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Gynae cancers Flashcards

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1
Q

CIN is diagnosed at colposcopy. What does CIN stand for?

A

Cervical intraepithelial neoplasia

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2
Q

What are the 3 grades of CIN? What do they tell you?

A
  • CIN 1, 2, 3
  • The level of dysplasia (premalignant change) in the cells of the cervix
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3
Q

How does HPV promote the development of cancer?

A

HPV produces 2 proteins (E6, E7) which inhibit tumour suppressor genes (p53, pRb)

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4
Q

What is CIN 3 sometimes known as?

A

Cervical carcinoma in situ

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5
Q

What does CIN 1 indicate? Does it require treatment?

A
  • Mild dysplasia
  • Affecting 1/3 the thickness of epithelial layer
  • Likely to return to normal without treatment
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6
Q

What does CIN 2 indicate? Does it require treatment?

A
  • Moderate dysplasia
  • Affecting 2/3 the thickness of the epithelial layer
  • Likely to progress to cancer if untreated
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7
Q

What does CIN 3 indicate?

A
  • Severe dysplasia
  • Full thickness of the epithelial layer affected
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8
Q

What are cells from cervical smear examined for?

A

Dyskaryosis (pre cancerous change)

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9
Q

What are cells from colposcopy examined for?

A

Dysplasia (pre malignant change)

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10
Q

Who requires cervical screening every 3 years vs every 5 years?

A
  • Women 25-49 = 3 years
  • Women 50-64 = 5 years
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11
Q

How long should women wait for a routine cervical smear post partum?

A

Until 12 weeks post party

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12
Q

What is the management of the following smear results?
1. Inadequate sample
2. HPV negative
3. HPV positive with normal cytology
4. HPV positive with abnormal cytology

A
  1. Repeat the smear after at least three months
  2. Continue routine screening
  3. Repeat the HPV test after 12 months
  4. Refer for colposcopy
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13
Q

What 2 stains are used in colposcopy? What do they show?

A
  1. Acetic acid - abnormal cells will appear white
  2. Iodine - healthy cells will stain brown
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14
Q

What procedure can be carried out during a colposcopy procedure under local anaesthetic?

A

Loop biopsy

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15
Q

What procedure is carried out under general anaesthetic to treat CIN?

A

Cone biopsy

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16
Q

What are the FIGO stages of cervical cancer?

A
  • Stage 1: Confined to the cervix
  • Stage 2: Invades the uterus or upper 2/3 of the vagina
  • Stage 3: Invades the pelvic wall or lower 1/3 of the vagina
  • Stage 4: Invades the bladder, rectum or beyond the pelvis
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17
Q

What monoclonal ab may be used in combination with other chemotherapies in the treatment of metastatic/recurrent cervical cancer? What does it target? What does it prevent?

A
  • Bevacizumab (Avastin)
  • Vascular endothelial growth factor A
  • The development of new blood vessels
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18
Q

What strains of HPV cause…
1. Genital warts
2. Cervical cancer

A
  1. 6/11
  2. 16/18
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19
Q

What’s the most common type of vaginal cancer?

A

Secondary vaginal cancer

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20
Q

Where has vaginal cancer typically metastasised from?

A

Cervix/endometrium

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21
Q

What is the precancerous condition from endometrial cancer? What are the two types

A

Endometrial hyperplasia
- Hyperplasia without atypia
- Atypical hyperplasia

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22
Q

How is endometrial hyperplasia treated? What are the 2 options?

A

With progestogens
- IUS
- Continuous oral progestogens

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23
Q

What are 2 risk factors for endometrial cancer that are not related to unopposed oestrogen?

A
  • Diabetes
  • Hereditary nonpolyposis colorectal cancer/Lynch syndrome
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24
Q

Who does NICE recommend referring for TVUSS with endometrial cancer in mind?

A

Women > 55 yrs with…
- Unexplained vaginal discharge
- Visible haematuria + raised platelets, anaemia or elevated glucose levels

