gynae - cancers

Question 1

What type of cervical cancer is most common, and what virus is it strongly associated with?

Answer 1

• Type: Squamous cell carcinoma (80%)
• Next most common: Adenocarcinoma
• Cause: Human papillomavirus (HPV), particularly types 16 and 18 (cause 70% of cases)
• Transmission: Sexually transmitted

Question 2

What are key risk factors for cervical cancer?

Answer 2

• Early age of first sexual intercourse
• Multiple sexual partners
• Smoking
• HIV or immunosuppression
• Long-term COCP (>5 years)
• Multiple full-term pregnancies
• Non-attendance at cervical screening
• Family history

Question 4

What are the possible presentations of cervical cancer?

Answer 4

• Often asymptomatic, detected on smear

Symptoms:

• Postcoital bleeding
• Intermenstrual or postmenopausal bleeding
• Vaginal discharge
• Pelvic pain or dyspareunia

Speculum findings:

• Ulceration, inflammation, visible tumour, bleeding

Question 5

How is cervical intraepithelial neoplasia (CIN) graded?

Answer 5

• CIN 1: Mild dysplasia (lower 1/3 of epithelium)
• CIN 2: Moderate dysplasia (2/3 thickness)
• CIN 3: Severe dysplasia/full thickness; high risk of cancer
  AKA carcinoma in situ

Question 6

What is LLETZ and when is it used?

Answer 6

LLETZ: Large Loop Excision of the Transformation Zone

• Removes abnormal tissue using diathermy loop
• Done during colposcopy, under local anaesthetic
• Risks: Bleeding, discharge, increased risk of preterm labour

Question 7

Who gets cervical screening and how is it done?

Answer 7

• Ages 25–49: every 3 years
• Ages 50–64: every 5 years

Exceptions: HIV, immunosuppression, previous CIN, pregnancy

Process:

• HPV testing first
• If HPV positive → cytology
• Colposcopy if abnormal

Question 8

cervical cancer management

Answer 8

• CIN and eary-stage 1A: LLETZ or cone biopsy
• stage 1B-2A: radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy
• stage 2B-4A: chemo and radiotherapy
• stage 4B: combination of surgery, radiotherapy, chemo and palliative care

Question 9

What is the most common symptom and cause of endometrial cancer?

Answer 9

• Symptom: Postmenopausal bleeding
• Cause: Excess unopposed oestrogen

-> Stimulates endometrial growth

-> Most are adenocarcinomas

Question 10

endometrial cancer presentation

Answer 10

• postmenopausal bleeding
• postcoital bleeding
• intermenstrual bleeding
• unusually heavy menstrual bleeding
• abnormal vaginal discharge
• haematuria
• anaemia
• raised platelet count

Question 11

What are the risk factors for endometrial cancer?

Answer 11

• Obesity (aromatase in fat converts androgens to oestrogen)
• Anovulation (e.g. PCOS)
• Oestrogen-only HRT
• Tamoxifen
• Early menarche, late menopause
• Nulliparity
• Type 2 diabetes (insulin stimulates endometrial cells)
• Lynch syndrome (HNPCC)

Question 12

How is endometrial cancer investigated?

Answer 12

• TVUS: Endometrial thickness <4 mm is reassuring postmenopause
• Pipelle biopsy: highly sensitive
• Hysteroscopy + biopsy: If needed

Question 13

How is endometrial cancer managed?

Answer 13

• Stage 1–2: Total abdominal hysterectomy with bilateral salpino-oophrectomy
• Advanced stages: Radical hysterectomy, radiotherapy, chemo
• Progesterone: May slow progression in some cases

Question 14

What are the types of ovarian cancer?

Answer 14

• Epithelial tumours (most common; serous subtype is most frequent)
• Germ cell tumours (e.g. dermoid cysts; raised AFP, hCG) - benign
• Sex cord-stromal tumours - can be benign or malignant
• Metastatic (e.g. Krukenberg tumour from GI tract; signet ring cells)

Question 15

What are the risk and protective factors for ovarian cancer?

Answer 15

• Age >60
• BRCA1/2 mutations
• More ovulations (early menarche, late menopause, nulliparity)
• Smoking
• Clomifene use

Question 16

protective factors for ovarian cancer

Answer 16

• COCP
• Pregnancy
• Breastfeeding

Question 17

What are the common symptoms of ovarian cancer?

Answer 17

Non-specific:

• Bloating
• Early satiety
• Pelvic/abdominal pain
• Urinary urgency/frequency
• Weight loss
• Mass or ascites

Question 18

How is ovarian cancer investigated?

Answer 18

• CA125 + Pelvic ultrasound
• CT scan + biopsy (laparoscopy or paracentesis)
• AFP & hCG in <40s (germ cell tumours)

Question 19

How is ovarian cancer managed?

Answer 19

• Surgery (laparotomy with staging and debulking)
• Adjuvant chemotherapy (except in early, low-grade)
• CA125 for monitoring recurrence

Question 20

What type of cancer is most common in the vulva and who is at risk?

Answer 20

90% Squamous cell carcinoma

Risks:

• Age >75
• Lichen sclerosus
• HPV
• Immunosuppression

Question 21

What is lichen sclerosus and how is it managed?

Answer 21

Autoimmune skin disorder: white, shiny patches

• Symptoms: Itching, pain, fissures, dyspareunia
• Treatment: Potent steroids (e.g. clobetasol), emollients
• Complication: 5% risk of squamous cell carcinoma

Question 22

What are the symptoms of vulval cancer?

Answer 22

• Vulval lump, ulceration, pain, bleeding, itching
• Often affects labia majora
• May present with groin lymphadenopathy

Question 23

How is vulval cancer diagnosed and treated?

Answer 23

Diagnosis: Biopsy of lesion ± sentinel lymph node biopsy

Treatment depends on stage:

• Wide local excision
• Groin node dissection
• Chemotherapy or radiotherapy

Question 24

2ww/FDS: cervical

Answer 24

Cervix appears clinically suspicious on speculum exam (e.g., ulcerated, irregular, friable, bleeding)

Question 25

2ww/FDS: endometrial

Answer 25

Aged ≥55 with postmenopausal bleeding (even single episode)

Question 26

2ww/FDS: ovarian

Answer 26

If both CA125 raised + abnormal ultrasound

Question 27

2ww/FDS:

Answer 27

Unexplained vulval lump, ulceration, bleeding or lesion that: - Persists >3 weeks, or - Is suspicious on exam