Gynae Oncology Flashcards by Theo Pelly

What is cervical entropion?

More irregular redness resulting from minor lacerations during childbirth

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What is cervical ectopy?

Are puberty, rising oestrogen levels cause the cervix to evert

Columnar tissue lining the cervical canal is everted on to the centre of the cervix

This appears as a red area around the os, and is a normal finding in younger women

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What is cervical intraepithelial neoplasia (CIN)?

The presence of atypical cells within the squamous epithelium of the cervix

This is a histological diagnosis made only on biopsy

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What are the different grades of CIN?

CIN1 - mild dysplasia- atypical cells are found only in the lower third of the epithelium

CIN2 - moderate dysplasia - atypical cells are found in the lower two thirds of the epithelium

CIN3 - severe dysplasia - atypical cells occupy the full thickness of the epithelium- this is carcinoma in situ

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How is CIN managed?

Without treatment, a third of women will develop cervical cancer over the next 10 years- however it depends on the grade

If mild dysplasia (CIN1), may only require repeat colposcopy.

If more dysplasia, excision with LLETZ - large loop excision of the transformation zone - to depth of 8mm

If abnormality is not completely visible, do cone biopsy

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What is CGIN?

Cervical glandular intraepithelial neoplasia

Rare
Arises within the cervical anal
Precursor to cervical adenocarcinoma

Definitely requires treatment

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How common is cervical cancer, and in whom does it occur?

12th most common cancer in women

Most common between ages of 45 and 55 years

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What are the risk factors for cervical cancer?

Smoking
Unprotected sexual intercourse
Previous STI
HIV
On immunosuppressants

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How does cervical cancer present?

Post coital bleeding, Intermenstrual bleeding, post menopausal bleeding
Persistent, offensive, blood stained discharge
Pain in late disease
Swollen leg- thrombosis in the pelvis

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How is cervical cancer investigated?

Speculum
BE
PR

Colposcopy
Cervical biopsy
FBC UandEs LFTs
MRI pelvis
Ct abdomen and chest

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How is cervical cancer staged?

0 - carcinoma in situ
1 - confined to cervix
2 - disease beyond cervix but not to pelvic wall or lower 1/3 of vagina
3 - disease to pelvic wall or lower 1/3 vagina
4 - invades bladder, rectum, or metastasis

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How does cervical cancer spread?

Direct or local to vagina, bladder, parametrium, bowel
Lymphatic- para metrial nodes, internal, external, common iliac etc
Blood borne- lungs and liver

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What are the treatment options for cervical cancer?

LLETZ
Hysterectomy
Radical hysterectomy
Fertility sparing - trachelotomy - removal of cervix, and stitch placed to give support in the case of future pregnancy
Radiotherapy/chemotherapy if later stages - platinum based chemo

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What is the histological type of cervical cancer?

SCC in 70%
Adenocarcinoma in 25%
Small cell or TCC

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What is the five year survival of cervical cancer?

67%

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How common is ovarian cancer and what age does it typically affect?

Fifth most common cause of cancer in women

6000 new cases a year in the uk

Effects women usually between the age of 60 and 70

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What are risk factors for ovarian cancer?

Anything that prolongs time spent ovulating

Multiparty
Late menopause
Early menarche
HRT
Endometriosis
Difficulties conceiving - IVF 
BRCA1/2
Turners syndrome

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How does ovarian cancer typically present?

Abdominal pain
Pressure effects on the bladder or rectum
Dyspnoea
GI upset and anorexia
Abnormal vaginal bleeding
Asymptomatic

On examination:
Adnexal mass
Shifting dullness
Irregular abdominal mass - omental cake

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How is ovarian cancer staged?

Stage 1 - limited to one or both ovaries
Stage 2 - pelvic extension or implants
Stage 3 - microscopic peritoneal implants outside of the pelvis, or limited to the pelvis with extension to the small bowel or omentum
Stage 4 - distant mets

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How does ovarian cancer spread?

Direct spread- omental cake, invasion to bowel/bladder

Haematogenous - liver and spleen

Lymphatic - para-aortics to diaphragmatic lymph nodes

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What investigations are indicated in ovarian cancer?

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Pelvic USS
Ca125 in 80%
Ca19.9 for mets from pancreas
CEA for mets from bowel
AFP, hcg, LDH 
CXR 
FBC, UandEs, LFTs 
Ct 
Paracentesis of ascites

What is the management of ovarian cancer?

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TAH and BSO, with omentectomy, lymph node sampling, peritoneal biopsies with peritoneal washings or ascitic fluid for cytology

Adjuvant chemotherapy with platinum

What is the five year survival of ovarian cancer?

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Typically presents late

75% of cases of ovarian cancer presents as stage 3/4 disease

1- 75-90%
2- 45-60%
3- 30-40%
4- less than 20%

What is the histology of ovarian cancer?

