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Gynaecological Malignancies Flashcards

(105 cards)

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1
Q

What is the most common presentation of endometrial cancer?

A

Post-menopausal bleeding

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2
Q

If endometrial cancer occurs in pre-menopausal women, how would it present?

A

Inter-menstrual bleeding

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3
Q

At what age range is the peak incidence of endometrial cancer?

A

50-60 years

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4
Q

If endometrial cancer is diagnosed in a woman aged < 40, what should be considered?

A

Lynch syndrome

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5
Q

80% of endometrial cancers are what histological type?

A

Adenocarcinomas

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6
Q

What is the precursor lesion to endometrial adenocarcinomas?

A

Atypical endometrial hyperplasia

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7
Q

What is the main risk factor for the development of endometrial adenocarcinomas?

A

Exposure to unopposed oestrogen

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8
Q

In type 2 (non-endometrioid) endometrial cancers, what protein is almost always mutated?

A

Tp53

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9
Q

What is the biggest risk factor contributing to unopposed oestrogen exposure in women with endometrial cancer?

A

Obesity

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10
Q

How is Lynch syndrome (HNPCC) inherited?

A

Autosomal dominant

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11
Q

What screening do women with Lynch syndrome (HNPCC) undergo?

A

Colonoscopy from age 25, TVUS and CA125 levels from age 35

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12
Q

What endocrine condition is a risk factor for endometrial cancer?

A

PCOS

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13
Q

What are some medications that are risk factors for endometrial cancer?

A

Tamoxifen and oestrogen-only HRT

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14
Q

What are some examples of protective factors for endometrial cancer?

A

Hysterectomy, COCP, Mirena-IUS, pregnancy

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15
Q

Who should receive an urgent referral using the suspected cancer pathway for endometrial cancer?

A

Women aged 55+ with post-menopausal bleeding

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16
Q

What is the first line investigation for endometrial cancer? What is this used to establish?

A

TVUS- used to establish the endometrial thickness

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17
Q

What is a normal endometrial thickness in post-menopausal women?

A

< 4mm

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18
Q

Other than TVUS, what investigations are indicated for women with post-menopausal bleeding and suspected endometrial cancer?

A

Hysteroscopy and endometrial biopsy

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19
Q

How is endometrial cancer managed in the first instance?

A

Total abdominal hysterectomy, with bilateral salpingo-oophorectomy

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20
Q

What adjuvant treatment options can be used for endometrial cancer?

A

Radiotherapy +/- chemotherapy

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21
Q

What treatment can be utilised for women with endometrial cancer who are not suitable candidates for surgery, or who wish to preserve their fertility?

A

Progesterone supplements (POP or Mirena-IUS)

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22
Q

Who is cervical cancer most likely to present in?

A

Pre-menopausal women (most common aged 25-29)

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23
Q

How does cervical cancer present?

A

Post-coital, inter-menstrual or persistent vaginal bleeding

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24
Q

What are some clinical features of advanced cervical cancer?

