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Obs & Gynae > Endometrial and Ovarian Cancer > Flashcards

Endometrial and Ovarian Cancer Flashcards

(105 cards)

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1
Q

What is type 1 endometrial cancer

A

Endometriod adenocarcinoma

Most common

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2
Q

What is the precursor for type 1

A

Endometrial hyperplasia with atypia

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3
Q

What is type 2 endometrial cancer

A

Uterine serous = most common
Uterine clear cell
More aggressive and higher grade

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4
Q

What is a precursor for type 2

A

Serous intraepithelial carcinoma

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5
Q

What causes endometrial cancer

A

Stimulation of endometrium by oestrogen without protective effects of progesterone

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6
Q

Where is progesterone produced

A

CL in pregnancy

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7
Q

What are the RF for endometrial cancer

A 
Age - post menopause
HNPCC
DM 
FH / PMH 
Hypertension
Tamoxifen 
Atypical hyperplasia 
Anovulation as no progesterone 
PCOS - anovulation 
High circulating oestrogen
Obesity
Early menarche
Late menopause
Nulliparity 
HRT - unopposed oestrgen
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8
Q

WHat is protective of endometrial cancer

A

OCP
Pregnancy
Mirena coil
Smoking

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9
Q

What cancer does HNPCC cause

A 
Breast
Ovarian 
Cervical
Bowel 
Endometrial
Prostate 
Ask in FH if anyone had these
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10
Q

How does endometrial cancer present

A

PMB
IMB if pre-menopause
Pain / discharge is unusual

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11
Q

What is PMB

A

Bleeding 12 months since last period

1 in 10 = cancer

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12
Q

What is endometrial cancer until proven otherwise

A

PMB

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13
Q

What makes you worry more and what should you do

A

Older patient with PMB or failed Rx

Refer urgent cancer pathway

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14
Q

What is important to ask in history

A 
Time, consistency, quantity of blood
Obestric and gynae
RF for Ca
Full menarche - menopause Hx
Contraception 
Menopause Sx to know if gone through if on coil
Drug Hx inc HRT
Tamoxifen - how long and any bleeding 
Last smear
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15
Q

What investigations can be done in primary care

A 
Urine dip - infection cause haematuria
VE + speculum
FBC - anaemia / bleed
CA-125 for ovarian 
Rx menorrhagia - refer if failed pre-menopause
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16
Q

What is done at clinic

A

Transvaginal USS

Biopsy = diagnostic

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17
Q

What does USS assess

A

Endometrial thickness and contour

Should be thin in post-menopausal

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18
Q

When do you biopsy

A

If >4mm in post-menopause
If >10mm in pre-menopause
Do pipette with speculum or hysteroscopy
Dx by histology

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19
Q

What do you do if cervix too inflamed for biopsy

A

EUA

Hysteroscopy

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20
Q

How do you stage

A

Surgical / pathological

MRI

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21
Q

What do all patients on tamixoen with bleeding get

A

Transvaginal USS

HYsteroscopy

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22
Q

How do you treat hyperplasia with no atypia

A

Progesterone e.g. Mirena IUS

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23
Q

What else does USS pick up

A 
Endometrial thickness
Look at ovaries - shrink in post
Follicles sugest residual activity
Polyp
Fibroid
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24
Q

