gynae cancers Flashcards
(49 cards)
Histology cervical cancer
squamous cell cancer (80%)
adenocarcinoma (20%)
Biggest risk factor in developing cervical cancer?
HPV 16,18 & 33
What virsuses cause genital warts
HPV 6 & 11
How does HPV cause cervical cancer?
HPV 16 & 18 produces the oncogenes E6 and E7 genes respectively
E6 inhibits the p53 tumour suppressor gene
E7 inhibits RB suppressor gene
screening pathway for cervical cancer
- Test for high-risk human papillomavirus strains (hrHPV)
If negative return to normal recall - If positive → cytology
If cytology negative, retest hrHPV in 12 months
If hrHPV is then negative return to recall, if hrHPV positive repeat again in 12 months
If hrHPV is positive at 24 months, cytology is normal refer to colposcopy anway - If cytology positive → colposcopy
If sample is inadequate HPV cervical screening, what do you do?
Retest in 3 months
If inadequate again –> colposcopy
Normal recall for cervical screening
Age 25 years: first invitation.
Age 25-49 years: screening every 3 years.
Age 50-64 years: screening every 5 years.
Women 65 years of age or older if they have not had a cervical screening test since 50 years of age or a recent cervical cytology sample is abnormal.
cervical screening and pregnancy
cervical screening in pregnancy is usually delayed until 3 months postpartum unless missed screening or previous abnormal smears.
women with HIV and cervical screening
Cervical cytology at diagnosis.
Cervical cytology should then be offered annually for screening.
What is the test of cure pathway for CIN?
Individuals who have been treated for CIN1, CIN2, or CIN3 should be invited 6 months after treatment for a test of cure repeat cervical sample in the community
Management of cervical intraepitlealial neoplasia
Large loop excision of the transformation zone (LLETZ)
Cervical cancer stage 1A
Confined to cervix, only visible by microscopy and less than 7 mm wide:
A1 = < 3 mm deep
A2 = 3-5 mm deep
Gold standard of treatment is hysterectomy +/- lymph node clearance
Nodal clearance for A2 tumours
For patients wanting to maintain fertility, a cone biopsy with negative margins can be performed
Radical trachelectomy is also an option for A2
Cervical cancer stage 1B
Confined to cervix, clinically visible or larger than 7 mm wide:
B1 = < 4 cm diameter
B2 = > 4 cm diameter
Radiotherapy with concurrent chemotherapy is advised
Radiotherapy may either be bachytherapy or external beam radiotherapy
Cisplatin is the commonly used chemotherapeutic agent
For B2 tumours: radical hysterectomy with pelvic lymph node dissection
Stage II and III cervical cancer
Stage 2: Extension of tumour beyond cervix but not to the pelvic wall
A = upper two thirds of vagina
B = parametrial involvement
Stage 3: Extension of tumour beyond the cervix and to the pelvic wall
A = lower third of vagina
B = pelvic side wall
NB: Any tumour causing hydronephrosis or a non-functioning kidney is considered stage III
Radiation with concurrent chemotherapy
Radiotherapy may either be bachytherapy or external beam radiotherapy
Cisplatin is the commonly used chemotherapeutic agent
If hydronephrosis, nephrostomy should be considered
Stage IV cervical cancer
Extension of tumour beyond the pelvis or involvement of bladder or rectum
A = involvement of bladder or rectum
B = involvement of distant sites outside the pelvis
Radiation and/or chemotherapy is the treatment of choice
Palliative chemotherapy may be best option for stage IVB
What complications is there with LLETZ and cone biopsy
pre term labour in future pregnancies
What does FSH do?
development of follicle beyond secondary
stimulates granulosa cells to multiply and produce oestrogen
Induces LH receptors on granulosa cells of the dominant follicle
What does oestrogen do?
stimulates proliferation of granulosa cells
exerts negative feedback on the secretion of gonadotrophins
works with progesterone to maintain lining in luteal phase
What does LH do?
stimulates theca cells to synthesise androgens
the mid-cycle surge in LH causes ovulation
What does progesterone do?
Helps to build and maintain endometrial lining
progesterone is produced in large amounts by the corpus luteum to maintain the lining
the drop in progesterone due to degeneration of corpus luteum (due to no hCG) causes endmetrial shedding
what are the 4 key follicular stages
Primordial follicles
Primary follicles
Secondary follicles
Antral follicles (also known as Graafian follicles)
Histology of most endometrail cancers
adenocarcinoma
risk factors for endometrial cancer
obesity
Nulliparity (Nulliparity is a risk factor for endometrial cancer. This is because during pregnancy, the balance of hormones shifts towards progesterone, which is a protective factor.)
early menarche
late menopause
unopposed oestrogen. The addition of a progestogen to oestrogen reduces this risk (e.g. In HRT). The BNF states that the additional risk is eliminated if a progestogen is given continuously
diabetes mellitus
tamoxifen
polycystic ovarian syndrome
hereditary non-polyposis colorectal carcinoma
2 week wait criteria for ?endometrial cancer
Age over 55 with post menopausal bleeding (must be >12 months since last period)
Consider if over 55 and:
Unexplained vaginal discharge
Visible haematuria plus raised platelets, anaemia or elevated glucose levels
