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44 Cards in this Set
- Front
- Back
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Most common gynaecological cancers in order of mortality and rates
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1. Breast (1/11)
2. Ovarian (1/70) 3. Cervical (1/223) 4. Endometrial (1 in 80) |
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Pathological types of cervical carcinoma
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Squamous (75-80%)
Adenocarcinoma (15-20%) |
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What is postulated to cause metaplasia of the cervical cells?
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Acidic vaginal environment, post puberty when transformation zone lies within the endocervix
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What is a (cervical) ectropion?
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Hypertrophy and extension of the endocervical columnar glands onto the ectocervix (often exacerbated by hormones -> pregnancy and OCP use)
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Which strains of HPV cause warts and which are precursors to cancer?
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HPV 16,18, (33,35) = cancer
HPV 6, 11 = warts |
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What % of young women will clear the HPV virus within 2 years?
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60%
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What are the grades of CIN?
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Grade 1: mild dysplasia/HPV infection
Grade 2: Moderate dysplasia Grade 3: Severe dysplasia, Ca in-situ (CIN 1= LSIL, CIN 2/3 = HSIL) |
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What is the mode of spread for cervical carcinoma?
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Direct invasion - rectum, vagina, cervical stroma)
Lymph nodes - internal and external illiac Blood and intraperitoneal Ix include: EUA, IVP, CXR, Barium enema |
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Risk factors for cervical carcinoma?
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- HPV 16 & 18
- Smoking -Multiple sexual partners - Early coitarche - OCP - Multiparity |
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Common presentation of cervical carcinoma?
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Routine pap smear
Abnormal PV bleeding (PCB, post-meopausal, irregular) Late urine outflow obstruction or PR bleeding, weight loss |
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Differentials for cervical abnormalities?
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- cervical ectropian
- cervicitis -cervical polyp -vaginal trauma (PCB) |
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PAP smear sensitivity and specificity?
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50% sensitivity (not sensitive to adenocarcinoma)
95% specificity 5% false +ve |
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Protocol for pap smears?
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Australian guidelines:
- biennial PAPs once sexually active or 18-70yrs - women have yearly vault smear following hysterectomy and every 2 yrs thereafter - if CIN 1 then repeat in 6-12 - CIN >1 then immediate colposcopy + LLETZ or cone bx - Repeat colp and bx at 6mth -Repeat pap at 12mths - if smear is unsatisfactory repeat 3-6wks |
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Colposcopy
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Indicated to check for presence of CIN:
- transformation zone must be visualised - iodine then applied (low or high grade cells show glycogen depletion) - acetic acid is applied and abnormal cells turn white -bx is taken from these areas |
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Complications and advice following colposcopy?
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- Bleeding, discharge for up to a week
- Avoid tampons, swimming, sex during the week |
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Side effects of LLETZ?
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- bleeding and d/c for up to a week
- 1% chance of cervical stenosis or incompetence - haemorrhage, shock, infection, - anaesthetic cx if under GA |
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Indications and Side effects of Cone bx?
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Indications:
- adenocarcinoma - early invasive disease inconsistent colp results S/E: D/C higher rates of cervical incompetence and stenosis |
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Advise 3-4wks following any gynae procedure?
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Avoid sex (prevents infection)
Avoid tampons Avoid baths, spas, swimming pools PAP smears every 6mths for 1st year then yearly after that. |
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What is the most common cause of death in cervical ca and why?
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Due to bilateral ureteral obstruction and uraemia as cancer often spreads through cardinal ligaments and can obstruct both ureters causing hydronephrosis and obstruction
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Px for Cervical ca?
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85% 5 yr survival for Stage I and II
20-70% 5 yr if >Stage IIb |
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Endometrial cancer background
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Associated with PCOS, obesity and DM. Usually post-meopausal (median age of 60-65yrs; though 10-20% are pre-menopausal)
Post-menopause enodmetrium atrophies without stimulation from oestrogen. Excess, unopposed oestrogen = uncontrolled endometrial growth and hyperplasia - cystic glandular hyperplasia - Complex hyperplasia w/out atypia -Atypical -> 15-50% will become invasive |
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Risk Factors for endometrial cancer?
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- Increasing age
- PCOS, obesity (due to conversion of androgen to oestrogen) - oestrogen secreting tumour - Anovulation/oligo as not regularly exposed to progesterone - nulliparity (don't get respite from oestrogen during pregnancy) - DM and Insulin resistance - HTN - hereditary non-polyposis colon cancer - PHx of breast (Tamoxifen rx) |
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Presentation of endometrial cancer and spread?
