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MFSRH part 2 > Gynae Oncology > Flashcards

Gynae Oncology Flashcards

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1
Q

Treatment of Persistent GTN with FIGO score >6

A

Combined chemotherapy

Continue for 6 weeks after HCG levels are normal

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2
Q

Overall 5 year survival of breast cancer

A

57-66%

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3
Q

What is the false positive rate of mamographic screening

A

10% in younger women

5% in older women

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4
Q 
Cervical screening guidelines for 
England
Wales
Scotland
N. Ireland
A

England - 25-49 yo 3 yearly
50-64 yo 5 yearly

Wales and N. Ireland - as England

Scotland - 20-60 yo 3 yearly

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5
Q

Presentation of Paget’s disease of the vulva

A

Burning

Raised erythematous lesion

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6
Q

Treatment of choice for Paget’s disease of the vulva

A

Surgery

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7
Q

Recurrence rate after surgical treatment of Paget’s disease of the vulva

A

30%

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8
Q

What proportion of cervical invasive cancers are squamous carinomas?

A

90% squamous

10% adenocarcinoma

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9
Q

What is the commonest type of vaginal cancer

A

90% squamous

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10
Q

Usual management of invasive vaginal cancer

A

Radiotherapy

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11
Q

Management of squamous or adenocarcinoma of the cervix

A

Both managed the same

Best treated with surgery +/- radiotherapy

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12
Q

Does methotrexate have any impact on adenocarcinoma of the cervix

A

Yes but not curative. Causes some regression

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13
Q

Presentation of adenocarcinoma of the endocervix

A

PV bleeding
Offensive PV discharge
Pain
Haematuria

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14
Q

Management of smear showing CIN 1 (mild dyskaryosis)

A

Check HPV status

If HR HPV +be refer to colposcopy

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15
Q

Management of smear showing CIN 2

A

Refer to colposcopy

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16
Q

Clinical presentation of androgen producing tumours

A

androgen producing tumours are usually adrenal or ovarian

rapid hair growth
virilization and clitoral enlargement
masculinization
androgenic symptoms

timeframe of 3 to 6 months

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17
Q

What hormone do Granulosa cell tumours produce?

What are the symptoms

A

Granulosa cell tumours produce oestrogen
can lead to vaginal bleeding and breast tenderness
General symptoms - bloating etc

may lead to endometrial hyperplasia, polyps or endometrial cancer.

ultrasound appearance vary from completely solid to cystic

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18
Q

Most common Type of Ovarian Cancer

A

Epithelial Cancers

90% of ovarian cancers

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19
Q

What proportion of ovarian cancers are Germ cell carcinomas?

And who do they affect

A

Germ cell carcinoma
5% of cases of ovarian cancers

Usually in women in their 20’s

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20
Q

Three main subtypes of ovarian Germ cell carcinoma

A

Three main subtypes:
teratoma
dysgerminomas
endodermal sinus tumors

Other subtypes are
Embryonal cancer
polyembryoma
choriocarcinoma 
mixed type
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21
Q

What proportion of ovarian cancers are Stromal carcinoma?

What are the 2 main types?

A

Stromal carcinoma
5% of cases of ovarian cancers

Two main types:
granulosa cell tumors
sertoli-leydig cell tumors

Granulosa cell tumours typically secrete oestrogen

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22
Q

What proportion of ovarian cancers are Small cell carcinoma?

Who do they usually affect?