A

Weight loss, back/pelvic pain, urinary/faecal leakage

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25
What are the two most common types of cervical cancer, and how common is each?
Squamous cell carcinoma (80%) and adenocarcinoma (20%)
26
What is the precursor lesion to squamous cell cervical cancer?
Cervical intra-epithelial neoplasia
27
What is the precursor lesion to adenocarcinoma of the cervix?
Cervical glandular intra-epithelial neoplasia
28
Which histological type of cervical cancer is more associated with low socioeconomic status and early onset of sexual activity?
Squamous cell carcinoma
29
What is the most common cause of cervical cancer (be specific)?
HPV infection, mainly types 16 and 18
30
What are some risk factors for persistent genital HPV infection which doesn't clear up on its own?
Smoking and immunosuppression
31
Which women get screened for cervical cancer, and how often do they get screened?
Women aged 25-49 get screened every 3 years, women aged 50-64 get screened every 5 years
32
Who is the HPV vaccine offered to?
Boys and girls aged 12-13 and MSM
33
What is the first line investigation for suspected cervical cancer?
Colposcopy and punch biopsy
34
For a final diagnosis of cervical cancer to be made, one of which two types of biopsy must be done?
LLETZ or cone biopsy
35
What imaging investigation is used to determine the size and assess the spread of a cervical cancer?
Pelvic MRI
36
What is the gold standard management for early stage (localised to the cervix) cervical cancer?
Hysterectomy +/- lymph node clearance
37
What surgical management is available for women with early stage cervical cancer who want to maintain their fertility?
Cone biopsy
38
What adjuvant treatment is recommended in addition to surgery, in women with cervical cancer who have positive surgical margins or where lymph nodes are positive for metastatic disease?
Chemotherapy
39
What is the gold standard management for late stage (outwith the cervix) cervical cancer?
Radical chemoradiotherapy
40
What chemotherapy agent is commonly used in the management of cervical cancer?
Cisplatin
41
What are two fertility sparing treatment options for cervical cancer?
Cone biopsy and LLETZ
42
What happens with regard to cervical screening in pregnancy, assuming the woman is up to date with her smears?
Withhold until 3 months post-partum
43
How long does it take for results of cervical screening to come back?
2 weeks
44
What action is required for a cervical screening result that states 'borderline or mild dyskaryosis'?
High risk HPV test
45
What action is required if a woman has undergone high-risk HPV testing and it comes back negative?
Back to routine screening
46
What action is required if a woman has undergone high-risk HPV testing and it comes back positive?
Colposcopy within 6 weeks
47
What action is required for a cervical screening result that states 'moderate or severe dyskaryosis' or 'invasive cancer or glandular neoplasia suspected'?
Refer for colposcopy within 2 weeks
48
What action is required for a cervical screening result that states 'inadequate'?
Repeat test in 3 months
49
How many inadequate cervical smears warrant a colposcopy?
Three
50
How is CIN 1 normally treated?
It usually resolves spontaneously, a repeat colposcopy should be done at 12 months to ensure resolution
51
If CIN 1 has not resolved after a year, what treatment is required?
LLETZ or cold coagulation
52
How is CIN 2 normally treated?
LLETZ
53
What are some treatment options for CIN 3?
LLETZ, cone biopsy or hysterectomy
54
After a LLETZ procedure, women are advised to avoid sex, the use of tampons and swimming for how long?
4 weeks
55
What is the main obstetric complication associated with LLETZ and cone biopsies?
Preterm delivery
56
What test of cure is required after undergoing treatment for CIN?
Cervical cytology and high-risk HPV testing at 6 months
57
If a woman has undergone follow-up after treatment of CIN, and high-risk HPV testing comes back negative, what is done next with regards to future screening?
Return to routine screening
58
If a woman has undergone follow-up after treatment of CIN, and high-risk HPV testing comes back positive or if moderate/severe dyskaryosis is detected, what is done next?
Colposcopy
59
Vulval carcinoma is usually seen in who?
Older women
60
Vulval carcinoma is now sometimes seen in younger women (30s/40s) as a result of what?
High-risk HPV infection
61
How does vulval carcinoma tend to present?
Vulval lump or ulcer (may be associated with pain, discharge, itch)