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- PV bleeding
ALL POST-MENOPAUSAL BLEEDING SHOULD BE ASSUMED ENDO CA until proven otherwise - Adnexal mass -U/S showing thick endometrium - local, venous, lymphatic, tubal |
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Mx of endometrial cancer?
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- Surgery: Dx, Ix and Rx
- For disease beyond the uterus: radiotherapy, chemotherapy and hormonal |
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Px of endometrial cancer?
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>80% of women present early
5yr survival is >90% |
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Different types of ovarian tumours?
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70% are benign, 20% malignant and 10% borderline.
- epithelial (80% - imitate different epithelial types) - germ cell: teratoma or dermoid (15% - young women) -choriocarcinoma - like placental tissue, doesn't require pregnancy |
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Presentation of ovarian tumours?
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- asymptomatic until late
- vague sx, weight loss, back pain, indigestion etc once ovary is big and metastases. |
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Investigations for ovarian ca?
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- Ca-125 (epithelial type)
-HCG (choriocarcinoma) -AFP (germ cell) -Inhibin -Ca19-9 U/S shows ovarian mass CT body |
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Treatment of ovarian ca?
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Surgical clearance is typically extensive: hysterectomy + bilat salpingo-oophrectomy + appendicectomy+ peritoneal washings and nodes
Combination chemo is usually warranted if malignant, borderline just treated with surgery |
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Px
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Not good as most present late due to lack of sx
40% of women with advanced with go into remission with chemoRx |
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Differentials of breast lumps?
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Inflammatory: mastitis, mammary duct ectasia (dilated milk duct), fat necrosis
Benign: fibroadenosis, fibroadenoma, duct papilloma, lipomas, haemangioma Malignant: DCIS, LCIS, invasive carcinoma |
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Most common causative organism of pyogenic mastitis?
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S aureus
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Characteristics of mammary duct ectasia?
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Nipple d/c; can be bloody but normally green, toothpaste like. Hence mistaken for malignancy but not r/ship
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Characteristics of fibrocystic change?
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Fibrocystic change encompassess fibroadenosis, fibrosis, epithelial hyperplasia and cysts.
Have a smooth outline but not as mobile as fibroadenomas (mimic ca), causes cyclical discomfort (commonly pre-menstrual), cysts are most common cause of lumps, develops at any age |
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Characteristics of fibroadenoma?
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Commonest type of benign tumour, highly mobile with fibrous capsule + calcification.
Arises from CT and epith V rarely metastasises |
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Characteristics of a duct papilloma?
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Much less common than a fibroadenoma; presents with blood stained nipple D/C
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Significance of:
- Paget's Disease of the Nipple - Peau d'orange - Puckering/Tethering |
- malignant disease of the nipple, may look like eczema
- lymphatic blockage due to ca - invasion of skin and nipple by ca |
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Risk factor for breast cancer?
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- Age >55
- Strong FHx (BRCA1/2) - Hx of DCIS/LCIS or atypical ductal hyperplasia -Nulliparity -First child >35yrs ->5 yrs HRT -early menarche, late menopause |
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Ix for breast cancer?
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Triple test:
- clinical -bx core or FNA -mammogram/U/S |
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Recommendations for the screening of breast cancer?
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Mammography: 50-70yr recommend biennial. More sensitive in the post-menopausal group, NOT dx
U/S in younger women |
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Mx of breast cancer?
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Surgical: Wide local excision, + axillary clearance + radio OR masectomy + axillary clearance
(if +ve sentinel node bx) Adjuvant: radio - minimises recurrence Hormonal: Tamoxifen SERMs less S/E as tamoxifen and at least as effective Aromatase inhibitors: (converts andogens to oestrogens in other bodily tissues --> fat therefore decreased circulating oestrogens), less S/E and as effective as tamoxifen Chemo: used when lymph node involvement |
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Gestational trophoblastic disease
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Abnormally proliferating trophoblasts which are capable of unlimited growth, invasion an metastases, while normal embryonic development is lost
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Different types of gestational trophoblastic disease?
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Benign - hydatidaform mole
Malignant - invasive mole, choriocarcinoma |
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Characteristics of GT disease?
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- occur in association with a pregnancy
- Their DNA always differs from that of the patient's own DNA - BHCG is a reliable tumour marker - Nearly 100% responsive to chemotherapy |
