Gynaecological Cancers Flashcards
(37 cards)
In terms of staging, why does ovarian cancer have a high mortality rate?
- Most ovarian cancers aren’t caught until they’ve metastasised into the abdominal cavity (Stage III)
- Before this, Stage I (ovary) and Stage 2 (only repro) are less lethal, but harder to detect
- Hence, many women don’t find out until it’s too late
What are some proposed causes of ovarian cancer?
- Excessive ovulation can cause progressive damage, hurting genes and causing cancer
- Or, perhaps inflammatory disease (e.g. PCOS) can cause it
Risk/protective factors for ovarian cancer
- Anything that increases # of ovulation (late menopause, early menarche, no kids), FHx, and endo/PID all predispose
- Anything that decreases # of ovulations (e.g. contraceptives, kids/breastfeeding, hysterectomy) all protect
Which genes/genetic syndromes confer ovarian cancer risk?
- BRCA1 and BRCA2
- Lynch Syndrome (HNPCC); DNA mismatch error
What are some common clinical features of first ovarian cancer presentation (i.e. later in disease course)?
- Ascites
- Bowel obstruction
- Pelvic mass
Early symptoms of ovarian cancer
- Bloating
- Abdominal pain
- Changes in urinary/bowel patterns (incl constipation)
Why can’t CA-125 be used in ovarian cancer screening? What can we use it for instead?
- It’s elevated in some ovarian cancer patients, but also in people with benign conditions (like endometriosis)
- Therefore, use it as a follow-up
The investigation used to confirm/diagnose ovarian cancer is…
Biopsy
Treatment of localised vs non-localised ovarian cancer
- Localised: surgical removal of affected (and, if no fertility wanted, other) adnexa. Adjuvant chemotherapy is ↑ risk
- Non-local: Surgery and chemotherapy (+/- neoadjuvant chemo to shrink lesion). Removal of uterus/omentum may be indicated also
Ovarian cancer natural hx
- Chemosensitive, but then recurs
- Over time, become resistant
- Causes fatal bowel obstruction
Two most common chemo drugs in ovarian cancer are…
- Carboplatin
- Paclitaxel
What are the different pathological kinds of ovarian cancer? Which is most common?
- Serous (most common)
- Mucinous
- Seromucinous
- Endometrioid
- Clear cell
Role of different imaging modalities in finding/staging ovarian cancer
- Ultrasound (transabdominal < TV) useful for detection; incl doppler to check for internal blood supply of ?lesions
- MRI can help follow up detected mass, and CT can assess masses founded on distended abdo (is this a common pres?)
- CT for staging
Which imaging modality is used to detect ovarian cancer mets? Where are the most common sites for mets?
- CT is used to detect
- Common sites are liver, omentum (why?)
How do we image for ovarian cancer recurrence?
- FDG PET
- Radioactively labelled glucose goes into tissue and creates abnormal hot spots on imaging
Why is endometrial cancer incidence increasing?
- Endometrial cancer has been linked to obesity
- Since obesity is increasing, so too is endometrial cancer
Clinical features of endometrial cancer
- Abnormal uterine bleeding (incl. post-menopausal)
- Abdo pain, difficulty urinating
Investigations for diagnosis of suspected endometrial cancer
- TV Ultrasound
- Biopsy (pipelle/hysteroscopy)
Stages of endometrial cancer
1: only in uterus
2: spread to cervix
3: outer uterus/nearby lymph nodes
4: spread to distal organs
Treatment of endometrial cancer (incl. fertility considerations)
- Most of the time, total/partial hysterectomy +/- nearby lymph node sampling +/- adjuvant chemo
- In rare young cases, may attempt conservative management with OCP or IUD
Pathological (molecular) classification of endometrial carcinoma
- Molecular classification (POLE mutant, MMR-deficient [which syndrome is this like?], p53 abberant, none)
Describe the role of different imaging modalities in uterine cancer
- Ultrasound (detection)
- MRI (local staging of tumours) -> local = high res
- CT (distal staging +/- incidental detection)
What is the early stage of cervical cancer called? At what point does it become true cancer?
- Early form is cervical intraepithelial neoplasia (CIN)
- Once it crosses the basement membrane: cancer
Symptoms of cervical cancer?
- Abnormal bleeding (after sex, intermentrual, post menopause)
- Abnormal vaginal discharge (originating from cervix)
