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YEAR 4 O+G > Gynae Cancers > Flashcards

Gynae Cancers Flashcards

1
Q

summary: endometrial hyperplasia

A
  • precancerous
  • treated with progesterone (IUS or POP)
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2
Q

presentation endometrial cancer

A
  • PMB
  • IMB/PCB/HMB
  • abnormal PV discharge
  • haematuria
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3
Q

def: endometrial cancer

A

80% adenocarcinomas
oestrogen dependent

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4
Q

RFs: endometrial cancer

A
  • age
    increased number ovulation:
  • nulliparity
  • late menopause
  • early menarche
    exposure to unopposed oestrogen:
  • obesity
  • PCOS
  • tamoxifen
  • T2DM
  • HNPCC (lynch syndrome)
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5
Q

protective factors: endometrial cancer

A
  • COCP
  • mirena coil
  • multiparity
  • smoking
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6
Q

ix: endometrial cancer

A
  • TVUSS for endometrial thickness >4mm
  • pipelle biopsy
  • OP hysteroscopy with biopsy
  • FIGO staging
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7
Q

FIGO staging: endometrial cancer

A

stage 1 = confined to uterus
stage 2 = invades the cervix
stage 3 = invades ovaries, fallopian tubes, vagina or lymph nodes
stage 4 = involves bladder, rectum or beyond pelvis

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8
Q

referral criteria: endometrial cancer

A
  • PMB = 2ww
  • unexplained vaginal discharge in >55yo = refer for TVUSS
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9
Q

rx: endometrial cancer

A
  • TAH and BSO
  • radical hysterectomy
  • radiotherapy
  • chemotherapy
  • progesterone if palliative to slow progression
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10
Q

common types: ovarian cancer

A

epithelial cell tumours (serous - most common)

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11
Q

def: Krukenberg tumour

A

metastasis in ovary from GI tract cancer (mainly stomach)
SIGNET RINGS on histology

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12
Q

key word: signet rings

A

Krukenberg tumour

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13
Q

RFs: ovarian cancer

A
  • age - peaks at 60
  • BRCA 1 and 2 (family hx)
  • increased number ovukations (early menarche, late menopause, nulliparity)
  • obesity
  • smoking
  • recurrent use clomifene
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14
Q

protective factors: ovarian cancer

A
  • COCP
  • breast feeding
  • pregnancy
  • late menarche
  • early menopause
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15
Q

presentation: ovarian cancer

A

no specific symptoms
* abdominal bloating
* early satiety
* loss of appetite
* pelvic pain
* urinary symptoms
* weight loss
* abdominal/pelvic mass
* ascites
* referred hip/groin pain if mass pressing on obturator nerve

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16
Q

referral criteria: ovarian cancer

A

2 week wait if:
* ascites
* pelvic mass
* abdominal mass

further investigations (CA125) if over 50 and new symptoms of IBS/change in biwel habit
* abdominal bloating
* early satiety
* pelvic pain
* urinary frequency/urgency
* weight loss

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17
Q

ix: ovarian cancer

A
  • CA125 >35IU/mL significant)
  • pelvic ulstrasound

(CT scan, histology and paracentesis)

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18
Q

risk of malignancy: ovarian/endometrial cancer

A
  • menopausal status
  • ultrasound findings
  • CA125 level
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19
Q

ix: germ cell tumour

A
  • CA125
  • alpha-fetoprotein
  • hCG

women under 40 with complex ovarian mass

20
Q

staging: ovarian cancer

A

FIGO staging
1. confined to ovary
2. spread past ovary but inside pelvis
3. spread past pelvis but inside abdomen
4. spread outside abdomen

21
Q

rx: ovarian cancer

A

surgery and chemotherapy

22
Q

assoc: cervical cancer

A

HPV 16 and18
HPV vaccine at 12-13 to prevent this

23
Q

RFs: cervical cancer

A

increased risk of catching HPV:
* early sexual activity
* increased number of sexual partners
* sexual parters who have had more partners
* not using condoms

non-engagement with cervical screening

others:
* smoking
* HIV
* COCP for more than 5 years
* increased number FT pregnancies
* Fhx
* diethylstilbestrol during fetal development

