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Repro > malignancy > Flashcards

malignancy Flashcards

1
Q

presentation of cervical cancer

A

abnormal vaginal bleeding
vaginal discharge
pelvic pain
dyspareunia

  • Ulceration
  • Inflammation
  • Bleeding
  • Visible tumour
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1
Q

types of cervical cancer

A
  • Squamous cell carcinoma (80%)
  • Adenocarcinoma
  • Small cell cancer
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2
Q

organism associated with cervical cancer

A

HPV 16 and 18

(6 and 11 cause genital warts)

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3
Q

cervical intraepithelial neoplasm CIN

A

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

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4
Q

investigations for Cervical screen

A

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

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5
Q

what zone does cervical cytology assess cells from

A

Transformation zone

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6
Q

colposcopy results

A
  • Acetic acid: damaged cells appear white
  • Iodine: only taken up by normal cells
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7
Q

staging of cervical cancer

A

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

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8
Q

management cervical cancer

A

stage 1A1- excision of cervical transitional zone or hysterectomy
stage 1B- radical hysterectomy or chemo-radiotherapy
stage IIB- IV just chemoradiotherapy

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9
Q

presentation of endometrial cancer

A

abdnormal vaginal bleeding
post menopausal bleeding- high index of suspicious
intermenstrual bleeding
endometrial hyperplasia

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10
Q

types of endometrial cancer

A

adenocarcinoma (80%)
serous and clear cell carcinoma (high grade)

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11
Q

RFs endometrial cancer

A
  • 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
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12
Q

investigations of endometrial cancer

A

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

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13
Q

staging of endometrial cancer

A

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

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14
Q

management endometrial cancer (stages)

A

stage 1 and 2- Total abdominal/laparoscopic hysterectomy with bilateral saplingo-oophorectomy
high risk- chemotherapy
stage 3-4 - radiotherapy

progesterone for palliative

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15
Q

management of endometrial hyperplasia

A

IUS
COPP levonorgestrel

16
Q

presentation ovarian cancer

A

insidious onset
indigestion and poor appetite
bloating
early satiety
abdominal or pelvic mass
pelvic pain
urinary symptoms
weight loss
ascites

17
Q

types of ovarian cancer

A
  • Serous tumours (the most common)
  • Endometrioid carcinomas
  • Clear cell tumours
  • Mucinous tumours
  • Undifferentiated tumours
18
Q

risk factors for ovarian cancer

A
  • 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
19
Q

referral criteria ovarian cancer

A

2 week wait if physical exam reveals
ascites
pelvis mass
abdo mass

20
Q

investigations for ovarian cancer

A
  • 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
21
Q

staging ovarian cancer

A

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

22
Q

management of ovarian cancer

A

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.

23
Q

vulval cancer presentation

A

age >60
vulval pain
itching
bleeding
lump or ulceration

24
Q

risk factors vulval cancer

A
  • Intraepithelial neoplasia or cancer at another site
  • Lichen sclerosus
  • Smoking
  • Immunosuppression
  • HPV
25
Q

type of vulval cancer

A

squamous cell

26
Q

vulval intraepithelial neoplasia VIN

A

precancerous affecting the squamous epithelium of the vulval skin that may precede vulval cancer

classical and warty VIN can be low grade or high grade

differentiated always high grade

27
Q

diagnosis VIN

A

punch biopsy or excisional biopsy

28
Q

stages of vulval cancer

A

1- <2cm
2- >2cm
3- local spread. unilateral nodes
4- distant or advanced local spread. pelvic nodes involved

29
Q

vulval cancer management

A

depends on staging
surgery- primary. can be radical or wide excision
chemo/radio- in advanced

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