Where would a polyp be discovered and how do you treat

A

Treat at hysteroscopy with myosure

Remove and send to lab

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25
How is endometrial cancer staged
``` FIGO 1 = in uterine body / myometrium 2 = cervix 3 = belong uterus but confined to pelvis and PA noe 4 = involves bladder / bowel / inguinal ```
26
How do you treat endometrial cancer
Surgical trans abdominal hysterectomy + BSO Washings RT if LN +Ve
27
What do you give if high risk histology
Chemotherapy
28
What do you do if advanced
RT | Progesterone for palliation
29
What is advised if atypia
Hysterectomy
30
What are other causes of PMB
``` Atrophic vaginitis Resiual ovarian activity (peri-menopause) HRT Polyps Fibroids Endometrial hyperplasia Other cancers - cervix / vulval / bladder Vagina = rare Endometritis Cervicitis - C+G ```
31
Why don't fibroids present with PMB
Usually calcify after menopause
32
What does prognosis depend on
Histological type and grade Stage Lymph vascular invasion
33
What causes endometrial hyperplasia
``` Age Smoking Unopposed oestrogen - nulli, early menarche Tamoxifen Obesity PCOS DM Thyroid Ovarian tumour that secrete hormones - sertoli. / granulosa ```
34
How does it present
Abnormal bleeding
35
If no atypia
Progesterone | Dilation and curettage for excess tissue
36
What do you do if atypia
TAH + BSO
37
What does tamoxifen do
Anti-oestrogen in breast | Pro-oestrogen in endometrium
38
What is most common type of ovarian cancer
Serous - germ cell
39
What are other type
Clear cell Endometriod Mucinous
40
How is ovarian cancer staged
``` FIGO 1 = limited to ovaries 2 = local spread to pelvis 3 = peritoneal spread 4 =distant mets, para-aortic, liver ```
41
What gene is associated with ovarian cancer
BRCA - AD - Tumour suppressor gene involved in DNA repair Also HNPCC
42
When would you be referred to genetic clinic
2+ relatives ovarian 1+ ovarian and 1+ breast Known mutation FH colon cancer
43
Who is considered high risk
Gene mutation | 2+ relatives
44
What do high risk people get
Prophylactic oophorectomy and salpingectomy after family complete
45
How does ovarian cancer present
``` Vague Poor appetite Indigestion Altered bowel habit Bloating Weight gain Early satiety Abdo pain Pressure symptoms- urgency / diarrhoea ```
46
When should you suspect
``` Older women Non specific abdominal pain Blaoting Early satiety / poor appeitite Increased urinary frequency ```
47
What is DDX of bloating
IBS Coeliac IBD GI cancer
48
How do you exclude Ddx
IBS rare in >50 Colonoscopy Abdo USS
49
What are RF for ovarian cancer
``` Age - rare <30 HNPCC BRCA1+2 Incessant ovulation - nulli, early menarche, last menopause HRT Obesity Smoking Endometrisosi FH ```
50
What is protective
OCP Pregnancy Breast feeding
51
What do you do in GP is suspect ovarian cancer
Abdo and pelvic exam Ca125 Refer USS urgent Refer directly to gynaecologist URGENT if mass / ascites found O/E
52
What is Ca125 and what is abnormal
Protein antigen tumour marker 80% raised in ovarian >35 = abnormal
53
What else can raised Ca125
``` Cyst Endometriosis Fibroids Menstruation PID COlon / pancreas / breast ca Liver effusion / cirrhosis Irritation of peritoneum ```
54
If Ca125 raised what do you do
Refer for USS | If suggest malignancy = refer
55
What are other investigation
CT for staging if USS cancer Biopsy Ascitic fluid tap if ascites
56
What is best way to Dx
Laparotomy + removal of ovary
57
What on USS suggest malignancy
``` Multi-locular Solid Bilateral Ascites Intra-abdominal ```
58
What score is used to calculate likelihood of cancer
RMI | USS x menopause xCa125
59
If symptoms of IBD in>50
OVARIAN CANCER
60
When do you do a Ca125
``` >50 Abdominal discomfort Early satiety Loss of appetite Pelvic / abdo pain Increased urinary ```
61
How do you treat ovarian cancer
