Gynae Oncology Flashcards
(111 cards)
1
Q
What is an ovarian cyst?
A
Fl filled sac in ovary
2
Q
What are physiological cysts?
A
Cysts that predominate through menstrual cycle
3
Q
What are the 2 general rules with ovarian cysts?
A
Do not raise concern unless symptomatic
Resolution should be confirmed by scanning 12 weeks later
4
Q
What is the RMI
A
Risk Malignancy Index
Tool used to determine likelihood of a mass related to malignancy
5
Q
What is a simple ovarian cyst?
A
One that contains fl only
6
Q
What is a complex ovarian cyst?
A
Can be irregular and can contain solid material, blood or have septations or vascularity
7
Q
Functional non-neoplastic ovarian cysts (2)
A
Follicular
Corpus Luteal cysts
8
Q
How big is a ovarian follicular cyst
A
<3cm
9
Q
What does an ovarian follicular cyst represent?
A
Developing follicle in 1st 1/2 menstrual cycle
10
Q
How big is a corpus luteal cyst?
A
<5cm
11
Q
When does a corpus luteal cyst occur?
A
In luteal phase of menstrual cycle after formation of corpus luteum
12
Q
What are pathological ovarian cysts? (3)
A
Endometrioma
Polycystic ovaries
Theca lutein cyst
13
Q
Another name for endometrioma
A
Chocolate cysts
14
Q
Who gets endometriomas
A
Those with endometriosis
15
Q
What is an endometrioma?
A
Bleeding into cyst
16
Q
What are theca lutein cysts a consequence of?
A
raised hCG
17
Q
When should theca lutein cysts resolve?
A
Upon resolution hCG levels
18
Q
E.g.s of epithelial ovarian tumours (3)
A
Serous cystadenoma
Mucinous cystadenoma
Brenner tumour
19
Q
Which is the most common type of malignant ovarian tumour?
A
Serous cystadenoma
20
Q
What % serous cystadenoma are bilateral?
A
30%
21
Q
Are mucinous cystadenomas usually unilateral or bilateral?
A
unilateral
22
Q
Are mucinous cystadenomas usually unilocular or multiloculated?
A
Multiloculated
23
Q
Are Brenner tumours usually uni or bilateral?
A
Unilateral
24
Q
Brenner tumour - appearance
A
Solid grey/yellow
25
Which ovarian tumours contain teeth, hair, skin and bone?
Mature cystic teratoma (dermoid cysts)
26
Who do dermoid cysts occur in?
young pregnant women
27
What percentage dermoid cysts are bilateral?
10%
28
What is the most common type of ovarian stromal tumours?
Sex-cord tumours/fibromas
29
What are sex-cord tumours associated with?
Ascites/pleural effusion
30
How to investigate and manage pre-menopausal women (<40) for ovarian cysts
If simple cyst on USS - No CA125
LDH, aFP, hCG
Rescan in 6w
If persistent or >5cm - consider laparoscopic cystectomy or oophorectomy
31
Managing ovarian cysts in post-menopausal women - low RMI
Follow up in 1yr w/ USS + CA125 if <5cm
32
Managing ovarian cysts in post-menopausal women - moderate RMI
Bilateral oophorectomy
33
Managing ovarian cysts in post-menopausal women - High RMI
Refer for staging laparotomy
34
What type of ovarian cancer do post-menopausal women get?
Epithelial cell carcinoma
35
What type of ovarian cancer do pre-menopausal women get?
Germ cell tumours
36
Risk factors ovarian cancers
Incr ovulations: early menarche, late menpause, nulliparity
| Familial - BRCA1/2, HNPCC
37
Protective factors against ovarian cancer (2)
Pregnancy + lactation
| OCP
38
Is there a screening program for ovarian cancer in the UK?
No
39
How does ovarian cancer present early on?
Asymptomatic
40
S+S ovarian cancer
persistent bloating
Early satiety +/- loss appetite
Pelvic + abdo pain
Others - incr urgency/freq, vaginal bleeding
41
What could you find in a woman with ovarian cancer on examination?
Cahexia
Abdo pelvic mass
Ascites
Br tenderness
42
What does an ovarian adenocarcinoma spread?
```
Transcoloemic spread
(directly into abdo + pelvis)
```
43
Stage 1a ovarian Ca
One ovary is affected, capsule intact
44
Stage 1b ovarian Ca
Both ovaries are affected, capsule is intact
45
Stage 1c ovarian Ca
One/both ovaries = affected, + capsule is not intact, or malignant cells in abdo cavity (ascites)
46
Stage 2 ovarian Ca
Disease is beyond the ovaries but confined to pelvis
47
Stage 3 ovarian Ca
Disease is beyond the pelvis but confined to the abdomen
48
In stage 3 ovarian Ca, which 3 structures are frequently involved?
Omentum
Small bowel
Peritoneum
49
Stage 4 ovarian Ca
Disease beyond abdomen
50
Investigations from ovarian cancer in primary care
CA-125 levels
51
Who in primary care gets their CA-125 levels tested?
Women >50y/o
| Abdo Sx
52
If a patients CA-125 levels are >35 - what is the next step?
USS abdo + pelvis
53
How is RMI calculated?
U x M x CA125
U = USS score
M = Menopause index
54
What is used for staging of ovarian cancer?
CT pelvis and abdo
55
Ovarian Ca - if unfit for surgery, what Mx should be offered?
