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Women's health > Cervix and ovarian cancer > Flashcards

Cervix and ovarian cancer Flashcards

1
Q

Cervical cancer : Definition

A

Cancer arising from the changes in the squamous epithelial cells lining the cervix
- Squamous cell carcinoma is the most common type

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2
Q

Cervix : Anatomy

A

⦁ Cervix is split into 2 parts
1. Endocervix
⦁ closer to the uterus ‘upper part’
⦁ Histology : Columnar epithelial cells;that produce mucus.

  1. Ectocervix
    ⦁ Continuous with the vagina
    ⦁ Histology :mature squamous epithelial cells.
  2. **The squamocolumnar junction **
    Where squamous epithelium of the ectocervix and the columnar epithelium of the endocervix meet.
  3. **Transformation zone **
    * right where the two types of cells meet
    * where sub-columnar reserve cells multiply and transform into immature squamous epithelium through a process called metaplasia.
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3
Q

Cervical cancer : Pathophysiology

A

Cervical intra epithelial neoplasia : occurs when there is dysplasia in the immature squamous epithelium at the transformation zone

⦁ Transformation of normal cervical epithelium into precancerous lesions (cervical intraepithelial neoplasia, CIN)
⦁ eventually invasive carcinoma

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4
Q

Cervical cancer : Risk factors

A
  1. HPV
  2. Smoking
  3. Long term COOP use
  4. Immunosupression
  5. HIV
  6. High rate of sexual partners
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5
Q

Cervical cancer : Main risk factor

A

Human papillomavirus (HPV) infection
HPV 16
HPV 18

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6
Q

Cervical cancer : Clinical features

A
  1. Heavy/Irregular vaginal bleeding
  2. Pain during sex or bleeding after sex
  3. Pelvic or lower back pain
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7
Q

Cervical intraepithelial neoplasia : Defintion

A

Abnormal changes in the cells of the cervix
Pre cancerous lesion if untreated can progress to cervical cancer

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8
Q

Cervical intraepithelial neoplasia : Grading

A
  1. CIN 1 - Mild dyskaryosis
    - 1/3 of cervical area
    * Corressponds with infection of HPV and will self resolve within 6 months
    * No treatment required
  2. CIN II- moderate dyskaryosis
    * 2/3 thickness of surface area of surface
    * Moderate changes
  3. CIN III - severe dyskaryosis
    * Full thickness of cervic
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9
Q

CIN : Management

A
  1. Large loop excision of the transformation zone
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10
Q

Cervical cancer : Clinical features

A

⦁ May be detected during routine cervical cancer screening
⦁ Abnormal vaginal bleeding: postcoital, intermenstrual or postmenopausal bleeding
⦁ Vaginal discharge

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11
Q

Cervical cancer : Sites of metastasis

A

Liver, lungs, bone

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12
Q

Cervical cancer : Staging - Stage 1

A

1A : Confined to cervix, only visible by microscopy and less than 7 mm wide
- A1 : < 3mm deep
- A2 : 3-5mm deep

1B : Confined to cervix, clinically visible or larger than 7 mm wide:
- B1 <4cm diameter
- B2 - > 4 cm diameter

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13
Q

Cervical cancer : Staging - Stage 2

A

Extension of tumour beyond cervix but not to the pelvic wall

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14
Q

Cervical cancer : Staging - Stage 3

A
  1. Extension of tumour beyond the cervix and to the pelvic wall
  2. Any tumour causing hydronephrosis or a non-functioning kidney is considered stage III
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15
Q

Cervical cancer : Staging - Stage 4

A

Extension of tumour beyond the pelvis or involvement of bladder or rectum

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16
Q

Cervical cancer : Management- Stage 1 A

A

Gold standard : hysterectomy +/- lymph node clearance

  • A2 (3-5cm deep) - Lymph nodal clearance
  • If wanting to maintain fertility : Cone biopsy with negatve margins (removal of cone shaped wedge from cervix)
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17
Q

Cervical cancer : Management- Stage 1 B

A
  1. B1 tumours: radiotherapy with concurrent chemotherapy is advised
  2. B2 tumours: radical hysterectomy with pelvic lymph node dissection
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18
Q

Cervical cancer : Management- Stage 2/3

A
  1. Radiotherapy and chemotherapy
  2. Nephrostomy : In hydronephrosis
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19
Q

Cervical cancer : Management- Stage4

A

Radiation and/or chemotherapy is the treatment of choice } palliative

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20
Q

Cervical cancer : Complications of disease and management

A
  1. Loss of fertility
    ⦁ Hysterectomy
    ⦁ Radiation therapy can lead to premature ovarian failure and uterine damage
  2. Urinary Dysfunction
    ⦁ Ureteral obstruction: Advanced cervical cancer can infiltrate the ureters, causing obstruction and hydronephrosis
    ⦁ Urinary incontinence and retention: Surgery and radiation therapy can damage nerves and muscles controlling urinary function, leading to urinary incontinence or retention.
  3. Bowel Dysfunction
    ⦁ Obstruction: Direct invasion of the tumour into the rectum, or radiation-induced fibrosis, can cause bowel obstruction.
    ⦁ Radiation proctitis: Radiation therapy can induce inflammation and damage to the rectum, causing symptoms such as diarrhoea, urgency, and rectal bleeding.
  4. Lymphedema
    ⦁ Lymph node dissection and radiation therapy can disrupt the lymphatic system, leading to lymphedema.
  5. Sexual Dysfunction
    ⦁ Treatments for cervical cancer, such as surgery and radiation, can affect sexual function by causing changes in anatomy
    ⦁ vaginal dryness, pain during intercourse, and a decrease in sexual desire.

