malignancy

Question 1

presentation of cervical cancer

Answer 1

abnormal vaginal bleeding
vaginal discharge
pelvic pain
dyspareunia

• Ulceration
• Inflammation
• Bleeding
• Visible tumour

Question 1

types of cervical cancer

Answer 1

• Squamous cell carcinoma (80%)
• Adenocarcinoma
• Small cell cancer

Question 2

organism associated with cervical cancer

Answer 2

HPV 16 and 18

(6 and 11 cause genital warts)

Question 3

cervical intraepithelial neoplasm CIN

Answer 3

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

Question 4

investigations for Cervical screen

Answer 4

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

Question 5

what zone does cervical cytology assess cells from

Answer 5

Transformation zone

Question 6

colposcopy results

Answer 6

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

Question 7

staging of cervical cancer

Answer 7

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

Question 8

management cervical cancer

Answer 8

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

Question 9

presentation of endometrial cancer

Answer 9

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

Question 10

types of endometrial cancer

Answer 10

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

Question 11

RFs endometrial cancer

Answer 11

• 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

Question 12

investigations of endometrial cancer

Answer 12

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

Question 13

staging of endometrial cancer

Answer 13

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

Question 14

management endometrial cancer (stages)

Answer 14

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

progesterone for palliative

Question 15

management of endometrial hyperplasia

Answer 15

IUS
COPP levonorgestrel

Question 16

presentation ovarian cancer

Answer 16

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

Question 17

types of ovarian cancer

Answer 17

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

Question 18

risk factors for ovarian cancer

Answer 18

• 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

Question 19

referral criteria ovarian cancer

Answer 19

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

Question 20

investigations for ovarian cancer

Answer 20

• 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

Question 21

staging ovarian cancer

Answer 21

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

Question 22

management of ovarian cancer

Answer 22

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.

Question 23

vulval cancer presentation

Answer 23

age >60
vulval pain
itching
bleeding
lump or ulceration

Question 24

risk factors vulval cancer

Answer 24

- Intraepithelial neoplasia or cancer at another site - Lichen sclerosus - Smoking - Immunosuppression - HPV

Question 25

type of vulval cancer

Answer 25

squamous cell

Question 26

vulval intraepithelial neoplasia VIN

Answer 26

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

Question 27

diagnosis VIN

Answer 27

punch biopsy or excisional biopsy

Question 28

stages of vulval cancer

Answer 28

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

Question 29

vulval cancer management

Answer 29

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