malignancy Flashcards
presentation of cervical cancer
abnormal vaginal bleeding
vaginal discharge
pelvic pain
dyspareunia
- Ulceration
- Inflammation
- Bleeding
- Visible tumour
types of cervical cancer
- Squamous cell carcinoma (80%)
- Adenocarcinoma
- Small cell cancer
organism associated with cervical cancer
HPV 16 and 18
(6 and 11 cause genital warts)
cervical intraepithelial neoplasm CIN
grading system for level of dysplsia in cells of cervix
1- mild dysplasia. affecting 1/3 the thickness of the epithelial layer, likely to return to normal without treatment
II- moderate
III- severe very likely to porgress to cancer if untreated
investigations for Cervical screen
screening is every 5 years for 25-64 age
hrHPV if pos then
cytology if normal retest after one year, if shows dyskaryosis- colposcopy
Large loop excision of the transformation zone (LLETZ): histological evidence of in situ or invasive
punch biopsy
what zone does cervical cytology assess cells from
Transformation zone
colposcopy results
- Acetic acid: damaged cells appear white
- Iodine: only taken up by normal cells
staging of cervical cancer
PET- CT
MRI
Stage IA: Invasive cancer identified only microscopically
IA1<3mm depth x <7mm diameter
IA2 <5mm x 7mm diameter
stage IB: clinical tumours confined to cervix
stage 2- vaginal spread in upper 2/3
stage 3- lower vagina or pelvic spread
stage 4- bladder and/or rectal involvement
management cervical cancer
stage 1A1- excision of cervical transitional zone or hysterectomy
stage 1B- radical hysterectomy or chemo-radiotherapy
stage IIB- IV just chemoradiotherapy
presentation of endometrial cancer
abdnormal vaginal bleeding
post menopausal bleeding- high index of suspicious
intermenstrual bleeding
endometrial hyperplasia
types of endometrial cancer
adenocarcinoma (80%)
serous and clear cell carcinoma (high grade)
RFs endometrial cancer
- Obesity
- Diabetes
- Unopposed E2 therapy (Tamoxifen)
- PCOS
- Early menarche & Late menopause
- HNPCC/Lynch type II familial cancer syndrome
- Precancerous Condition Associated with Endometrial Cancer
- Endometrial hyperplasia
investigations of endometrial cancer
transvag US in women >55 unexplained vaginal discharge and visible haematuria plus raised platelets, anaemia or elevated glucose levels
2 week wait urgent cancer referral for any case of postmenopausal bleeding
pipelle biopsy
hysteroscopy with endometrial biopsy
MRI for staging
staging of endometrial cancer
1A- inner myometrium
1B- outer myometrium
2- invade cervix
3A- serosa/adnexa
3B- vagina/parametrium
3C- pelvic or para aortic nodes
4- bladder/ bowel/ intra adbominal/inguinal nodes
management endometrial cancer (stages)
stage 1 and 2- Total abdominal/laparoscopic hysterectomy with bilateral saplingo-oophorectomy
high risk- chemotherapy
stage 3-4 - radiotherapy
progesterone for palliative
management of endometrial hyperplasia
IUS
COPP levonorgestrel
presentation ovarian cancer
insidious onset
indigestion and poor appetite
bloating
early satiety
abdominal or pelvic mass
pelvic pain
urinary symptoms
weight loss
ascites
types of ovarian cancer
- Serous tumours (the most common)
- Endometrioid carcinomas
- Clear cell tumours
- Mucinous tumours
- Undifferentiated tumours
risk factors for ovarian cancer
- Increasing Age (peaks age 60)
- HNPCC/Lynch type II familial cancer syndrome
- BRCA1 and BRCA2 genes
- Increased number of ovulations (early menarche, late menopause, nulliparity, HRT, fertility treatment)
- Obesity
- Smoking
- Recurrent use of clomifene
referral criteria ovarian cancer
2 week wait if physical exam reveals
ascites
pelvis mass
abdo mass
investigations for ovarian cancer
- CA125 blood test (>35 IU/mL is significant)
- Abdomen and Pelvic ultrasound
- CT scanto establish the diagnosis and stage the cancer
- Histology(tissue sample) using a CT guided biopsy, laparoscopy or laparotomy
- Paracentesis(ascitic tap) can be used to test the ascitic fluid for cancer cells
staging ovarian cancer
1-4
1- limited to ovaries
2- one or both ovaries with pelvic extension
3- one or both ovaries with peritoneal implants outside
4- distant mets
management of ovarian cancer
depends on patient fitness and staging
early disease- surgery can include removal of the uterus, ovaries, Fallopian tubes and infracolic omentectomy
advanced disease- debulking surgery
Adjuvant chemotherapy in combination with surgery
Intraperitoneal chemotherapy may be performed at the time of operation
Biological therapies are being trialled.
vulval cancer presentation
age >60
vulval pain
itching
bleeding
lump or ulceration