6.** Fistula Formation**
⦁ Advanced cervical cancer or treatment-related damage
⦁ lead to the development of fistulas such as vesicovaginal (bladder and vagina) or rectovaginal (rectum and vagina) fistulas.

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21
Q

Cervical cancer : Screening : Describe process

A

A smear test is offered to all women between the ages of 25-64 years
⦁ 25-49 years: 3-yearly screening
⦁ cervical screening in pregnancy is usually delayed until 3 months post-partum
⦁ 50-64 years: 5-yearly screening

  1. HPV first system : sample is tested for high-risk strains of HPV first
  2. Cytotological sample : only done if +ve for HPV cervical cancer causing strain
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22
Q
A
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23
Q

Cervical cancer : Screening : Negative hrHPV

A

return to normal recall

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24
Q

Cervical cancer : Screening : Positive hrHPV - next step

A
  1. Samples are examined cytologically
  2. If the cytology is abnormal ie. epithelial changes or dyskaryosis of any degree → colposcopy
  3. If cytology is normal -> Repeat HPV first test in 12 months
    * - If Repeat HPV test is negative } normal recall
    * - If repeat HPV test is positive } repeat again in 12 months
    * - Repeat HPV test is positive 24 months later } Colposcopy
25
Q

Cervical cancer : Screening : Positive hrHPV - ‘Inadequare sample’

A

I. Repeat the sample within 3 months
II. If two consecutive inadequate samples then → colposcopy

26
Q

Germ cell ovarian tumor : Pathophysiology

A
  1. Ovaries contain multiple folliciles
  2. Each follicle is made up of a germ cell - also known as oocyte which is an immagure cell
  3. Germ cells are pluripotent cells found in the ovaries which eventually differentiate into eggs.
  4. Uncontrollable division of the germ cells in the ovaries can lead to ovarian tumors or cancer
27
Q

Ovarian cancer : most common type

A
  1. 90% are epithelial cancer - majority of which are serous carcinomas
28
Q

Ovarian cancer : Risk factors

A
  • BRCA1 or the BRCA2 gene
  • HNPCC - Lynch syndrome
    Anything which increases the number of ovulation cycles in a lifetime
  • early menarche, late menopause, nulliparity
29
Q

Ovarian cancer : Clinical features

A

⦁ abdominal distension and bloating
⦁ abdominal and pelvic pain
⦁ urinary symptoms e.g. Urgency
⦁ early satiety
⦁ diarrhoea

30
Q

Ovarian cancer : Investigation

A
  1. CA125 : FIRST LINE
    may also be raised due to endometriosis/ovarian cysts
  2. CA124 > 35 } Raised
  3. Urgent US of Abdomen and Pelvis
  4. Labs : Beta HCG/ AFP/LDH
31
Q

Germ cell Ovarian tumor :Teratoma

A

Contains all types of tissues - hair, teeth, neurons

  1. Immature teratomas :
    - Arise from neuroectoderm
    - Malignant and metastasise quickly
  2. Mature cystic teratoma / Dermoid cyst
    * Arise from any germ layer : lines with epithelial tissue thus contain skin, hair, teeth
    * Most common benign ovarian tumor in young women <30
    Sx : Non symptomatic, increased risk of torsion
32
Q

Germ cell Ovarian tumor : Yolk sac tumor

A
  • Definition : consists of germ cells which differentiate into yolk sac tissue
  • Incidence : Most common germ cell tumor in children
  • Histology : Schiller-Duval bodies seen under the microscope - rings of cells around blood vessels
  • Progression : malignant and very aggressive

Release AFP - Alpha fetal protein

33
Q

Germ cell Ovarian tumor : Choriocarcinoma

A
  1. Definition : Germ cells which differentiate in to syncytiotrophoblast cells - placental tissue which releases Beta HCG
  2. Progression : small tumors which secrete high levels of Beta HCG causing -> ovarian cysts to form
34
Q

Germ cell Ovarian tumor : Dysgerminoma

A

Definition : Germ cells differentiate into oocytes and grow uncontrollable

Histology : central nucleos surrounded by clear cytoplasm

Presentation : Release LDH

Incidence : Most common malignant ovarian tumor

35
Q

Epithelial-Stromal ovarian tumors : definition

A

Ovaries contain multiple folliciles
Each follicle is made up of a germ cell - also known as oocyte which is an immature cell
1. Stromal tissue : connective tissue cells found between the follicles
1. Epithelium tissue : layer of epithelial cells lining the surface of the ovaries

36
Q

Epithelial-Stromal ovarian tumors : Pathophysiology

A
  • During ovulation, the follicle ruptures and releases the egg, which inadvertently leads to epithelial cell damage.
  • To fix that damage the epithelial cells have to undergo cell division to replace and heal the tissue.
  • Each time cells divide there is a chance of a mutation and the possibility of tumor formation
  • This means that with more ovulatory cycles, there’s increased risk of tumor formation.
37
Q

Which is the most common benign epithelial tumor?