A

Small cell carcinoma of the ovary

0.1% of cases of ovarian cancers (very rare)

Usually in women in their 20’s

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23
Q

Definitions Complete Molar pregnancy

A

Complete Molar: Abnormal diploid conceptus with absence of foetus (typically 46XX)

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24
Q

Define Partial Molar pregnancy

A

Partial molar

Abnormal triploid conceptus that may have fetal tissue typically 69XXY

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25
Define Choriocarcinoma
Malignant tumour of trophoblast
26
What proportion of pregnancies are molar?
1 in 1000 pregnancies per year are molar
27
What proportion of pregnancies are effected by choriocarinoma
1 in 45,000 pregnancies effected by choriocarcinoma 70% of choriocarcinoma occurs after molar pregnancy 20% after TOP 10% after normal pregnancy
28
Classic Clinical Features of molar pregnancy
Irregular vaginal bleeding Hyperemesis Large for gestational age uterus Early Miscarriage
29
Classic Biochemical Features of molar pregnancy
Excessive HCG production | In 3% of cases excess HCG sufficient to trigger hyperthyroidism
30
Diagnosis of molar pregnancy
Ultrasound assessment Formal diagnosis is on histopathological assessment following evacuation
31
Advice regarding chemo for breast cancer and breastfeeding
should not breastfeed whilst taking tamoxifen, trastuzumab (herceptin®) or during chemotherapy. Women on chemotherapy should wait at least 14 days from their last chemotherapy dose before breastfeeding
32
What is the most common cancer in females?
Breast cancer
33
How many pregnancies are affected by breast-cancer development?
Breast cancer in 1 in 3000 pregnancies
34
Treatment of breast cancer during pregnancy
Surgical treatment can be considered in all trimesters Systemic chemotherapy contraindicated in 1st trimester - high rate of fetal abnormality Chemo Safe from the second trimester. Radiotherapy contraindicated until after delivery - unless life saving/preserve function eg spinal cord compression Tamoxifen and trastuzumab (herceptin®) contraindicated in pregnancy
35
Why is breastfeeding while on chemotherapy not advised?
risk of neonatal leucopenia. Breast feeding should be delayed until 14 days after last chemotherapy dose
36
What is associated with Differentiated VIN?
Differentiated VIN is associated with lichen sclerosus
37
What is Undifferentiated or usual/classical VIN associated with?
Undifferentiated or usual/classical VIN is associated with high risk HPV - 16 + 18 undifferentiated VIN is often seen in younger women and may be multifocal
38
Predisposing conditions to vulval cancer
lichen sclerosus (may lead to differentiated VIN prior to carcinoma) high-risk HPV i.e. 16 and 18 (may lead to undifferentiated or usual type VIN prior to carcinoma)
39
What is the Risk of developing invasive vulval disease in women with lichen sclerosus?
4%
40
5 yr survival of vulval cancer
No LN involvement >80% Inguinal LN involvement <50% Iliac and other Pelvic LNs 10-15%
41
What is stage 1 vulval cancer
Confined to vulva 1A = Lesions ≤ 2cm with < 1mm stromal invasion 1B = Lesions > 2 cm in size OR with stromal invasion > 1 mm confined to the vulva or perineum
42
What is stage 2 vulval cancer
Stage 2 vulval cancer Tumour of any size ``` with extension to adjacent perineal structures - lower 1/3 urethra - lower 1/3 vagina - anus with negative nodes ```
43
What is stage 3 vulval cancer
Stage 3 vulval cancer Tumour of any size with or without extension to adjacent perineal structures (lower 1/3 urethra; lower 1/3 vagina; anus) with positive inguinofemoral nodes 3A (I) = 1 LN met (≥5 mm) OR (II) 1 - 2 LN met (< 5 mm) 3B (I) = 2+ LN mets (≥5 mm) OR (II) 3+ LN mets (< 5 mm) 3C = Positive nodes with extra capsular spread
44
What is stage 4 vulval cancer
Tumour invades other regional (upper 2/3 urethra; 2/3 vagina) or distant structures 4A (I) = Upper urethral and/or vaginal mucosa; bladder mucosa; rectal mucosa or fixed to pelvic bone OR (II) Fixed / ulcerated inguinofemoral LN 4B = Any distant mets including pelvic LN
45
Bowel obstruction may occur in what percentage of women following radiotherapy for cervical carcinoma