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Epithelial - derived from mullerian epithelium - 85%

Sex cord or stromal

Germ cell

How are the BRCA genes implicated in ovarian cancer?

BRCA1 - 39% will get ovarian ca by 70 | BRCA2 - 11-16% get ovarian ca by 70

What are the risk factors for endometrial cancer?

``` Obesity - increased oestrogen Diabetes PCOS - Anovulatory cycles Age - peak 65-75 Early menarche Late menopause Nulliparity Unnopposed oestrogen therapy FH of breast, ovary, colon cancer Tamoxifen Prior pelvic irradiation Sex cord stromal tumour of the ovary ```

What are protective factors for endometrial cancer?

Pregnancy Diet and exercise IUS Reduced menstrual history eg early menopause of COCP

How does endometrial cancer spread?

Direct - through cavity to cervix, Fallopian tubes to ovaries Lymphatic - pelvic to para aortic nodes Haematogenous - rare to liver, lungs

What investigations are required in endometrial cancer?

``` Speculum and bimanual exam Biopsy with or without hysteroscopy USS to assess endometrial thickness MRI - invasion Ct ```

What are the treatment options in endometrial cancer?

Hysterectomy with oophorectomy Laparoscopy best for obese women Radiotherapy/chemo - high grade, high stage tumours High dose progestogens- can reverse the premalignant phase of hyperplasia. Also for palliative

What is the staging of endometrial cancer?

1- limited to body of uterus 2- limited to body if uterus and cervix 3- extension to uterine serosa, peritoneal cavity or lymph nodes 4- extension to adjacent organs or beyond true pelvis

What is the premalignant stage of endometrial cancer?

Hyperplasia with atypia - excessive proliferation of endometrial glands and stroma Comes with atypia had much higher risk of progression to cancer

What are the different histological types of endometrial cancer?

Endometrioid adenocarcinoma - 80-85% Papillary serous 10% Clear cell 4%

What is the average age of diagnosis of invasive and noninvasive vulval cancer?

Invasive - 70 | Non-invasive - 50

What are the risk factors for vulval cancer?

``` Age - 50% over 70 HPV Smoking Immunodeficiency Lichen sclerosis Melanoma- personal or family history ```

What is the premalignant form of vulval cancer?

Vulgar intraepithelial neoplasia - abnormal cells found only in the surface later of vulval cancer The higher the grade, the greater the chance of invasive carcinoma

How does vulval cancer present?

Asymptomatic Itching Pain Bleeding (PMB) ``` On examination: Skin often thicker and lighter than skin around it Raised mass- red, pink, white Ulcerated mass Warty mass ```

How do vulval cancers spread?

Local invasion of adjacent structures Lymph nodes - inguinal, inguinofemoral

What investigations are indicated for vulval cancer?

Examination to assess direct spread - PR, PV, inguinal lymphadenopathy Biopsy MRI to assess spread

What is the management of vulval cancer?

``` Wide local excision if suspicious area Vulvectomy Lymphadenectomy Radiotherapy Chemotherapy ```

What is the average age of diagnosis of invasive and noninvasive vulval cancer?

Invasive - 70 | Non-invasive - 50

What are the risk factors for vulval cancer?

``` Age - 50% over 70 HPV Smoking Immunodeficiency Lichen sclerosis Melanoma- personal or family history ```

What is the premalignant form of vulval cancer?

Vulgar intraepithelial neoplasia - abnormal cells found only in the surface later of vulval cancer The higher the grade, the greater the chance of invasive carcinoma

How does vulval cancer present?

Asymptomatic Itching Pain Bleeding (PMB) ``` On examination: Skin often thicker and lighter than skin around it Raised mass- red, pink, white Ulcerated mass Warty mass ```

How do vulval cancers spread?

Local invasion of adjacent structures Lymph nodes - inguinal, inguinofemoral

What investigations are indicated for vulval cancer?

Examination to assess direct spread - PR, PV, inguinal lymphadenopathy Biopsy MRI to assess spread

What is the management of vulval cancer?

``` Wide local excision if suspicious area Vulvectomy Lymphadenectomy Radiotherapy Chemotherapy ```

What is the five year survival rate of vulval cancer?

Local - 86% Regional - 54% Distant - 16%

How common is endometrial cancer?

Most common genital tract cancer 4th most common cancer in women

How common is vulval carcinoma?

Accounts for 5% of genital tract cancers

What is the management of abnormal smear tests? Mild, moderate and severe dysplasia

``` Normal - repeat in three years Mild dysplasia - repeat in 4-6 months Mild on two occasions - colposcopy Moderate - colposcopy Severe/CIN - colposcopy GLandular IN - urgent colpsocopy/hysterectomy ``` Mild/moderate must be tested for HPV first, if positive refer for colposcopy Annual screening in immunosuppressed patients!

Gynae Oncology Flashcards

(51 cards)