Endometrial, Cervical, Vulval and Ovarian Cancer

Question 1

why is the prognosis of ovarian cancer often poor?

Answer 1

because it has vague symptoms so often presents late

Question 2

what investigations are carried out to diagnose ovarian cancer?

Answer 2

• abdo/pelvic ultrasound
• abdo/chest/pelvic CT
• marker: CA 125
• laparotomy

Question 3

what marker can be raised in ovarian cancer that can also be found in other cancer and benign conditions?

Answer 3

CA 125

Question 4

what are the stages of ovarian cancer?

Answer 4

1 - ovaries only
2 - pelvic involvement
3 - peritoneal/nodal involvement
3 - distant metastases

Question 5

how is ovarian cancer managed?

Answer 5

• surgery (biopsy/staging/resection/debulking)

- chemotherapy

Question 6

which genetic condition can cause higher risk of developing ovarian cancer?

Answer 6

• HNPCC/Lynch syndrome

- BRCA gene mutation

Question 7

what is BRCA gene?

Answer 7

a tumor suppressor gene

Question 8

name a few symptoms that women with ovarian cancer may present with

Answer 8

• abdominal discomfort
• indigestion/early satiety
• constipation
• bloating/weight gain
• ascites
• pelvic mass

Question 9

which type of contraception provides some protection against ovarian cancer?

Answer 9

oral combined pill

Question 10

what type of surgery is carried out for ovarian cancer?

Answer 10

laparotomy

Question 11

how is the risk of malignancy (RMI) identified for ovarian cancer?

Answer 11

• Ultrasound
• Menopausal status
• CA 125

Question 12

what is the average age for ovarian cancer to develop?

Answer 12

50-60

Question 13

what are the risk factors for developing vulval cancer?

Answer 13

• lichen sclerosus
• vulval intraepithelial neoplasia (VIN)
• smoking
• immunosuppression

Question 14

name a few symptoms of VIN/vulval cancer

Answer 14

• itch
• pain
• burning
• bleeding from site
• lump/ulcer

Question 15

how is vulval cancer diagnosed?

Answer 15

punch biopsy or excision biopsy

Question 16

how is vulval cancer treated?

Answer 16

• excision of lesion
• excision of lymph nodes
• chemotherapy/radiotherapy

Question 17

how is vulval cancer staged?

Answer 17

1. <2cm in size
2. > 2cm in size
3. inguinal/femoral lymph node involvement
4. pelvic lymph node involvement

Question 18

what type of cancer is vulval cancer?

Answer 18

squamous cell carcinoma

Question 19

what are the subtypes of vulval intraepithelial neoplasia (VIN), and what is the usual population presenting with each?

Answer 19

• usual type VIN: HPV infection related, commonly younger women
• differentiated VIN: not HPV related, common in older women

Question 20

what red flag symptom indicates potential cervical cancer?

Answer 20

post-coital bleeding

Question 21

name a few symptoms of cervical cancer

Answer 21

abnormal bleeding:
- post-coital bleeding
- heavy menstrual bleeding
- intermenstrual bleeding
discharge
pain

Question 22

what is the cause of cervical cancer?

Answer 22

HPV infection

Question 23

what are the two strains of HPV that cause cervical cancer?

Answer 23

HPV 16 and HPV 18

Question 24

what type of cancer is the majority of cervical cancers?

Answer 24

squamous cell carcinoma

Question 25

what staging is used for cancers of the female reproductive tract?

Answer 25

FIGO staging

Question 26

what are the FIGO stages?

Answer 26

``` 0 - carcinoma in situ 1 - larger area of same tissue 2 - spread to adjacent organs 3 - spread to pelvic organs 4 - distant metastases ```

Question 27

how is cervical cancer staged?

Answer 27

biopsy PET-CT scan MRI scan

Question 28

which area of the cervix is most likely to develop cancer?

Answer 28

transformation zone

Question 29

what are the management options for cervical treatment?

Answer 29

- excision of transformation zone - radical hysterectomy + chemo/radiotherapy - chemo/radiotherapy - brachytherapy

Question 30

what is the most effective way to prevent cervical cancer?

Answer 30

cervical cancer screening program - smear test

Question 31

what are the subsets of Stage 1 cervical cancer?

Answer 31

Stage 1A - cancer only visible microscopically | Stage 1B - cancer visible on examination of cervix

Question 32

what chemotherapy treatment is used for cervical cancer among others?

Answer 32

cisplatin

Question 33

what are the main symptoms of endometrial cancer?

Answer 33

abnormal vaginal bleeding | post-menopausal bleeding

Question 34

what are the risk factors for endometrial cancer?

Answer 34

- post-menopause - increase/unopposed levels of oestrogen (early menarche, late menopause, low parity, OCP, PCOS) - obesity - smoking - atypical endometrial hyperplasia - Lynch syndrome

Question 35

what are the main investigations carried out to diagnose endometrial cancer?

Answer 35

- transvaginal ultrasound - endometrial biopsy - hysteroscopy - MRI for staging

Question 36

what is the cut off for normal endometrial thickness in post-menopausal women?

Answer 36

4mm`

Question 37

why is measuring endometrial thickness not a reliable diagnostic tool for endometrial cancer in pre-menopausal women?

Answer 37

because during normal cycle endometrium thickness varies a lot

Question 38

histologically, what are the two types of endometrial carcinoma?

Answer 38

- endometrioid adenocarcinoma: commonest type, younger women, fairly good prognosis if caught early - uterine serous/clear cell carcinoma: older women, rapidly aggressive, can be fatal

Question 39

what is the management of endometrial cancer?

Answer 39

- total hysterectomy + bilateral salpingo-oophorectomy - chemotherapy - radiotherapy - progesterone (palliative)

Question 40

what staging method is used for endometrial cancer?

Answer 40

FIGO staging