Palliative care
56
What surgical technique should be used to assess the level of spread of ovarian cancer?
Midline laparotomy
57
Surgical Management ovarian Ca
Total hysterectomy, bilateral oopherectomy + partial omentectomy
58
Biopsy of peritoneum in ovarian cancer: Mx of stage 1
Retroperitoneal LN biopsy
59
Biopsy of peritoneum in ovarian cancer: Mx of stage s+
Retroperitoneal LN removal
60
Chemotherapy - stage 1a/b ovarian Ca
No chemo!
61
Chemo - stage 1c ovarian Ca
6xyxles of carboplatin
62
Chemo - stage 2-4 ovarian Ca
Carbplatin +/- paclitaxel
63
Poor prognosis ovarian Ca (3)
Advanced stage
Poorly differentiated
Slow response to chemo
64
Follow up ovarian Ca
```
Continue to monitor CA125
CT scanning (detect residual disease or relapse)
```
65
Mx - heavy vaginal bleeding in ovarian Ca
High dose progestogens
| Radiotherapy
66
Mx - ascites ovarian Ca
Drainage + dexamethasone
67
Mx - partial bowel obstruction ovarian Ca
Metoclopramide/enema
68
Mx - complete bowel obstruction ovarian Ca
Cyclizine
69
How should the last 24hours in ovarian cancer before death be Mx
Anxiolytics + analgesics
70
Which HPV are associated with cervical cancer
16 + 18
71
RF HPV/Cervical cancer (9)
```
Starting sex @ younger age
Multiple sexual partners
HIV
Herpes
Smoking
<20 y/o
COCP
Low SE
Exposure to DES
```
72
Timing smears <50 y/o
3 yearly
73
Timing smears >50
5 yearly
74
Where in the cervix does cancer tend to develop?
Squamocolumnar junction
75
What are the 2 premalignant cells of cervical cancer
CIN - Cervical intraepithelial neoplasia
| CGIN - cervical glandular intraepithelial neoplasia
76
What does CIN transform into?
Squamous cell carcinoma
77
What does CGIN transport into?
Adenocarcinoma
78
Features of cervical dyskaryosis (4)
Disproportionate nuclear enlargement
Hyperchromasia
Mutlinucleation
Irregular chromatid distribution
79
When performing a colposcopy, what features are you looking for in cervical cancer?
Mosaicism
| Punctuations
80
What is used to stain abnormal cells in colposcopy?
Acetic acid
81
Sx cervical cancer (5)
```
IMB
Post-coital bleeding
Pain
Dysuria
Abnormal smear
```
82
Stage 1 Cervical cancer
Microscopic <4cm
83
Stage 2 Cervical cancer
Parametrium - tissues outside uterus, around uterus
84
Stage 3 Cervical cancer
Pelvic side walsl
85
Stage 4 Cervical cancer
Distant Mets
86
Ix Cervical cancer
Cone biopsy
CHX
IVU
Cystoscopy + sigmoidoscopy
87
Tx stage 1 cerivcal cancer
LLETZ/radical hysterectomy
88
Tx stage 2 cervical cancer
Radical hysterectomy/chemoradiotherapy
89
Tx stage 3 cervical cancer
Chemoradiotherapy
90
Tx stage 4 cervical cancer
Chemoradiotherapy
91
5 year prognosis - stage 1 cervical cancer
80-93%
92
5 year prognosis - stage 4 cervical cancer
5-16%
93
Why has the incidence of endometrial cancer increased?
Increased obesity
94
Peak incidence endometrial cancer
60-75 y/o
95
What is the most common type of endometrial cancer?
Adenocarcinoma
96
Why does endometrial cancer occur
Unopposed oestrogen
97
What are the 4 stages of endometrial cancer
1 - Simple hyperplasia
2 - complex hyperplasia
3 - complex hyperplasia
4 - Adenocarcinoma
98
4 stages of endometrial cancer
1) Simple hyperplasia
2) Complex hyperplasia
3) Complex hyperplasia w/ atypia
4) Adenocarcinoma
99
RF Endometrial cancer (10)
```
Early menarche/late menopause
Low parity
PCOS
HRT (O only)
Tamoxifen use
DM
Age
Obesity
FHx HNPCC
HTN
```
100
Features endometrial Ca (4)
PMB
Clear/white vaginal discharge
Abnorm cervical smears
Advanced? W loss/ abdo pain
101
What is the grading system used for endometrial cancer?
FIGO
102
Low FIGO endometrial cancer
I - endometrium only
103
High FIGO endometrial cancer
II - Myometrium
III - Other pelvic structures
IV - Distant mets
104
O/E endometrial Ca
Abdo/pelvic mass
| Vulval/vag atrophy. cervical lesions
105
DDx endometrial Ca (6)
```
Vulval atrophy
Vulval pre-malig/malig conditions
Cervical polyps
Cervical Ca
Endometrial polyps
Endometrial atrophy
```
106
Ix Endometrial Ca (3)
Pippelle biopsy
Pelvic USS
Hysteroscopy
107
Features of endometrial Ca on USS
>4mm endometrial thickness
| Endometrium = white glow
108
Tx Simple endometrial hyperplasia
W+W
| Lose some weight
109
Tx Complex endometrial hyperplasia
W+W
Lose some weight
Mirena coil
110
Tx Complex endometrial hyperplasia + atypia
TAH
111
Tx endometrial adenocarcinoma
TAH
