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O&G > Gynae cancers > Flashcards

Gynae cancers Flashcards

1
Q

What are the groups of ovarian cancers?

A
  • Epithelial (70%)
  • Germ cell (20%)
  • Sex cord/ stomal cell (10%)
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1
Q

What are the benign epithelial cancers?

A
  • Serous cystadenoma
  • Mucinous cystadenoma
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2
Q

What are the malignant epithelial cancers?

A
  • Endometriod
  • Clear cell
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3
Q

What are the benign germ cell tumous?

A
  • Mature teratoma (dermoid cyst)
  • Dysgerminoma
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4
Q

What are the malignant germ cell tumours?

A
  • Immature teratoma
  • Choriocarcinoma
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5
Q

What are the sex cord/ stomal tumours?

A
  • Fibroma (Meig’s syndrome)
  • Granulosa-theca cell tumour
  • Leydig-sertoli cell tumour
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6
Q

What is Meig’s syndrome?

A
  • Right sided pleural effusion
  • Fibroma
  • Ascites
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7
Q

What is a common tumour that metastasises to the ovaries?

A

Gastric/ colonic tumours, causing Krukenberg tumour formation in the ovary

Mucin-producing signet-ring cells

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8
Q

What are the stages of ovarian cancer?

A

FIGO
1. In the ovaries
2. In the pelvis
3. In the abdominal cavity (including regional lymph nodes)
4. Metastases outside the abdomenal cavity

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9
Q

What is the management for stage I ovarian cancer?

A

Hysterectomy and bilateral salpingo-oophorectomy + adjuvant chemo

(If fertility wishes to be preserved and they’re stage Ia, unilateral oophorectomy)

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10
Q

What is the management for stage 2 ovarian cancer?

A

Debulking surgery + neo/adjuvant chemo

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11
Q

What is the managment for stage 3 ovarian cancer?

A

Debulking surgery + neo/adjuvant chemo + Bevacizumab

If surgery can’t be performed, platinum based chemo and symptomatic management (eg. ascitic drainage, laxatives)

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12
Q

What is the management for stage 4 ovarian cancer?

A

Same as stage 3, palliative care more likely

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13
Q

What is the first line chemo regimen for ovarian cancer?

A

Combined carboplatin + paclitaxel every 3 weeks for 6 cycles

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14
Q

What are the investigations once treatment for ovarian cancer is complete?

A

CT
CA125 - tends to rise in recurrence, if cancer recurs treat as palliative

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15
Q

What is the mechanism of carboplatin?

A

Causes cross-linkage of DNA stands leading to cell cycle arrest

Calculated using GFR

16
Q

What is the mechanism of Paclitaxel?

A

Causes microtubular damage preventing replication and cell division

Pre-emptive steroids given to reduce hypersensitivity reactions and side effects

Causes total loss of body hair

17
Q

What is the mechanism of Bevacizumab?

A

Monoclonal antibody against VEG-F inhibiting angiogenesis

18
Q

What is the management of vulval cancer?

A

Excision
- 15mm margin
- Large lesions can be shrunk by neoadjuvant radiotherapy (often + chemotherapy)

19
Q

When is full inguinofemoral lymphadenectomy done in vulval cancers?

A

If the lesion has a depth of >4cm

20
Q

How can full iliofemoral lymphadenectomy be avoided in vulval cancers?

A

Sentinal node biopsy

  • Dye and radioactive nucleotide injected into the vulval tumour to identify senital node
  • If sential node positive, full IFL
21
Q

What can be used instead of surgery for vulval cancers?

A

If patient is unfit, radical radiotherapy

22
Q

What are the complications of inguinofemoral lymphadenectomy?

A
  • Poor wound healing
  • Infection
  • VTE
  • Chronic lymphoedema
23
Q

When is adjuvant radiotherapy indicated for vulval cancers?

A

If excision margins are close or in the presence of two or more groin node mets

24
Q

What is the risk of malignancy index for ovarian cancer?

A

RMI = UxMxCa125

U= ultrasound findings (0=0, 1=1, 2=>=2)

M= menopause (1=pre, 2=post)

Score of >250 = gynae referral

25
Q

What is the managment for endometrial hyperplasia without atypia?

A
  1. Address risk factors
  2. Levonogestrel IUS
    (3. If they don’t want LNG-IUS, continuous oral progesterone)

Surveillance and endometrial biopsy 6 months

26
Q

What is the management for endometrial hyperplasia with atypia?

A

Non-fertility preserving:
- Hysterectomy with bilateral salpingo-oophorectomy

Fertility-preserving:
- LNG-IUS or continous oral progesterone
- Surveillance and biopsy at 3 months

27
Q

What is the FIGO staging for endometrial cancer?

A
  1. Confined to the uterus
  2. Spread to the cervical stroma
  3. Local/ regional spread (adnexa, upper 2/3 vagina, pelvic/ paraaortic lymph nodes)
  4. Extension to the pelvic wall, lower 1/3 vagina, kidneys
28
Q

What is the managment of stage 1 endometrial cancer?

A

Total hysterectomy and bilateral salpingo-oophorectomy

29
Q

What is the managment of stage 2 endometrial cancer?

A

Radical hysterectomy and LN assessment (+ adjuvant chemo)

30
Q

What is the management of stage 3 endometrial cancer?

A

Maximal debulking surgery + chemo + radio

31
Q

What is the management of stage 4 endometrial cancer?

A

Maximal debulking surgery, may take a palliative approach with high dose progesterone

32
Q

What is the benefit of post-op radiotherapy?

A

Will reduce recurrance rates, but doesn’t improve overall survival rates

33
Q

What is the risk with hormone treatment for endometrial hyperplasia?

A

High rates of relapse

O&G (11 decks)

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