24
Q

presentation: cervical cancer

A
  • may be asymptomatic picked up on screening
  • abnormal vaginal bleeding (IMB, PCB, PMB)
  • vaginal discharge
  • pelvic pain
  • dyspareunia
25
Q

appearance: cervical cancer

A
  • ulceration
  • inflammation
  • bleeding
  • visible tumour
26
Q

staging: CIN

A

diagnosed at colposcopy
CIN I - mild dysplasia affecting 1/3 thickness of epithelial layer - likely to return with no treatment
CIN II - moderate dysplasia, affecting 2/3 epithelial thickness and likely to progress to cancer if untreated
CIN III - severe dysplasia and very likely to progress to cancer in untreated (cervical carcinoma in situ)

27
Q

screening: cervical cancer

A

smear test every 3 years 25-49 and every 5 years 50-64
DO NOT SMEAR IF LESION SEEN - only for asymptomatic women
checks for dyskaryosis

  • HIV - screened annually
  • women over 65 may request if they have not had since age 50
  • women with previous CIN or immunocompromised may require additional rests
  • pregnancy women due routine smear should wait 12 weeks post-partum
28
Q

rx: smear results

A
  • Inadequate sample – repeat the smear after at least three months
  • HPV negative – continue routine screening
  • HPV positive with normal cytology – repeat the HPV test after 12 months
  • HPV positive with abnormal cytology – refer for colposcopy
29
Q

steps: colposcopy

A

speculum and using acetic acid and iodeine solution
* acetic acid causes abnormal cells to appear white (aceetowhite) - CIN or cervical cancer
* Schiller’s iodine test with stain normal cells brown and with not stain abnormal areas

punch biopsies and large loop excision of transfomation zone can be performed

30
Q

rx: CIN

A

LLETZ - diathermy removes abnormal cells - can cause preterm labour) - local anaesthetic
cone biopsy - treatment for CIN and early stage cancer - GA

31
Q

staging: cervical cancer

A

FIGO staging
1. confined to cervix
2. invades uterus or upper 2/3 vagina
3. invades pelvic wall or lower 1/3 vagina
4. invades bladder, rectum or beyond pelvis

32
Q

rx: cervical cancer

A

CIN or early stage 1A - LLETZ or cone biopsy
stage 1B-2A radical hysterectomy and removal of local lympth nodes + chemo + radio
stage 2B-4A chemo and radio
stage 4B - surgery, radio, chemo and palliative

33
Q

rx: recurrent cervical cancer

A

Bevacizumab (avastin) targets VEGF-A

34
Q

HPV 6 and 11

A

genital warts

35
Q

HPV 16 and 18

A

cervical cancer

36
Q

type: vulval cancer

A

squamous cell carcinoma (90%)
very few malignant melanoma

37
Q

RFs: vulval cancer

A
  • advanced age (75+)
  • immunosuppresion
  • HPV
  • LICHEN SCLEROSIS
38
Q

presentation: vulval cancer

A
  • vulval lump
  • ulceration
  • bleeding
  • pain
  • itching
  • lymphadeopathy in groin
39
Q

main affected area: vulval cancer

A

labia majora
* irregular mass
* fungating lesion
* ulceration
* bleeding

40
Q

high grade squamous intraepithelial lesion: vulval cancer

A

associated with HPV infection 16 and 18
RF - smoking

41
Q

low grade squamous intraepithelial lesion: vulval cancer

A

HpV 6 and 11

42
Q

differntiated VIN: vulval cancer

A

older women
not associated with HPV

43
Q

diagnosis: vulval cancer

A
  • biopsy of lesion
  • sentinel node biopsy
  • CTAP
44
Q

staging: vulval cancer

A

FIGO staging
* WLE
* groin node dissection
* chemotherapy
* radiotherapy

45
Q

rx: atypical endometrial hyperplasia

A

total hysterectomy

46
Q

rx: post-menopausal atypical endometrial hyperplasia

A

TAH and BSO

YEAR 4 O+G (6 decks)

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