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Gynaecological Cancers Flashcards

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1
Q

Where is ovarian cancer usually found? and Where does it spread to?

A

Attaches to the surface of the organ rather than invading the parenchyma
Peritoneal cavity
Bowel mesentery
Liver capsule

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2
Q

What are the causes of ovarian cancer?

A

BRCA mutation
Precursor lesion
p53 mutation

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3
Q

What is the most common cause of gynaecological cancer death?

A

Ovarian

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4
Q

What are the signs & symptoms of ovarian cancer?

A 
Asymptomatic
Weight loss
Fatigue
Pressure effects on bowel & bladder
Bloating/feeling full/loss of appetite
Pelvic/abdo pain
Dragging sensation
Urinary frequency/urgency (pressure effects)
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5
Q

What are the risk factors for ovarian cancer?

A 
Nulliparity/continuous ovulation
Early menarche/late menopause
HRT
Endometriosis
Difficulty conceiving
Genetics: BRCA 1-2, Lynch II Syndrome

COCP-Protective

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6
Q

When is a 2week wait appropriate for query ovarian cancer?

A

Ascites

Abdo/pelvic mass NOT fibroids

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7
Q

What markers can be considered for ovarian cancer?

A

Ca125: Serous, endometrioid
Ca19.9: Mucinous
CEA

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8
Q

How specific is Ca125?

A

Not very

Also elevated in inflammation & during periods

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9
Q

What other investigations can be done for ovarian cancer?

A 
Abdo exam, palpate supraclavicular lymph nodes, breast/chest/vaginal/rectal exam 
Staged at time of laparotomy 
Pelvic USS
Biopsy
Staging: CT & MRI
Ascites: Paracentesis
Peritoneal biopsy & washing
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10
Q

How is ovarian cancer treated?

A

Stage 1: TAH & bilateral S-O
OR unilateral S-O without TAH
Retroperitoneal lymph node assessment
Stage 2-4: TAH, lymph node dissection, bilateral S-O
Adj: Omentectomy & platinum based chemo

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11
Q

What are the stages of ovarian cancer and which stage do most ovarian cancers present?

A
  1. Macroscopically confined to ovaries
  2. Beyond ovaries confined to pelvis
  3. Beyond pelvis confined to abdomen
  4. Disease beyond abdomen
    MOST PRESENT: Stage 3 or 4
    Most common gynaecologist cancer causing death
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12
Q

What are the malignant types of ovarian cancer?

A

Adenocarcinoma
Adenocarcinofibroma
SCC
Transitional cell carcinoma

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13
Q

What are the benign types of ovarian cancer?

A

Cystadenoma
Epiermoid cyst
Adenofibroma

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14
Q

What type of cancer makes up the majority of vulval cancers?

A

SCC

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15
Q

What is a pre-cancerous sign of vulval cancer?

A 
Lichen Sclerosus (autoimmune loss of collagen leading to thin epithelium)
Progresses to differentiated VIN
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16
Q

How is vulval cancer investigated?

A

Incisional biopsy >1mm

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17
Q

How is vulval cancer treated?

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A

1a: WLE 15mm margin
1b: Triple incision, WLE & dissect groin nodes
2: Neo RT/chemo & reconstruction (flap coverage/ skin graft)
3-4: Radical vulvectomy

18
Q

How is endometrial cancer defined?

Study These Flashcards
A

An epithelial malignancy of the uterine corpus mucosa

19
Q

What is the most common type of endometrial cancer?

Study These Flashcards
A

Adenocarcinoma

20
Q

How common is endometrial cancer?

Study These Flashcards
A

Common

Most common gynaecologist tumour in the developed world

21
Q

What is the pathophysiology of endometrial cancer?

Study These Flashcards
A

OE affects expression of genes leading to altered regulation of cellular signals= endometrial hyperplasia.

22
Q

What stage is precancerous in endometrial cancer?

Study These Flashcards
A

Atypical hyperplasia

23
Q

What are the causes of endometrial cancer?

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A

Endometrial hyperplasia
Familial cancer syndromes
Endogenous OE stimulation of the endometrium (obesity, PCOS)
Exogenous OE stimulation of the endometrium (HRT)

24
Q

What are the signs & symptoms of endometrial cancer?

Study These Flashcards
A 
PMB!!! (1year after cessation of periods)
Discharge (pyometra-pus in uterus)
Irregular menstrual cycle in older women
Uterine/adnexal mass
Fixed uterus
25
What are the RFs of endometrial cancer?
``` Mostly OE dependent = linked to unopposed OE Obesity Nulliparity Late menopause >50 PCOS Endometrial hyperplasia Tamoxifen Fhx ```
26
How is endometrial cancer investigated?
``` Urgent TVUS: Endometrial thickening >5mm Biopsy Histopathology Hysteroscopy MRI ```
27
How is endometrial cancer managed?
1: TAH & bilateral S-O 2: TAH, bilateral S-O, lymph node sampling 3: Radical RT +/- TAH OR Progesterone OR combined chemo 4: Internal/external brachy OR Progesterone
28
How is endometrial cancer staged?
Locally invasive cancer 1: Confined to uterus 2: Spread to cervix 3: Spread outside of the uterus 4: Spread to bowel & surrounding organs
29
What is the cause of cervical cancer?
HPV 16 & 18
30
What is the most common type of cervical cancer?
SCC
31
How does cervical cancer spread?
Spreads along the embryological development pattern
32
What are the signs & symptoms of cervical cancer?
Abnormal vaginal bleeding- PCB/IMB/PMB Chronic mucoid/purulent/blood stained discharge Pelvic pain Dyspareunia Cervical mass/bleed Advanced: Malaise, weight loss, pain, haematuria
33
What RFs are associated with cervical cancer?
``` HPV infection 16 & 18 HIV/immunoS Early onset of sexual activity <18 Multiple sexual partners Smoking ```
34
What investigations are done in suspected cervical cancer?
``` VE/Speculum Smear test Colposcopy: Punch biopsy w/ acetic acid HPV testing Staging: MRI & CT ```
35
In Cervical cancer what will a smear test show?
Dyskaryosis
36
How is cervical cancer managed?
1a1: LLETZ/ cone biopsy 1b1 WANTING FERTILITY: Radical trachelectomy 1-2a: Radical AH & lymph node dissection & upper 1/3 of vagina, adjuvant chemo 2b-4: RT/Chemo
37
What are the stages of cervical cancer?
0: Carcinoma in situ 1: Confined to cervix, only surgically treatable stage a1= <3mm deep a2= <5mm deep b1= <4cm b2= >4cm 2: Upper vagina NOT pelvic wall a= not parametrium b= invasion of parametrium 3: Pelvic wall or 1/3 lower vagina or ureteric obstruction 4: Bowel wall, bladder, distal mets
38
What does CIN mean?
Cervical intraepithelial neoplasm 1: Low grade, can regress back to normal 2-3: Full thickness
39
In what cancer are signet cells seen?
Krukenberg's tumour Mucin secretion Secondary ovarian Ca Primary usually Gastric/colon
40
What are the types of epithelial ovarian cancer?
``` SEROUS Mucinous Endometrioid Clear cell Transitional cell Mixed Undifferentiated ```
41
What are the components of Meig's syndrome?
``` Ovarian fibroma Ascites Pleural effusion (R sided most common) ```

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