Gynaecological Cancer Flashcards
(24 cards)
What is the most common form of endometrial cancer?
Adenocarcinoma
What is atypia?
Precancerous state (endometrial hyperplasia can predispose to atypia)
Risk factors for endometrial hyperplasia
Unopposed oestrogen (stimulation of endometrium without effects of progesterone)
Risk factors of endometrial cancer
Anovulation (early menarche, late menopause, low parity, PCOS, unopposed HRT, tamoxifen)
Age (65-75)
Obesity (^ SC fat = faster rate of peripheral aromatisation of androgens > oestrogen = ^ unopposed oestrogen levels)
Hereditary factors (hereditary non-polyposis colorectal cancer AKA Lynch syndrome)
Clinical features of endometrial cancer
PMB
O/E abdominal / pelvic masses, vulval / vaginal atrophy, cervical lesions
DD of endometrial cancer
Vulval atrophy
Vulval pre-malignant / malignant conditions
Cervical polyps
Cervical cancer
Endometrial hyperplasia without malignancy
Benign endometrial polyps
Endometrial atrophy
Investigations for endometrial cancer
TVUS (^ endometrial thickness)
Endometrial biopsy (indicated in women with endometrial thickness >3mm)
MRI / CT used for staging
Biopsy findings for endometrial cancer
Hyperplasia +/- atypia
Malignancy
FIGO staging
Endometrial cancer
Stage I - carcinoma within uterine body
Stage II - carcinoma may extend to cervix but not beyond uterus
Stage III - carcinoma extends beyond uterus but confined to pelvis
Stage IV - carcinoma involved bladder or bowel, or metastasised to distant sites
Endometrial hyperplasia management
Progestogens (Mirena IUS)
Surveillance biopsies
Endometrial hyperplasia with atypia management
Total abdominal hysterectomy + BL salpingo-oophroectomy
Regular surveillance biopsies (if surgery contraindicated)
Endometrial carcinoma Stage I management
Total hysterectomy + BL salpingo-oophroectomy
Endometrial carcinoma Stage II management
Radical hysterectomy +/- lymphadenectomy)
Endometrial cancer Stage III management
Maximal de-bulking surgery
Additional chemotherapy + radiotherapy
Endometrial cancer Stage IV management
Maximal de-bulking surgery
Palliative approach (radiotherapy + low dose progestogens)
Most common type of cervical cancer
Squamous cell carcinoma
Adenocardinoma
Mixed
Cervical cancer development (cellular)
Cervical intraepithelial neoplasia
1 = mild dysplasia
2 = moderate dysplasia
3 = severe dysplasia + in situ carcinoma
4 = invasive carincoma
Risk factors for cervical cancer
Smoking
STIs inc HPV 16 & 18 (cont proteins that suppress p53 in cervical epithelial cells)
LT COCP
Immunodeficiency
Clinical features of cervical cancer
abnormal vaginal bleeding (PCB, PMB, IMB)
Vaginal discharge (blood, foul)
Dyspareunia
Pelvic pain
Weight loss
Oedema, loin pain, rectal bleeding, radiculopathy, haematuria (advanced disease)
DD of cervical cancer
STI
Cervical ectropion
Polyp
Fibroid
Pregnancy related bleeding
Cervical cancer investigations
Pre-menopausal: Chlamydia trachomatis, colposcopy + biopsy
Post-menopausal: urgent colposcopy + biopsy
Cervical cancer staging
Stage 0 - carcinoma in situ
Stage 1 - confined to cervix (A = microscopic identification, B = gross lesions + clinically identifiable)
Stage 2 - beyond cervix but not pelvic sidewall OR involves vagina but not lower 1/3 (A = no parametrise involvement, B = obvious parametrial involvement)
Stage 3 - extends to pelvic sidewall / involves lower 1/3 of vagina / hydro nephrons is not explained by other cause (A = no extension to sidewall, B = extension to side wall and / or hydronephrosis)
Stage 4 - extends to bladder or rectum, or metastasis (A = involves bladder / rectum, B = involves distant mets)
Cervical cancer surgical management (staging)
Stage 1a - radical trachelectomy
Stage 1b/2a - radical hysterectomy + lymphadenectomy
Stage 4a / recurrent disease - Ant/Post/Total pelvic extenteration
Cervical cancer non-surgical management (staging)
Radiotherapy = gold standard for stage 1a-3
Chemotherapy = mostly used in palliative setting although used as an adjunct to surgery / radiotherapy
