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3A Obs & Gynae > gynae malignancy > Flashcards

gynae malignancy Flashcards

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1
Q

what staging is used for all gynae cancers

A

FIGO staging
1-4

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2
Q

what types of imaging are used for gynae cancers

A

PET
CT anterior posterior
MRI

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3
Q

what are the main types of gynae maliganancy

A

endometrial
cervical
vulval
ovarian

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4
Q

what is the most common gynae cancer worldwide

A

endometrial

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5
Q

what is the most common histological type of endometrial cancer

A

80% are adenocarcinoma (cancer of glandular epithelium)

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6
Q

describe type 1 endometrial cancer

A
  • more common
  • oestrogen raised
  • better prognosis
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7
Q

describe type 2 endometrial cancer

A
  • atrophic
  • due to p53 mutation which is tumour supressor gene
  • poor prognosis
  • may resemble ovarian tumour
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8
Q

what can type 2 endometrial cancer lead to

A

clear cell carcinoma / serous carcinoma

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9
Q

protective factors for endometrial cancer

A
  • COCP
  • IUS
  • breastfeeding
  • multiparity
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10
Q

risk factors for endometrial cancer

A

anything that causes unopposed cancer
- nulliparous
- obese
- early menarche
- late menopause
- oestrogen only HRT
- PCOS
- T2DM
- tamoxifen use

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11
Q

genetic risk factors for endometrial cancer

A
  • HPCC syndrome
  • KRAS mutation
  • p53 mutation
  • PTEN mutation
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12
Q

what is HNPCC syndrom

A

autosomal dominant mutation in MLH +MSH

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13
Q

symptoms of endometrial cancer

A

any post menopausal woman 50+ with unexplained post menopausal bleeding –> refer to urgent week wait to gynae

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14
Q

what does bimanual exam show for endometrial cancer

A

large + irregular uterus

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15
Q

1st line diagnosis for endometrial cancer

A

TV USS

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16
Q

what does TV USS for endometrial cancer show

A

if thickness is more than 5mm then it is bad

if pt is on HRT/tamoxifen then a thickness of more than 8mm is bad

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17
Q

gold standard diagnosis for endometrial cancer

A

hysteroscopy + biopsy

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18
Q

what are the FIGO staging for endometrial cancer

A
  1. only uterus
    • cervix
    • pelvis eg lymph nodes
  4. +extrapelvic eg bladder
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19
Q