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25
What endometrial thickness is normal in post menopausal women?
< 4 mm
26
What biopsy is used for endometrial cancer?
Pipelle biopsy
27
What are the FIGO stages for endometrial cancer?
- Stage 1: Confined to the uterus - Stage 2: Invades the cervix - Stage 3: Invades the ovaries, fallopian tubes, vagina or lymph nodes - Stage 4: Invades bladder, rectum or beyond the pelvis
28
What's the treatment of stage 1 and 2 endometrial cancer?
Total abdominal hysterectomy with bilateral salpingo-oophorectomy
29
What is VIN?
Vulval intraepithelial neoplasia - a premalignant condition affecting the squamous epithelium of the skin
30
What are the 3 types of VIN?
- Low grade squamous intraepithelial lesion - High grade squamous intraepithelial lesion - Differentiated VIN
31
What type of VIN is associated with HPV infection? What age group does this typically affect?
- High grade squamous intraepithelial lesion - Younger women aged 35 – 50 years
32
What type of VIN is associated with lichen sclerosis? What age group does this typically affect?
- Differentiated VIN - Older women aged 50-60
33
What can be used to estimate the risk of an ovarian mass being malignant? What does it take into account?
- Risk of malignancy index - Menopausal status, ultrasound findings, Ca 125
34
What are the FIGO stages for ovarian cancer?
- Stage 1: Confined to the ovary - Stage 2: Spread past the ovary but inside the pelvis - Stage 3: Spread past the pelvis but inside the abdomen - Stage 4: Spread outside the abdomen
35
Give 3 examples of dopamine agonists?
- Ropinirole - Bromocriptine - Cabergoline
36
Give 3 examples of MAOis?
- Isocarboxazid - Phenelzine - Selegiline
37
What is first line imaging when investigating possible... - Cervical cancer - Endometrial - Ovarian
- Cervical cancer - colposcopy - Endometrial - TVUSS - Ovarian - pelvic USS
38
What imagining is used to stage gynae cancer?
CT
39
What is the most common gynaecological malignancy?
Endometrial cancer
40
Endometrial cancer is caused by .......... . What can cause this?
Unopposed oestrogen Caused by... Late menopause Ovarian tumours Oestrogen only HRT PCOS Obesity Lynch syndrome
41
What gynae cancers present with bleeding?
Endometrial cancer Cervical cancer
42
RF for cervical cancer?
High risk HPV Missed vaccination Early age intercourse Multiple sexual partners STDs Smoking OCP usage
43
Clinical manifestations of ovarian/Fallopian tube cancer
Bloating Abdo pain Mass Change in bowel habit Increased urinary frequency
44
Investigations for breast cancer
Imaging - USS or mammography Biopsy - fine needle aspiration of core biopsy
45
When are USS used to investigate breast cancer
In younger women (<30). They are used to distinguish between solid lumps and cystic lumps
46
Breast cancer cells may have receptors that can be targeted with treatment. Name the 3 different receptors
Oestrogen receptors Progesterone receptors Human epidermal growth factor (HER2)
47
Name the breast cancer that doesn't express any of the three receptors. Does it carry a better/worse prognosis?
Triple-negative breast cancer Worse prognosis
48
Where does breast cancer typically metastasise?
Lungs Liver Bones Brain
49
Surgical options for breast cancer
Breast conservation (lumpectomy) Mastectomy Full/limited axillary clearance
50
When is full axillary clearance indicated in breast cancer?
If the axillary lymph nodes are clinically involved
51
What does axillary clearance in breast cancer increase the risk of?
Chronic lymphoedema in that arm
52
When is radiotherapy used in breast cancer?
Following breast conserving surgery to reduce the risk of recurrence
53
Name three scenarios chemo is used in breast cancer
Neoadjuvant therapy - to shrink the tumour before surgery Adjuvant chemo - after surgery to reduce recurrence Treatment of metastatic or recurrent breast cancer
54
When is hormonal treatment indicated in breast cancer?
If the breast cancer is oestrogen receptor positive
55
Name two hormonal treatments for breast cancer
Tamoxifen Aromatase inhibitors
56
What group of women is tamoxifen used in?
Premenopausal women
57
What group of women is aromatase inhibitors used in?
Post menopausal women
58
Name a aromatase inhibitor
Letrozole
59
How does tamoxifen treat breast cancer?
It blocks oestrogen receptors in breast tissue and stimulates them in the uterus and bones
60
Name one thing tamoxifen prevents and one it increases the risk of
Prevents osteoporosis Increases risk of endometrial cancer
61
How do aromatase inhibitors treat breast cancer?
Aromatase converts androgens to oestrogen. After menopausal this is the primary source of oestrogen. Aromatase inhibitors block this process.
62
What options are there for breast reconstruction?
Breast implants Flap reconstruction
63
What is flap reconstructions?
When tissue from another part of the body is used to reconstruct the breast
64
Why are women with PCOS at increased risk of endometrial cancer?
Normally after ovulation the corpus luteum releases progesterone. Women with PCOS ovulate infrequently/not at all -> insufficient progesterone. This means their endometrium proliferates in the presence of unopposed oestrogen -> endometrial hyperplasia -> rf for endometrial cancer
65
Give 2 options for reducing the risk of endometrial hyperplasia and cancer in PCOS
1. Mirena coil - provides continuous endometrial protection 2. Induce bleed every 3/4 months with COCP/cyclical progesterone

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