Term
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Definition
| Cancer of any epithelial cells |
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Term
| What is an adenocarcinoma? |
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Definition
| Cancer originating from any glandular tissue. |
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Term
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Definition
| Disordered growth with cells showing abnormalites. |
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Term
| What is pleomorphism in dysplasia? |
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Definition
| 2 or more species existing at the time, this is an indicator of rapid growth. |
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Term
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Definition
| Abnormal uncontrolled growth of cells. |
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Term
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Definition
| Staging system for gynaecological cancers. |
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Term
| What type of cancers might develop in the endometrium? |
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Definition
Papillary serous and Clear Cell Carcinoma, poor prognosis and rare.
Secretory carcinoma- Very rare but best prognosis.
Endometriod Adenocarcinoma, |
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Term
| What is the most common gynaecological cancer in the western world? |
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Definition
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Term
| What is the most common gynaecological cancer in the developing world? |
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Definition
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Term
| Name predisposing factors to endometrial cancer? |
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Definition
| Post menopausal, obese, nulliparous, long fertile period and unopposed oestrogen. |
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Term
| Name two factors which can be protective against endometrial cancers? |
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Definition
| Smoking and combined OCP. |
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Term
| What is the main contributing factor to the pathophysiology of endometrial cancer? |
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Definition
| Oestrogen- Causes uncontrolled proliferation of endometrium & ↑risk of cancerous mutation |
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Term
| What presentation would make you suspect endometrial cancer as a differential diagnosis? |
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Definition
| Post menopausal bleeding or irregular/heavy bleeding in premenopausal women. Pelvic pain, vaginal discharge, meastases. |
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Term
| What investigations would be appropriate when suspecting endometrial cancer? |
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Definition
Trans-vaginal USS- shows thickened endometrium.
Endometrial biopsy
Radiological staging using MRI. |
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Term
| What treatment should be considered for endometrial cancer? |
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Definition
Hysterectomy
Bilateral salpingoophrectomy
Radiotherapy and chemotherapy. |
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Term
| Whats the prognosis for endometrial cancer? |
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Definition
| 94% 5 year survival rate if not spread from endometrium. |
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Term
| What is the most common cancer of the ovaries? |
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Definition
| Ovarian carcinoma makes up 90% of primary ovarian cancers. |
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Term
| What is the most common cause of gynae cancer mortality in the UK? |
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Definition
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Term
| Which groups are most at risk of developing ovarian CA? |
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Definition
| Over 50YO, nulliparous, obese, genetic history, unopposed oestrogen (e.g HRT). |
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Term
| What genetic factors put women at risk of developing ovarian cancers? |
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Definition
BRCA1 - Dominant inheritable allele - Increases breast & ovarian CA likelihood
BRCA2 - Dominant inheritable allele - ↑ Breast, pancreatic & ovarian CA likelihood
HNPCC (Hereditary Non-Polyposis Colorectal Cancer) - Dominant inheritable allele ↑ Risk of colorectal, endometrial & ovarian CA. |
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Term
| What are the protective factors against ovarian cancer? |
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Definition
| OCP, sterilisation and breast feeding. |
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Term
| If ovarian CA becomes metastatic, where is likely to be the first site affected? |
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Definition
Omental cake forming on omentum.
May also spread to peritoneum/abdominal organ surfaces and to pleural cavities with ascites. |
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Term
| What causes ascites in ovarian cancer? |
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Definition
| Due to breakdown of the peritoneal barrier to extra-cellular fluid, lymph blockage and protein lost into ascites causing increased oncotic pressure. |
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Term
| Describe the stages for ovarian cancer progression |
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Definition
•Stage 1 - Limited to one/both ovaries only
•Stage 2 - Extension into pelvic region (e.g. uterine/tubal/broad ligament surface)
•Stage 3 - Extension beyond pelvis onto abdominal organs - Most common presentation
•Stage 4 - Distant Metastases |
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Term
| What symptoms would lead you to a differential diagnosis of ovarian cancer? |
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Definition
| Abdominal/pelvic pain, bloating and feeling full, urinary symptoms and constitutional e.g fatigue and weight loss. |
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Term
| What signs would lead you to a differential diagnosis of ovarian cancer? |
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Definition
| Abdominal distension, palpable abdominal/pelvic mass, shifting dullness and pleural effusion. |
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Term
| What investigations would you consider for suspected ovarian CA? |
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Definition
| Surgery, radiology for staging and CA-125 marker in order to track progression once diagnosis made. |
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Term
| What surgical treatment would be considered for ovarian CA? |
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Definition
Hysterectomy
Bowel resection, depending on spread
Interval debulking (chemo, surgery, chemo) |
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Term
| What chemotherapy should be considered for the treatment of ovarian cancer? |
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Definition
Carboplatin
Reduced dose in renal failure.