10-15%
46
Side effects from treatments of gynae malignancies with radiotherapy
of F treated for gynae malignancies: Infertility >50% have GI SE - diarrhoea, rectal bleeding and fistula formation. Bowel obstruction up to 14.5% following radiotherapy for cervical ca Bowel fistulae up to 8% after tx of cervical ca. Intraoperative ureteric injury in 1% of radical hysterectomy without prior radiotherapy 1% undergoing radiotherapy develop ureteric fibrosis + obstruction Radiation cystitis - 26% who survive > 5 yr Bladder atony common after radical hysterectomy. 2-3% requiring intermittent self-catheterisation. Shortening and stenosis of Vaginal epithelium common Dyspareunia is 55%
47
What follow up is advised for women treated for CIN 1-3
cervical screening at 6 months after treatment
48
Women with one previous molar pregnancy have what chance of the subsequent pregnancy being molar
1 in 80
49
Women with more than one previous molar pregnancy have what chance of the subsequent pregnancy being molar
1 in 10
50
In PMB an endometrial thickness with TVS of ≤ 4mm means what probability of endometrial carcinoma
<1%
51
Advice regarding timing of cervical smear for pregnant women
In pregnancy routine cervical screening should be deferred until at least 12 weeks postnatal. If previous smear abnormal refer for specialist opinion re mid-trimester sampling
52
High risk HPV types for cervical cancer
16 + 18
53
HPV 16 + 18 account for what % of cervical cancer?
70%
54
What types of HPV does gardasil cover?
16, 18 = cervical ca | 6, 11 = warts
55
What % of smear tests come back normal?
94%
56
What proportion of women have cervical cancer cells on their smear test?
1 in 1000
57
What proportion of smears on average are insufficient?
2%
58
What % of women who have a smear are referred to colposcopy?
4%
59
Management of an inadequate cervical smear
Repeat smear - not before 3m | If 3x inadequate smears refer to colposcopy - 6 weeks
60
Management of a borderline or low Grade dyskaryosis smear?
Test for HR HPV if HPV +be refer to colp within 6/52 If HPV -ve refurn to routine recall
61
Management of moderate / severe smear (high grade dyskaryosis)
Refer to colposcopy - urgent 2 week wait
62
Management of suspected cervical cancer or a glandular abnormality on smear test
Refer to colposcopy - 2 week wait
63
Life time risk of endometrial cancer in a patient with lynch syndrome?
50%
64
What cut of for the endometrium on tv Uss is used for excluding cancer in PMB patients
4mm
65
When a 4mm cut of is used on uss for excluding cancer in PMB patients what % of women will have an endometrial cancer which is missed?
1%
66
Bowel fistulae occur in what % of women having pelvic radiotherapy for cervical cancer?
5-10%
67
GI side effects from pelvic radiotherapy
Diarrhoea Rectal bleeding Fistulae Bowel obstruction
68
Urinary side effects from pelvic cancer surgeries or radiotherapy
Intraoperative ureteric injury - 1% Ureteric fibrosis Radiation cystitis Bladder atony
69
Sexual function side effects from pelvic radiotherapy
``` Vaginal shortening Vaginal stenosis Dysparunia Vaginal dryness Psyhoclogical dysfunction ```
70
Management of a patient with a RMI of >200
CT abdomen and pelvis | Refer to gynae onc MDT
71
What groups of patients are at higher risk of developing a complete molar pregnancy
Girls <15yo Women > 45 yo Women with a previous molar pregnancy
72
Breast cancer occurs in how many pregnancies
1 in 3000
73
Advice re breastfeeding whilst on breast cancer treatment
Women should not breastfeed whilst taking tamoxifen, trastuzumab (herceptin®) or during chemotherapy. Women on chemotherapy should wait at least 14 days from their last chemotherapy dose before breastfeeding.
74
Advice regarding tamoxifen and timing of conception
If planning future pregnancies women should stop tamoxifen three months prior to trying to conceive.
75
What % of endometrial cancers are genetic
2-5%
76
5 year survival in vulval cancer without lymph node spread
vulval cancer without lymph node spread 5year survival is over 80%

MFSRH part 2 (24 decks)

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