Laparotomy + clearance = 1st line | Chemo in later stages
62
How do you monitor
Ca-125 every 5 years
63
What do you do if recurrent
Chemo Palliate Surgery 2nd line
64
What do you do if not fit for surgery or chemo
Tamoxifen (selective oestrogen receptor antagonist)
65
What is an adnexal mass
Mass of ovary / Fallopian tube or connective tissue | Most ovarianly
66
What helps determine cause
Location Age Reproductive status
67
If pre-menopausal
``` Likely benign Associated with menstrual cycle Endometrioma Follicular cyst CL cyst Dermoid Pregnancy ```
68
If post menopausal
Must exclude cancer | Ca-125 useful
69
If solid ovarian mass post menopausal
Ovarian cancer | Adnexal torsion
70
Fallopian mass + pain + bleed
Exclude ectopic
71
Ovarian mass
``` Cancer Metastatic Cyst CL cyst Endometrioma ```
72
Mass in fallopian
Ectopic Hydrosalpinx Malignancy
73
Mass in connective tissue
Paraovarain cyst Abscess Broad ligament fibroid
74
What are urgent symptoms
Severe pain Fever 1st trimester bleed
75
How does a tubal-ovarian abscess present
Lower abdominal pain Fever Discharge Mass
76
What are other Sx of adnexal mass
``` Asymptomatic and found on routine USS Pelvic pain Pressure Sx Bloating Bleeding Discharge Fever Infertility Ascites Mass if extremely large ```
77
What is associated with infertility
Endometrioma | Hydrosalpinx
78
How do you investigate
``` Pregnancy test FBC Abdo + pelvic exam USS = 1st line Ca125 CT / MRI Surgical exploration ```
79
What suggest inflammation
Tender / pain | Fever
80
What needs urgent intervention
Ectopic Torsion Malignancy
81
What are types of ovarian cyst
``` Follicular CL cyst Dermoid Endometrioma - benign tumour Cystadenoma - serous or muconious ```
82
What is endometrioma also known as
Chocolate cyst
83
What causes follicular cyst
Non rupture of follicle Will regress after a few cycles Very common
84
What causes CL cyst
If CL doesn't break down i.e. due to pregnancy Resolves by 2nd trimester May notice in 1st Fills with blood / fluid so can cause bleed
85
What is dermoid cyst
From germ cell - teratoma Con contain skin / hair / teeth Usually asymptomatic but high risk of rupture Main complications = torsion
86
What is most common benign tumour in young
Dermoid
87
How does ovarian cyst present
``` Pain - dull ache May be worse during sex Bleeding ABdo distension Urinary Sx Pressure - constipaiton / freq ```
88
What happens if ruptures
Peritonitis May happen after strenuous activity / intercourse Present like torsion
89
When is CL cyst likely to rupture
Menstruation
90
When is CL unlikely
Post menopause as no eggs
91
How do you investigate
USS - unilocular and smooth | If rupture = free fluid
92
What needs biopsy
``` Malignant suspected USS Complex cyst Multillocular Septum Papilla ```
93
If <35 + smooth
Unlikely malignancy | Repeat USS
94
When do you refer
Post menopause as follicular / CL unlikely
95
What else do you do for complex as well as biopsy
AFP BHCG Ca-125 Cystectomy
96
What is Meig syndrome
Benign ovarian mass - fibroma Pleural effusion Ascites
97
How does ovarian torsion present
Sudden onset pain - unilateral iliac fossa
98
What causes
Ovary twists and blood supply disrupted Can lead to necrosis Usually due to cyst or tumour
99
If pain doesn't resolve what happens
``` Colicky Severe N+V Restless Fever Leucocytosis ```
100
How do you Dx
Tender palpable mass on examination USS shows free fluid / whirldwind Transvaginal > abdominal Laparoscopy = Dx
101
How do you Rx
Laparoscopy to untwist | Remove in infarction as won't resolve
102
Complication of cyst
Haemorrhage Torsion Rupture
103
Complication of torsion
Pain Infection Rupture = peritonitis / adhesion Loss of function of ovary due to ischaemia
104
Most common cyst <20
Dermoid - high rupture risk | - Cytic teratoma
105
Most common cyst overall
Follicualr

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