A

Serous cyst adenoma

38
Q

Epithelial-Stromal ovarian tumors : Serous tumors

A

Can be malignant or benign tumors
Benign : Serous cystadenomas

Malignant : Serous cystadenocarcinoma

Histology : arise from epithelial cells that line the outside of the ovaries
Presentation : Fluid filled cysts in both ovaries
Incidence : Post menopausal women

39
Q

Epithelial-Stromal ovarian tumors : Mucinoid tumors

A

Can be malignant or Benign

  • Malignant : Mucinous cystadenocarcinoma
  • Benign : Mucinous cysadenoma
  • Histology : mucus filled cysts, typically very very large
  • Presentation Unilateral ovary
40
Q

Ovarian cysts : Definition and incidence

A
  • Fluid filled growths that develop in the ovary
  • Incidence :during reproductive years
41
Q

Name two types of physiological cysts

A
  1. Follicular cysts
  2. Corpus luteum cysts
42
Q

Physiological cysts : Follicular cyst

A

Commonest type of ovarian cyst
1. Physiology : due to non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle

  1. Progress : regresses after several menstrual cycles
43
Q

Physiological cysts : Corpus luteum cyst

A

Physiology : corpus luteum doesn’t breakdown after menstrual cycle and instead may fill with blood or fluid forming cyst

44
Q

Ovarian cysts : Clinical features

A
  • Pelvic or lower abdominal pain
  • Dyspareunia : Painful sexual intercourse
45
Q

Ovarian cyst : management

A

*Ultrasound shows cyst *

  1. Premenopausal women
    - If < 5cm } repeat US 8 - 12 weeks
  2. Post menopausal women
    } refer to gynae for assesment regardless of size
46
Q

Layers of the uterus

A
  • Endometrium : mucosal layer made up of single layer of columnar epithelial cells
  • Under goes monthly cyclic changes
  • Perimetrium : layer continous with the lining of the peritoneal cavity
  • Myometrium : smooth muslce which contracts during childbirth
47
Q

Endometrial carcinoma : Definition

A
  1. Abnormal growth of the columnar epithelial cells which make up the endometrial glands
  2. Excess oestrogen stimulates endometrial hyperplasia which increases the risk of a mutation occurring
48
Q

Endometrial carcinoma : Risk factors

A
  1. Excess oestrogen
    * Many menstrual cycles : nulliparity, early menarche, late menarche
    * Tamoxifen : blocks oestrogen receptor in breasts for breast cancer but stumulates receptors in the uterus
  2. Excess adipose tissue : fat cells convert andrenal precursors into sex hormones
    * obesity
    * diabetes mellitus
    * polycystic ovarian syndrome
49
Q

Endometrial cancer : Genetic risk factor

A

HNPCC - Lynch syndrome

50
Q

Endometrial cancer : Clinical features

A
  1. Post menopausal bleeding } most common sx
  2. Menorrhagia or intermenstrual bleeding
  3. Unusual vaginal discharge
51
Q

Endometrial cancer : criteria for 2ww pathway

A

All women >= 55 years who present with postmenopausal bleeding

  1. First-line investigation : trans-vaginal ultrasound
    - a normal endometrial thickness (< 4 mm) has a high negative predictive value
52
Q

Endometrial cancer : Investigation

A

First line : Transvaginal US - endometrial thickness
: if > 4mm
Second line : Hysteroscopy with Endometrial Biopsy

53
Q

Endometrial cancer : Management

A

Localised disease :
* total abdominal hysterectomy with bilateral salpingo-oophorectomy
+ Post operative radiotherapy

54
Q

Vulval carcinoma : type

A

80% are squamous cell carcinomas

55
Q

Vulval carcinoma : Incidence

A

Women > 65

56
Q

Vulval carcinoma : Risk factors

A
  1. HPV infection
  2. Vulval intraepithelial neoplasia
  3. Immunosupression
  4. Lichen sclerosis
57
Q

Vulval carcinoma : Clinical features

A
  1. Lump or ulcer on the labia majora
  2. Inguinal lymphadenopathy
  3. itching, irritation
58
Q

Vulval intraepithelial neoplasia : defintion

A
  • Non invasion squamous lesion
  • Precursor of squamous cell carcinoma of the vulva
    *
59
Q

Uterine cancer

A

Leiomyosarcoma - malignant growth in the myometrium of the uterus

  • Rapidly enlarging pelvic mass
  • Abnormal vaginal bleeding and discharge
  • Pain and increased urinary frequency

Women's health (12 decks)

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