Oncology Flashcards
(32 cards)
what is the pathophysiology of post-menopausal bleeds?
- vaginal atrophy
- endometrial atrophy
- endometrial hyperplasia
- malignancy: endometrial, cervical cancer, ovarian tumours, vaginal cancer
- HRT
- polyps, fibroids
- anticoagulant and bleeding disorders
what is considered postmenopausal bleeding?
- more than 12m after last menstrual period in those not recieving hormone therapy
- HRT woman considered postmenopausal if more than 6m after menstruation stopped
what is the referral pathway for post-menopausal bleeds?
women over the age of 55 with postmenopausal bleeding should be investigated within two weeks by ultrasound for endometrial cancer
*women on HRT with postmenopausal bleeding still need to be investigated
how’s postmenopausal bleeds investigated?
- transvaginal ultrasound is the investigation of choice
- the endometrial lining thickness is assessed, for post-menopausal women with bleeding, an acceptable depth is <5mm
- Biopsy of the endometrium, obtained via hysteroscopy or pipelle
how is postmenopausal bleeds managed?
- hormonal therapy for atrophy
- surgical for polyps and malignancies
- supportive like topical oestrogen, HRT
- dilatation and curettage is performed to remove the excess endometrial tissue
what are some risk factors of cervical cancer?
- HPV
- young age of first intercourse
- multiple sex partners
- exposure as no barrier contraception
- smoking
- long term COCP
- immunosuppression
- HPV vaccine lack
- no compliance with screening
what is the pathogenesis of cervical cancer?
- commonly HPV 16 & 18
- produces E6 & E7 which suppress products of p53 tumour suppressor gene in keratinocytes
- infection common in late teens and early twenties and lasts 8m
- vaccine expected to prevent most cases
what is cervical intraepithelial neoplasia? how is it managed?
🤰🏽 pre-malignant condition occurring at transformational zone, asymptomatic, caused by HPV
- histological diagnosis
- tx: excisional large loop excision of transformation zone, cryocautery, diathermy, followup
what are the 4 stages of cervical cancer?
- 1 - confined to cervix
- 2 - beyond cervix but not pelvic wall or lower 1/3 of vagina
- 3 - pelvic spread, reaches side wall or lower 1/3 of vagina may cause hydronephrosis
- 4 - distant mets
what is the management of cervical malignancy?
- microinvasive carcinoma - conservative, if fertility an issue cone biopsy then hysterectomy
- clinical lesions - radical hysterectomy, chemoradio
- beyond stage 2 - chemoradio
- postop radio - LN involvement
- recurrent disease - radio, chemo, palliative, exenteration
when does cervical screening start?
- first invitation at 25
- 3 yearly to 25-50
- 5 yearly from 50-65
- after 65 only selected few
what does cervical screening involve?
-
cytology
- transformation zone of cervix cell collected
- detect dyskaryosis as mild/ moderate or severe
-
colposcopy
- low power binocular microscopy of cervix to look for signs of CIN or Ca
what is the cervical protective vaccine offered?
- covers Gardasil 6,11,16,18 and cervarix 16 & 18
- 3 injections over 6m, ideally prior to SI, 5 years protection, still need smears as some not covered
what are some risk factors of endometrial cancers?
- obesity
- early menarche and late menopause
- nulliparity
- PCOS
- unopposed oestrogen
- tamoxifen
- previous breast or ovarian cancer
- BRCA 1/2
- endometrial polyps
- DM
- Parkinson’s
what lowers the risk of endometrial cancer?
- continuous combined HRT
- COCP
- smoking
- physical activity
- coffee, tea
how does endometrial cancer commonly present?
- pre-menopausal
- prolonged, frequent vaginal bleeding and intermenstrual bleeding
- post-menopausal
- post-menopausal bleeding, less commonly blood stained, watery or purulent vaginal discharge
what is the pathophysiology of endometrial cancer?
- pre-malignant endometrial hyperplasia:malignancy co-exists with 25-50% of cases and 20% will develop Ca within 10 years
- type 1 - endometrial adenocarcinoma
- type 2 - papillary cerous, clear cell or caricnosarcoma
how is endometrial cancers staged?
FIGO Staging - 5 year survival decreases as stages increase
- stage 1 - limited to myometrium
- stage 2 - cervical spread
- stage 3 - uterine serosa, ovaries, tubes, vagina, pelvic, para-aortic lymph nodes
- stage 4 - bladder or bowel involvement with distant mets
how do you diagnose and investigate endometrial cancer?
*one stop postmenopausal bleeding clinic - history, exam, FBC, transvaginal USS, hysteroscopy, endometrial biopsy
- tissue sampling by pipelle biopsy
- hysteroscopy
- transvaginal USS
- bloods, imaging etc
how is endometrial cancer managed?
*age, fitness, patient preference taken into account
- 80% surgery with total hysterectomy PLUS bilateral salpingo-oophorectomy with peritoneal washing
- progestagens or primary radiotherapy
- adjuvant radiotherapy if high recurrence risk with external bram and brachytherapy
- advanced disease, inoperable or unfit for surgery with chemo, radio, hormones (aromatase inhibitors), palliative
what is the pathology of ovarian carcinoma?
- around 90% of ovarian cancers are epithelial in origin, with 70-80% of cases being due to serous carcinomas
- interestingly, it is now increasingly recognised that the distal end of the fallopian tube is often the site of origin of many ‘ovarian’ cancer
what are some risk factors for ovarian cancers?
- obesity
- nulliparity
- early menarche, late menopause
- unopposed oestrogen HRT
- family history
- BRCA 1/2
- endometriosis
what factors lower risk of endometrial cancers?
- COCP
- pregnancy
- breastfeeding
- hysterectomy
- oophorectomy
- sterilisation
- ?statin
how might ovarian cancers present?
non specific
- abdominal swelling
- pain
- anorexia
- N+V
- weight loss
- vaginal bleeding
- bowel sx
