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Obs Gynae > Gynae Oncology > Flashcards

Gynae Oncology Flashcards

(50 cards)

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1
Q

Most common types of cervical cancer?

A

SCC (80%)
adenocarcinoma (20%)

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2
Q

RFs for cervical cancer?

A

HPV !!!!!! (16,18,31)
incr. risk of exposure to HPV (young age at sexual intercourse, UPSI, incr. no. of sexual partners)
non-engagement with cervical screening programme
smoking
HIV, immunocompromised
COCP
multiparity
FHx
diethylstilbestrol exposure

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3
Q

Presentation of cervical ca?

A

asymptomatic (picked up through cervical screening)
abnormal vaginal bleeding (PMB, PCB, IMB)
vaginal discharge
pelvic pain
dyspareunia
ulceration, inflammation, bleeding, visible tumour on speculum exam

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4
Q

If suspected cervical ca on speculum exam, what to do?

A

urgent referral to colposcopy
do not take smear test

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5
Q

Colposcopy procedure?

A

colposcope used to visualise cervix
stains can be used
acetic acid (abnormal cells turn white ‘acetowhite’_
iodine (abnormal cells don’t stain)
can perform punch biopsy or LLETZ for tissue sample

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6
Q

When is LLETZ indicated?

A

Large Loop Excision of Transition Zone
CIN II and III
‘see and treat’ during colposcopy

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7
Q

Complications post-LLETZ?

A

bleeding
discharge
infection
if repeated or large biopsy -> incr. risk of cervical incompetence -> incr. risk of pregnancy loss or pre-term labour

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8
Q

Indications for Cone Biopsy?

A

CIN
Cervical Ca Stage 1A

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9
Q

Complications of Cone Biopsy?

A

pain
bleeding
infection
stenosis of cervix (scarring)
incr. risk of miscarriage and pre-term labour

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10
Q

Staging of Cervical Ca?

A

FIGO staging
Stage 1 - cervix
1A - microscopic
1B - gross lesion
Stage 2 - uterus or upper 2/3 of vagina
2A - no parametrial involvement
2B - obvious parametrial involvement
Stage 3 - pelvic sidewall or lower 1/3 of vagina
3A - no extension to sidewall
3B - extension to sidewall +/- hydronephrosis
Stage 4 - extension
4A - bladder or rectum
4B - distant mets

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11
Q

Management of Stage 1A cervical ca?

A

gold standard is hysterectomy +/- LN clearance
fertility-preserving -> cone biopsy with close follow up

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12
Q

Management of Stage 1B/2A cervical ca?

A

radical hysterectomy + LN clearance
chemo (cisplatin)
radiation (brachytherapy or external beam)

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13
Q

Management of stage 2b and 3 cervical ca?

A

chemo (cisplatin)
radiation (brachytherapy or external beam)

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14
Q

Management of stage 4 cervical ca?

A

palliative chemorads
Sx -> anterior/posterior/total pelvic exenteration

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15
Q

5yr survival rate of cervical cancer?

A

Stage 1 - 96%
Stage 2 - 54%
Stage 3 - 38%
Stage 4 - 5%

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16
Q

Post-menopausal bleeding is….?

A

endometrial cancer until proven otherwise

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17
Q

What type of cancer is endometrial ca?

A

80% adenocarcinoma
oestrogen-dependent cancer (unopposed oestrogen stimulates growth)

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18
Q

Risk Factors for endometrial ca?

A

exposure to unopposed oestrogen:
incr. age
early menarche
late menopause
oestrogen only HRT
nulliparity
obesity
PCOS
tamoxifen

T2DM
HNPCC

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19
Q

Protective factors against endometrial ca?

A

COCP
Mirena
incr. pregnancies
smoking

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20
Q

Endometrial protection in PCOS?

A

COCP
Mirena
Cyclical progesterones to induce withdrawal bleed

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21
Q

Presentation of endometrial ca?

Study These Flashcards
A

PMB!!!!!!!!
PCB
IMB
unusually heavy menstrual bleeding
abnormal vaginal discharge
haematuria
anaemia
raised platelet count

22
Q

When to refer for endometrial ca?

Study These Flashcards
A

‘2 week wait’ in all postmenopausal bleeding
TVUS in > 55yrs with visible haematuria or unexplained vaginal discharge

23
Q

Investigations for endometrial ca?

