Gynae cancers Flashcards
(48 cards)
Cancer strongly related to HPV and most common type
-Cervical
-Squamous cell carcinoma
HPV role in cervical cancer
-> E6 and E7 protein prodcution
-> Inhibit p53 and pRb tumour suppressor genes respectively
-> Type 16 and type 18 HPV strains are the biggest causes of cervical cancer
Risk factors for cervical cancer (7)
-Increased risk of HPV : increased no. of sexual partners, no condom used, early sexual activity
-Non engagement with cervical screening
-Smoking
-HIV
-COCP for >5 yrs
-Increased no. of full term pregnancies
-Fx
If not asymptomatic, how can cervical cancer present?
-> Abnormal vaginal bleeding (intermenstraul, postcoital or post-menopausal)
-Vaginal discharge
-Pelvic pain
-Dyspareunia
-If present : examine cervix with a speculum
-If cervix ulcerated, inflammed, bleeding or there is a visible tumour = urgent cancer referral for colposcopy
At what point are women screened for cervical cancer ?
-> Every 3 years aged 25-49
-> Every 5 years aged 50-64
How are women protected against cervical cancer and genital warts ?
-HPV vaccine before boys and girls become sexually active
If a smear comes back as HPV positive with abnormal cytology what is the outcome ?
-Refer for colposcopy
What can be diagnosed at colposcopy ?
-Cervical intraepithelial neoplasia -> grading system for level of dysplasia of the cells in the cervix
-CIN I -> mild, affects 1/3 and likely to return to normal if untreated.
-CIN II -> moderate, affects 2/3 of epithelial thickness. Likely to progress to cancer if untreated
-CIN III -> severe, likely to progress to cancer if untreated (cervical carcinoma in situ)
What are the 2 methods of tissue biopsy during a colposcopy ?
-Punch biopsy
-Large loop excision of the transformation zone
How is CIN treated at the very early stage of cervical cancer
-Cone biopsy
What are the stages of cervical cancer and how are they treated ?
-CIN/early stage 1A -> LLETZ or cone biopsy
-Stage 1b-2a (confined to cervix) - radical hysterectomy + removal of local lymph nodes + chemo or radio
-Stage 2 : invades uterus or upper 2/3 of vagina
-Stage 3 : invades pelvic wall or lower 1/3 of vagina
-Stage 4 : invades bladder, rectum or beyond the pelvis
-Stage 2b to 4a are treated with chemo and radiotherapy
What monoclonal antibody can be used in cervical cancer?
-Bevacizumab (avastin)
-targets VEGF-A reducing the development of new blood vessels
Endometrial cancer
-Type
-RF
-Presentation
-80% = adenocarcinomas
-Anything that increases expose to ‘unopposed oestrogen’ as it is an oestrogen-dependent cancer, obesity, T2DM and HNPCC/lynch syndrome.
-Postmenopausal bleeding !!!! + postcoital, intramenstrual or unsually heavy bleeding. Abnormal vaginal discharge, haematuria, anaemia and raised plt count.
What can increase a womans exposure to ‘unopposed oestrogen? (8)
-PCOS
-Obesity
-Increased age
-Earlier onset menstruation
-Late menopause
-Oestrogen only HRT
-No or fewer pregnancies
-Tamoxifen
What is endometrial hyperplasia and how is it treated ?
-> Precancerous condition involving thickening of the endometrium
-> 2 kinds : hyperplasia without atypia, atypical hyperplasia
-> mirena coil or continuous oral progestogens
What is the referral criteria in endometrial cancer suspicion
-2 week wait : postemenopausal bleeding
-Transvaginal USS in women over 55 : unexplained vaginal discharge or visible haematuria + raised plts, anaemia or elevated glucose levels
What are the 3 investigations for endometrial cancer
-Transvaginal USS for endometrial thickness (normal - <4mm post-menopause)
-Pipelle biopsy
-Hysteroscopy with biopsy
What are the stages of endometrial cancer
1 : confined to uterus
2 : invades the cervix
3 : Invades ovaries, fallopian tubes, vagina or lymph nodes
4 : invades bladder, rectum or beyond the pelvis
How are stage 1 and 2 endometrial cancers treated
-Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH and BSO)
What is the most common type of ovarian cancer ?
-Epithelial cell tumour
Give 6 RF for ovarian cancer
-Age (peaks at 60)
-BRCA1 and BRCA2
-Increased no. of ovulations : early onset periods, late menopause, no pregnancies
-Obesity
-Smoking
-Recurrent use of clomifene
Why would ovarian cancer cause referred hip or groin pain ?
-> If the mass presses on the obturator nerve
What are the initial investigations for an ovarian cancer
-CA125 blood test (>35 significant)
-Pelvic USS
-Risk of malignancy index
Women under 40 with complex ovarian mass require tumour markers for a possible germ cell tumour, what are they :
-Alpha-fetoprotein
-Human chorionic gonadrotropin (HCG)
