Please enable JavaScript.
Coggle requires JavaScript to display documents.
Gynaecological Malignancy: (Endometrial Cancer (Risk Factors: (Age, Weight…
Gynaecological Malignancy:
Endometrial Cancer
Epidemiology:
affects obese ladies in their 50's and generally post menopausal
Risk Factors:
Age
Weight: i.e. obesity
Paity: low parity is a RF
Menopause: as unopposed oestrogen
PCOS
History of HNPCC: high risk of varian, endometrial and colorectal cancer
Introduction:
most common gynaecological cancer
Protective Factors
COCP
Parity
Aetiology:
Tamoxifen
PCOS or oestrogen secreting tumors
HRT
Generally caused by unopposed oestrogen. meaning there is no progesterone protective effects
Pathophysiology:
Commonly adenocarcinomas
Spread via nodal, lymph or peritoneal
Presentation:
Irregular menstrual bleeding
Post menopausal bleeding
Diagnosis:
GOLD STANDARD: Hysteroscopy and Biopsy
If cancer is seen do a MRI to stage
Abdominal Ultrasound showing endometrial thickening
Staging:
Stage 1: confined to the uterus
Stage 2: extends to the cervix
Staging is done via the FIGO staging
Stage 3: involves the ovaries and lymph nodes
Stage 4: in other organs
Management:
Surgical: full hysterectomy and pelvic node removal
Adjuvant radiotherapy and Progesterone therapy may be needed
Endometrial Hyperplasia:
Definition:
Pre-malignant condition that can lead to endometrial cancer. Due to overgrowth of endometrial cells
Can be simple or complex hyperplasia
Epidemiology:
Common in women over 40
Similar RF to endometrial cancer: low parity, menopause etc
Presentation: irregular menstruation or PMB
Management:
Progesterone therapy is given to promote regression of the polyps
Ovarian Cancer
Aetiology:
Unknown but is thought to be due to ovarian epithelial cell irritation after ovulation. Most cancers are epithelial in origin. Some may be germ cell.
Also strong genetic link to BRCA and HNPCC
Symptoms:
Abdominal pain, Abdominal mass, Abdominal distension or bloating
Urinary frequency, constipation and post menopausal symptoms
As known as the silent killer: symptoms are very non-descript. Should be ? in any women over the age of 50 who comes in with vague symptoms and has a family history!
Risk Factors
:
FH: of BRCA or HNPCC
Non use of COCP
Nulliparous
Minor SE: smoking,obesity and early menopause
Investigations:
Routine bloods + Ca125 blood test
Abdominal Ultrasound scan
If any concerns do a CT scan
Risk of Malignancy Index:
Ca125 x USS score x pre/post menopausal. Score over 250 need a referral to an oncologist
Epidemiology:
It is common in women aged 60-64
Known as the silent killer as commonly presents as stage 3+
Ovarian Cancer is the 5th most common cancer, But the no.1 killer of the urogynae conditions.
Management:
Adjuvant Chemotherapy
Surgery: total hysterectomy
Cervical Cancer:
Symptoms:
Vaginal Discharge
Vaginal discomfort or urinary symptoms
Late symptoms include: painless haematuria, rectal bleeding or change in bowel habits or increased urinary frequency
Abnormal bleeding: PC, IMB or after micturitaion or defecation
Investigations:
Pre menopausal: chlamydia swab
`Post menopausal: urgent two week wait
Colopscopy, Cone biopsy and CT pelvis
Pathogenesis:
Majority of histology shows that they are: squamous cell variety
In the transition zone of the cervix: the cells are constantly changing from columnar cells to squamous cells. It is this area that is particularly prone to be cancerous.
Persistent Infection of the HPV virus 16 and 18 leads to cervical intraepithelial neoplasm
Primary tumors can range from a bulky ectocervical to a destructive tumor. Whilst invasive tumors can range from micro-invasive to invasive.
Risk Factors
Early age of 1st SI < 16
Multiple partners
Previous STIs
Lower SE status
Smoking
HPV virus infection
Epidemiology
Most common cancer in 20-30s
Numbers have gone down recently due to cervical screening and the HPV injection
Definition:
Neoplasm of the squamous cells of the cervix. Caused by persistent infection with the HPV virus
M
anagement:
More invasive: cone biopsy +/- radiotherapy/chemotherapy
LLETZ procedure
Cervical Intraepithelial Neoplasm
Pre- cancerous condition that is confined to the epithelium
These cells are normally found in the transformation zone. Treatment is a LLETZ procedure . Categorised CN1-CN3 (full epidermis thickness)