Study These Flashcards
A

TVUS (endometrial thickness >4mm)
Pipelle biopsy (highly sensitive, useful for exclusion)
Hysteroscopy with endometrial biopsy

24
Q

Staging of endometrial ca?

Study These Flashcards
A

FIGO Staging
Stage 1 - confined to uterus
Stage 2- invades cervix
Stage 3 - invades ovaries, fallopian tubes, vagina or LNs
Stage 4 - invades bladder, rectum or beyond pelvis

25
What is endometrial hyperplasia?
precancerous condition involving thickening of the endometrium hyperplasia with atypia hyperplasia without atypia
26
Mx of endometrial hyperplasia?
without atypia -> manage with progesterones (Mirena IUS) and surveillance with atypia -> treat as cancerous, TAHBSO
27
Mx of endometrial ca?
Stage 1 - TAHBSO Stage 2 - Radical hysterectomy + LN assessment Stage 3 + 4 - maximal de-bulking sx + chemorads
28
Prognosis of endometrial ca?
usually good 75% present with Stage 1 Stage 1 has 90% 5yr survival rate
29
Types of ovarian ca?
epithelial cell tumours germ cell tumours sex cord stromal tumours metastasis (Kruckenburg tumour -> from GI ca)
30
Types of epithelial cell tumours?
serous tumours (most common) endometrioid carcinomas clear cell tumours mucinous tumours undifferntiated
31
Types of germ cell tumours?
teratomas/dermoid cysts associated with ovarian torsion raised AFP and hCG
32
Types of sex cord stromal tumours?
Sertoli-Leydig cell tumours granulosa cell tumours
33
What is a Kruckenburg tumour?
ovarian mets from GI tract ca 'signet-ring' cells on histology
34
Risk Factors for ovarian ca?
age (peak 60) BRCA1 and BRCA2 incr. no. of ovulations (early menarche, late menopause, nulliparity) obesity smoking recurrent use of clomifene
35
Protective factors for ovarian ca?
pregnancy breast-feeding COCP
36
Presentation of ovarian ca?
non-specific -> often late presentation abdominal bloating early satiety anorexia pelvic pain urinary symptoms weight loss ascites abdo or pelvic pain
37
When to refer for suspected ovarian ca?
2 week wait if: ascites pelvic mass abdo mass CA125 if > 50 with: new IBS abdo bloating early satiety pelvic pain urinary frequency weight loss
38
Risk of Malignancy Index includes?
Menopausal Status US findings Ca 125 multiply 3, RMI > 250 requires referral to gynae
39
Red flag US findings for ovarian ca?
multilocular cyst solid area mets bilateral lesions ascites
40
Investigations for ovarian ca?
RMI (CA125, pelvic US) CT (staging) histology paracentesis women <40 with complex ovarian mass: AFP HCG
41
Causes of raised CA125?
ovarian ca endometriosis fibroids adenomyosis pelvic infection liver disease pregnancy
42
Staging of ovarian ca?
Stage 1 - confined to ovary Stage 2 - spread past the ovary, but inside the pelvis Stage 3 - spread past the pelvis, but inside the abdomen Stage 4 - spread past the abdomen
43
Mx of ovarian ca?
de-bulking sx and chemotherapy
44
Types of vulval ca?
90% are SCC malignant melanomas
45
RFs for vulval ca?
advanced age (>75yrs) immunosuppression HPV infection lichen sclerosus VIN
46
How many women with lichen sclerosus get vulval ca?
about 5%
47
Presentation of vulval ca?
incidental finding lump fungating lesion ulceration bleeding pain itching lymphadenopathy in groin
48
Investigations of vulval ca?
refer suspected vulval ca under 2wk wait pathway biopsy of lesion sentinel node biopsy CT for staging
49
Mx of vulval ca?
WLE, partial or radical vulvectomy groin LN dissection chemorads depending on staging
50
Staging of vulval ca?
FIGO staging Stage 1 - confined to vulva Stage 2 - extending to lower 1/3 of vagina, urethra or anus Stage 3 - upper 2/3 of vagina or urethra, bladder, rectum or LNs Stage 4 - ulcerated LNs, pelvic bone or distant mets

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