Genital Tract Malignancies Flashcards

1
Q

What is endometrial cancer?

A

Most common genital tract cancer
Very rare pre-menopausal
Adenocarcinoma
Adenosquamous carcinoma (poor prognosis)

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2
Q

What is the aetiology of endometrial cancer?

A

High ratio of oestrogen to progesterone

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3
Q

What are the risk factors for endometrial cancer?

A

Exogenous oestrogens w/o progestogen
Obesity (conversion of androgens to oestrogens)
PCOS - prolonged amenorrhoea
Nulliparity
Late menopause
Ovarian granulosa cell tumour (ovarian secreting)
Tamoxifen

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4
Q

What is the premalignant syndrome of endometrial tissue?

A

Oestrogen causes cystic hyperplasia of the endometrium -> atypical hyperplasia
PMB and is premalignant

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5
Q

How does endometrial cancer present?

A

Postmenopausal bleeding
IMB
Abnormal cervical smear

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6
Q

How does endometrial cancer spread?

A

Directly through myometrium into cervix and upper vagina
Lymph -> pelvic and para-aortic lymph nodes
-> bladder or bowel

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7
Q

How is endometrial cancer treated?

A

Most present with Stage 1
Hysterectomy and bilateral salpingo-ooepherectomy

External beam radiotherapy - follows surgery in high risk/lymph node involvement patients
also used for pelvic recurrence

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8
Q

What is the 5 year prognosis of endometrial cancers?

A

Stage 1 - 85%
Stage 2 - 70%
Stage 3 - 50%
Stage 4 - 25%

Overall - 75%

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9
Q

What uterine sarcomas exist?

A

Leiomyosarcoma
Endometrial stromal tumours (perimenopausal)
Mixed mullerian tumours (old age)

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10
Q

When does cervical cancer peak?

A

During 30s and 80s

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11
Q

What are the histologies of cervical cancer?

A

90% squamous cell carcinoma

10% adenocarcinoma (worse prognosis)

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12
Q

How does cervical cancer present?

A

Occult - picked up on biopsy or LLETZ
PCB
Offensive discharge
PMB

Later stages: uraemia, haematuria, rectal bleeding, pain

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13
Q

Where does cervical cancer spread?

A

Stage 1 - confined to cervix
Stage 2 - invasion into vagina or parametrium
Stage 3 - Invasion of pelvic wall/ureteric obstruction
Stage 4 - Invasion of bladder/rectal mucosa

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14
Q

How are cervical cancers investigated?

A

Confirm diagnosis - biopsy

Stage - vaginal and rectal exam, MRI, cystoscopy

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15
Q

How are microinvasive cervical cancers managed?

A
Cone biopsy (-> post-op haemorrhage or preterm labour)
Simple hysterectomy in older women
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16
Q

How are cervical carcinomas treated?

A

1a - cone biopsy/simple hysterectomy

1aii-1bi - laparoscopic lymphadenectomy and radical trachelectomy

1aii-2a - radical abdominal hysterectomy (LN -ve) or chemo-radiotherapy

> 2b or LN positive - chemo-radiotherapy alone

17
Q

What is the prognosis of cervical cancer?

A

Stage 1 - 95%
Stage 2 - 60%
Stage 3-4 - 10-30%

Overall - 65%

18
Q

What is the follow up for cervical cancer?

A

R/V at 3+6 months

then every 6 months for 5 years

19
Q

What is ovarian cancer?

A

Rates increase with age

90% are epithelial carcinomas
Serous cystadenocarcinoma
Endometrioid carcinoma
Mucinous cystadenocarcinoma (raised CEA)
Clear cell carcinoma
10% other
20
Q

What genes are linked to ovarian carcinomas?

A

BRCA1 - breast
BRCA2 - breast
HNPCC - bowel and endometrial

2 relatives + BRCA1 = 50% risk

21
Q

How does ovarian cancer present?

A
Vague - 70% present with stage 3/4
Bloating
Feeling full
Increased urgency and frequency
Breast/GI mass
22
Q

What are indicator of malignant ovarian mass?

A
Rapid growth >5cm
Ascites
Advanced age
Bilateral masses
Solid mass
Increased vascularity
23
Q

Where does ovarian cancer spread?

A

Within pelvis and abdomen (transcoelomic spread) - omentum, small bowel, peritoneum

24
Q

What investigations are done for ovarian cancer in primary care?

A

CA 125 levels
If >35 then USS of abdomen and pelvis is done
If USS identifies ascites/mass then urgent referral done

25
What investigations are done for ovarian cancer in secondary care?
If 250 then referred to MDT for CT pelvis and abdo
26
How is RMI calculated?
RMI = U x M x CA 125 USS result - multilocular cysts - solid areas - metastases - ascites - bilateral lesions Menopausal status - premenopausal = 1 - postmenopausal = 3
27
What is the management of ovarian cancer?
Midline laparotomy with total hysterectomy, bilateral salpingo-ooepherectomy and partial omentectomy Biopsy of peritoneal deposits Retroperitoneal lymph node assessment/removal Assessment of upper abdomen
28
What chemotherapy is given for ovarian cancer?
Platinum agent carboplatin/cisplatin +/- paclitaxel
29
What is the follow-up and prognosis of ovarian cancer?
CA 125 levels monitored | Death commonly from bowel obstruction or perforation
30
What is vulval cancer?
More common >60yrs Mainly SCC Others: melanoma, BCC, adenocarcinoma Associated with lichen sclerosis, immunosupression, smoking and Paget's disease of the vulva
31
How does vulval cancer present?
``` Pruritus Bleeding/discharge Mass Ulcer on labia majora or clitoris Enlarged inguinal lymph nodes ```
32
How is vulval cancer investigated and treated?
Biopsy | Local excision +/- groin lymphadenectomy
33
Where does secondary vaginal cancer arise from?
Cervix Endometrium Vulva GI tissue
34
How does primary vaginal cancer present?
Older women SCC Bleeding/discharge Mass/ulcer Tx: intravaginal radiotherapy
35
What is clear cell adenocarcinoma of the vagina?
Late teenage years Daughters of women prescribed DES during pregnancy Tx: radical surgery and radiotherapy
36
What is the initial management of PMB?
History and examination TV USS Hysteroscopy Pipelle