62
What is the most common histological type of vulval cancer?
Squamous cell carcinoma
63
What are some factors contributing to carcinogenesis of vulval cancer?
Intra-epithelial neoplasia, lichen sclerosus and chronic inflammation
64
What is the gold standard investigation for vulval cancer?
Vulval biopsy
65
What imaging investigations are required for advanced cases of vulval cancer?
Pelvic CT/MRI
66
Where are vulval carcinomas most likely to spread to?
Inguinal lymph nodes
67
How is vulval cancer normally managed?
Radical vulvectomy + bilateral inguinal lymphadenectomy
68
What adjuvant treatment may be required for vulval cancer?
Radiotherapy
69
80% of vaginal cancers are metastatic spread from where?
The endometrium or cervix
70
When is the peak incidence of vaginal cancer?
60-70 years
71
How is a vaginal cancer most likely to present?
Vaginal bleeding or discharge
72
What is the most common histological type of vaginal cancer?
Squamous cell carcinoma
73
What is responsible for 60% of vaginal cancers?
HPV (especially type 16)
74
What iatrogenic treatment may contribute to the development of vaginal cancer?
Radiotherapy
75
What is the gold standard investigation for vaginal cancer?
Examination under anaesthesia and biopsy
76
How are most cases of vaginal cancer treated?
Radiotherapy
77
Where do leiomyosarcomas arise from?
The myometrium
78
What are the three red flag symptoms for ovarian cancer, especially if they are persistent or frequent?
Bloating, abdominal pain, fluctuating bowel habit
79
At what age is the median diagnosis of ovarian cancer?
60 years
80
What are two things that may be noted on examination of a woman with ovarian cancer?
Pelvic mass and free fluid (ascites)
81
> 90% of ovarian cancers are what broad type?
Epithelial cancers
82
What is the most common type of epithelial ovarian cancer?
Serous carcinoma
83
Which type of ovarian cancer is associated with BRCA mutations?
Serous carcinoma
84
After serous, what is the next most common type of epithelial ovarian cancer?
Mucinous carcinoma
85
Having endometriosis increases the risk of developing which ovarian epithelial cancers?
Endometrioid and clear cell
86
What is the name for a rare, placental, trophoblastic tumour that can develop in the ovary, and is associated with a raised HCG?
Choriocarcinoma
87
What is the most common malignant germ cell tumour of the ovary, which is seen almost exclusively in children and young women, and is associated with a raised HCG and AFP?
Dysgerminoma
88
What type of ovarian cancer is a slow growing tumour that produces oestrogen, is associated with raised inhibin levels, and presents with irregular/heavy bleeding or precocious puberty in young females?
Granulosa cell tumour
89
Which type of ovarian cancer produces androgens +/- testosterone, and leads to progressive masculinisation?
Sertoli cell tumour
90
What diagnosis should always be considered in cases of small, bilateral ovarian cancers?
Metastases from another primary
91
What are the most common mutations causing genetic ovarian cancer?
BRCA1 and BRCA2
92
How are the BRCA genes inherited?
Autosomal dominant
93
What prophylactic management for ovarian cancer is offered to women aged > 35 with a BRCA mutation?
Bilateral salpingo-oophorectomy
94
What is the tumour marker for ovarian cancer?
CA125
95
What can be a useful test to rule out a GI primary in someone with suspected ovarian cancer?
CEA
96
What is the first line imaging investigation for ovarian cancer?
Trans-vaginal ultrasound
97
If an ovarian cancer is suspected following TVUS, what is the next line imaging investigation?
CT or MRI chest/abdo/pelvis
98
What is the gold standard method of obtaining a sample of ovarian cancer for pathology?
Laparoscopy
99
Patients with an RMI score of more than what should be referred to gynae-oncology?
200
100
Which lymph nodes do ovarian cancers spread to?
Para-aortic (lumbar)
101
How is ovarian cancer which is confined to the ovary managed?
Surgery only
102
How is ovarian cancer which is not confined to the ovary managed?
Surgery + chemotherapy (adjuvant or neo-adjuvant)
103
What is the most commonly used chemotherapy agent for ovarian cancer?
Platinum based agents e.g. carboplatin
104
What are Krukenberg tumours? What histological feature do they show?
Gastric adenocarcinomas which metastasise to the ovary, they show signet-ring cells
105
How often should HIV positive women receive cervical cytology testing?
Annually

Obs & Gynae (Gynae) (5 decks)

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