where does endometrial cancer metastasize to

A

bladder
lung
liver

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20
Q

what imaging is used for FIGO staging of endometrial cancer

A

MRI

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21
Q

treatment for stage 1 and 2 endometrial cancer

A

hysterectomy with bilateral salpingo-osphorectomytr

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22
Q

treatment for stage 3 and 4 endometrial cancer

A

debulking surgery + adjuvant chem0

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23
Q

3 histological types of ovarian cancer and how common are they

A

epithelial 70%
germ cell 20%
sex cord 10%

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24
Q

what are the 2 types of epithelial ovarian cancer

A

serous - most common
mucuous

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25
what is serous epithelium ovarian cancer
fluid filled ovarian sac
26
what is mucuous epithelium ovarian cancer
large + can rupture and lead to pseudomyxoma peritonei - very rare
27
what are the 2 types of germ cell ovarian cancers
- teratoma (has hair + teeth) - dysgerminoma
28
what are the 3 types of sex cord ovarian cancers
theca - granulosa cells sertoli - leydig cells fibromas - meigs syndrome
29
protective factors for ovarian cancer
COCP breastfeeding multiparity
30
risk factors for ovarian cancer
unopposed raised oestrogen (same as endometrial) BRCA 1+2
31
symptoms of ovarian cancer
any post menopausal 50+ woman with NEW ONSET IBS/Gi/ urinary symptoms (eg bloating, constipation, indigestion, vague abdo pain, dysuria, retention) may have mets related symptoms eg jaundice for liver mets
32
1st line diagnosis for ovarian cancer
Ca125 blood test + TV USS only do TV USS if Ca125 is more than 35 U/mL
33
what does TV USS for ovarian cancer show
multioculated bilateral free fluid containing heterogenous cysts
34
other causes of raised Ca125
- menstruation - benign cysts - PID
35
gold standard diagnosis for ovarian cancer
endometrial pipelle biopsy
36
what is RMI
risk of malignancy index - confers how necessary a specialist assessment is for biopsy if score is more than 250 needs urgent referral
37
what 3 factors are considered for RMI
- menopausal status - Ca 125 - USS findings
38
FIGO staging for ovarian cancer
1. ovaries 2. + pelvis 3. + peritoeum/LN's 4. distant mets eg liver, brain, bowel
39
treatment for stage 1 ovarian cancer
hysterectomy + bilateral salpinho-oophorectomy
40
what are the pre surgery bloods for hysterectomy
FBC --> anaemia U+E --> renal function clotting screen --> DIC crossmatch group and save --> incase of transfusion
41
treatment for stage 2,3,4 ovarian cancer
optimal debulking + adjuvant chemo eg cisplatin
42
2 complications of ovarian cancer
1. stroma ovari 2. MEIG syndrome
43
what is stroma ovari
increase T4 due to ovarian tumour made of ectopic thyroid tissue
44
what is MEIG syndrome
fibroma + ascites + pleural effusion
45
epidimilogy of cervical cancer
affects 30-45 year old sexually active females
46
2 types of cervical cancers
squamos cell carcinoma - 90% adenocarcinoma - 10%
47
risk factors for cervical cancer
- high risk HPV strain!!! - unprotected sex - COCP use - HIV - immunosuprresion - no HPV vaccinated
48
what are the high risk HPV strains
16 + 18 are most important 35 + 45 are less important
49
how often is cervical screen done
starts at 25y done every 3 years until 49y then done every 5 years
50
how to do cervical screen
1. papsmear if anything suspicius then 2. cytology biopsy if anything suspicious then 3. colposcopy
51
if a patient has HIV how often do u do cervical screen
anually
52
what to do if pap smear gives inadequate sample
repeat in 3m if inadequate again --> repeat in 3m if inadequate again --> colposcopy
53
what to do if you have a high risk HPV strain positive patient with normal cytology
tell them to come again in 12m if happens again --> 12m recall again if happens third time --> colposcopy
54
when can u not do a pap smear
- if mensutruating - pelvic inflammatory disease - 12 weeks after birth or miscarriage
55
what are three levels of cytology results for cervical cancer
CIN 1(cervical intra epithelial neoplasia) CIN 2 CIN3
56
what does CIN 1 mean
not worrying not much difference to normal
57
what does CIN 2 mean
moderate dyskaryosis --> increased risk of cancer
58
what does CIN 3 mean
dyskaryosis major --> cervical cancer in situ
59
early symptoms of cervical cancer
asymptomatic
60
later symptoms of cervical cancer
cervical inflammation - post coital bleeding - inter menstrual bleeding - abnormal vaginal discharge - vaginal discomfort
61
survival of stage 1 cervical cancer
95% survival of 5y prognosis
62
survival of stage 4 cervical cancer
5% survival of 5 year prognosis
63
first line diagnosis for cervical cancer
speculum - shows eriosions, masses, ulcers
64
definitive exam for cervical cancer
coloposcopy/biopsy
65
describe FIGO staging for cervical cancer
1. cervix (A - microscope visible only, B - visibly confined) 2. +upper 2/3 of vagina 3. +lower 1/3 of vagina or pelvic wall 4. + bladder/rectum/extrapelvic
66
what are 90% of vulval cancers
squamos cel
67
what are 10% of vulval cancers
melanoma
68
what increases risk of vulval melanoma
tanning
69
age range affected by vulval cancer
35-55y females
70
risk factors of vulval cancer in younger females
HIV unprotected sex
71
risk factors of vulval cancer in older females
lichen sclerosis - severe fibrosis in epidermis of skin
72
symptoms of vulval cancers
vulvodyonia superficial dysparaneunia ulcers inguinal lymphadenopathy
73
diagnosis of vulval cancer
if suspected refer to 2 week wait for biopsy
74
treatment of vulval cancer
wide local excision + lymph node removal (<2cm FIGO1a) (>2cm or >-1cm deep FIGO 1b+)
75

3A Obs & Gynae (12 decks)

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