagnostic laparoscopy

22
Q

What is the management of ovarianc cancer

A

Surgery

Chemotherapy

23
Q

What are the stages of ovarian cancer

A

Stage 1: only in the ovary
Stage 2: out of the ovary but inside the pelvis
Stage 3: out of the pelvis but inside the abdomen
Stage 4: spread outside the abdomen (distant metastasis)

24
Q

What is Krukenberg Tumour

A

This is an ovarian malignancy that is a secondary metastatic tumour from another site.

25
Q

What are the risk factors of vulval cancer

A

Advanced age
HPV infection
Lichen Sclerosus (around 4% of women with lichen sclerosus get vulval cancer)

26
Q

What is Vulval Intraepithelial Neoplasia (VIN)

A
  • Pre-malignant condition which precedes vulval cancer
  • 2 Types:
    • HPV related (30-40yrs)
    • Lichen sclerosis (50-60yrs)
27
Q

How do we diagnose and manage Vulval Intraepithelial Neoplasia

A

Diagnosis is by biopsy and management is surgical, by wide local excision.

28
Q

What is the presentation of vulval cancer

A
  • often incidental finding
  • Pain
  • Itching
  • Discomfort
  • Discharging
  • Bleeding
  • Abnormal appearance or palpation on self examination
  • Lymphadenopathy in groin (inguinal and femoral nodes)
29
Q

What is the appearance of a vulval cancer

A
  • Most frequently affecting the labia majora
  • Irregular mass
  • Fungating
  • Ulcerating
  • Bleeding
30
Q

What is the management of vulval cancer

A
  • 2ww
  • Incisional biopsy for diagnosis if low concern for cancer
  • Sentinel node biopsy
  • Wide local excision to remove the cancer
  • Groin lymph node dissection to stage and clear cancerous nodes
31
Q

What is a cervical ectropion

A

cells normally seen on the inside of the cervix are seen on the outside surface.

32
Q

Who gets cervical ectropion

A

o Normal in teens, pregnancy and on pill
o Can bleed esp. after sex
o Usually resolves on own

33
Q

What is the management of mild changes on cervical smear

A

colposcopy or repeat smear in 6 months, then need 3 normal 6 monthly smears then discharged back to normal screening

34
Q

How can you treat an abnormal smear

A

o Laser ablation, cold coagulation, LLETZ, cone biopsy (local anaesthetic)

35
Q

What is colposcopy

A

 Colposcopy is very similar to smear but uses a magnifying glass and they may take a biopsy

36
Q

What happens with a moderate to severely abnormal smear

A
  • referred for colposcoy

- treatment

37
Q

What advice should be given to patients with treatment of their abnormal smear

A

 Treatment may cause period type pains, have paracetamol/ibuprofen
 No sex or tampons for 4 weeks as increase risk of infection

38
Q

Who gets HPV vaccine

A
  • All girls 12-13 (Can have catch up until 18)

- All boys 12-13

39
Q

Why do we give the HPV vaccine so young

A

 Spread from skin to skin contact and is found on hands, mouth and genitals
 This means the virus can be passed on during any kind of sexual contact including touching
 The vaccine works best if girls have it before they come in contact wih the virus, in other words before theyre sexually active
 So by vaccinating at this age we hope that no one will have been exposed to the virus yet making it most effective in preventing issues later on
 Studies have not shown an increase in prosmicuity seen the programmes has been introduced

O&G (13 decks)

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