2nd line for relapsed- same if platinum sensitive or CAELYX if platinum resistant. |
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Term
| When should radiotherapy be considered in the treatment of ovarian cancer? |
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Definition
|
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Term
| What targeted therapies are there avilable for the treatment of ovarian CA? |
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Definition
|
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Term
| What has caused a drop in incidence of cervical CA in the UK? |
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Definition
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Term
| In which age group is cervical cancer the most common? |
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Definition
| Spread evenly in all age groups above 25YO. |
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Term
| What factors increas your risk of developing cervical CA? |
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Definition
| Number of sexual partners (HPV), smoking OCP, HIV/immunosuppression. |
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Term
| What cervical area is more prone to dysplasia? |
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Definition
| Cervical transformation zone |
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Term
| What changes occurs at the cervical transformation zone during puberty? |
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Definition
| Area of cervical canal exerts to cervical os and undergoes squamous metaplasia due to the acidity of the vagina. |
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Term
| What is the most common cause of cervical cancer? |
|
Definition
HPV 16 and 18, over 70%.
Mucosa-mucosa transmission usually cleared in 1-2 years. |
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Term
| What is cervical intra-epithelial neoplasia? |
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Definition
| Term for cervical dysplasia before progression to neoplasia |
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Term
| What types of cancer would you expect to find in the cervix? |
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Definition
Squamous carcinoma >80%
Adenocarcinoma- most of the other 20% |
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Term
| If not picked up in screening, what presentation would lead you to the differential diagnosis of cervical cancer? |
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Definition
| Irregular bleeding, vaginal discharge and cervical lesion. |
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Term
| What investigation would you carry out if considering a diagnosis of cervical cancer? |
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Definition
| Colposcopy, cystoscopy, proctoscopy and radiological staging. |
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Term
| What treatments using colposcopy would you consider for the treatment of cervical CA? |
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Definition
Biopsy taken +/- Diathermy excision of transformation zone
LLETZ – large loop excision of transitional zone
Diathermy
Cryothermy
Lazer vapourisation
Cone biospy |
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Term
| What surgical options would you consider for the treatment of cervical CA? |
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Definition
Radical Tracalectomy (only suitable for early cancer, allows younger women to maintain their fertility
Requires sufficient length of cervix in order to remove enough cervix and still have enough left
Total Abdominal Hysterectomy +/- Vaginal Excision
Lymphadenectomy may also be indicated
Radical Hysterectomy |
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Term
| How can radiotherapy be administered in cervical cancer? |
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Definition
Brachytherapy- applicator placed in cervix and pellets pumped in.
External beam radiation |
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Term
| When would chemotherapy be used in the treatment of cervical cancer? |
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Definition
| When tumours are no resectable and in conjuction with radiotherapy. |
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Term
| What is the overall 5 year survival prognosis for cervical cancer? |
|
Definition
64%
90% with no spread and <20% at stage 4. |
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|
Term
| What does the national cervical screening programme aim to detect? |
|
Definition
| Cervical intra-epithelial neoplasia |
|
|
Term
| Where dyskariosis is detected in cervical smears, what is the next investigative step? |
|
Definition
| Colposcopy, unless borderline changes where women are recalled for repeat smears. |
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Term
| What vaccination programme is in place aiming to reduce cervical cancer? |
|
Definition
| Cervarix given to 12-13YO girls, 3 injections over 6 months. Protects against HPV 16&18. |
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Term
| When is the peak incidence of vulval cancer? |
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Definition
|
|
Term
| What cancer types would you expect to find in vulval CA? |
|
Definition
Squamous cell carcinoma 90%- rarely metastasises.
Melanoma 5%- High risk of metastases.
Basal cell carcinoma- very rare and very rarely metastasises. |
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Term
| What risk factors increase the chance of vulval cancer? |
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Definition
| >65YO, smoking, HPV infection, cervical/vaginal CA. |
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Term
| What presentation would lead you to consider vulval cancer as a differential diagnosis? |
|
Definition
| Lump/ulceration of vulva, topical itching and pain. |
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Term
| What investigations would you carry out when suspecting a vulval CA? |
|
Definition
Biopsy and radiological assesment.
PET scan can be used to assess lymph node spread. |
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|
Term
| What surgical treatment may be considered for a diagnosis of vulval cancer? |
|
Definition
Dependent on the size of the lesion.
Local Excisions
Total Vulvectomy
Lymphadenectomy |
|
|
Term
| When would radiotherapy and chemotherapy be considered in the treatment of vulval cancer? |
|
Definition
|
|
Term
| What risk factors predispose women to developing vaginal CA? |
|
Definition
| HOV16, past cervical cancer and HIV. |
|
|
Term
| What types of cancer would you expect to find in vaginal CA? |
|
Definition
Squamous cell carcinoma - 80% (>65YO)
Adenocarcinoma- 15% (young adulthood) |
|
|
Term
| What presentation would lead you to the differential diagnosis of vaginal CA? |
|
Definition
| Often asymptomatic, discharge, bleeding and pain. |
|
|
Term
| What investigations would you carry out if suspecting a diagnosis of vaginal CA? |
|
Definition
|
|
Term
| What treatments would be considered for a diagnosis of vaginal CA? |
|
Definition
| Surgery, chemotherapy and radiotherapy. |
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