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Medicine Notes Gynaecology Notes

Gynaecological Cancers Notes

Updated Gynaecological Cancers Notes

Gynaecology Notes

Gynaecology

Approximately 26 pages

Complete set of notes covering gynaecology. Includes pathophysiology, presenting features, investigation and management. Uses colour coding for different topics and tables and diagrams. Ideal for written or clinical finals...

The following is a more accessible plain text extract of the PDF sample above, taken from our Gynaecology Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Endometrial carcinoma

Type 1 disease Type 2 disease
  • Common

  • Oestrogen dependent

  • Earlier diagnosis

  • Premalignant hyperplasia

  • Receptor +ve

  • Better outcome

  • Older patients

  • Non-oestrogen dependent

  • Poorer prognosis

  • No pre-malignant stage

  • Rapid progression

Disease usually starts in the fundus and spreads slowly to muscle, cervix and peritoneum and metastasises to ovaries and lymph nodes

Risk factors

  • Obesity

  • Unopposed oestrogen therapy or tamoxifen

  • Nulliparity, early menarche, late menopause

  • FHx of breast, ovarian or colon ca

  • PCOS

Presentation

  • Usually presents after menopause

  • Pre-menopausal

    • Irregular abnormal bleeding

  • Post-menopausal

    • Bleeding (10% with PMB have malignancy) – initially lights but increases

    • Discharge

Pathology

  • Endometrial hyperplasia

    • Pre-malignant stage

    • Classified into simple, complex + atypical

      • Atypical = risk for malignancy

  • Endometrial carcinoma

    • Can be adenocarcinoma, papillary,

    • Adenosquamous or clear cell

Staging

  • 1 = in body of uterus only

  • 2 = in body and cervix

  • 3 = advanced beyond uterus but within pelvis

  • 4 = extends outside pelvis e.g bladder, bowel

Management

  • Stage I+II may be cured by TAHBSO +/- radiotherapy

  • In advanced disease consider radio +/- high dose progesterone (shrink tumour)

  • Chemo may be used if unresponsive

Prognosis

  • Overall survival rate 70%

  • Worse prognosis if

    • Poorly differentiated

    • Invasion of myometrium

    • Periotneal/nodal/vascular involvement

Cervical cancer + CIN

Commonest cancer in women in developing countries

In developed countries there are screening programmes aiming to identify a pre-malignant/pre-invasive stage – cervical intraepithelial neoplasia (CIN)

CIN

  • Develops in transformative zone (area at junction between endo + ectocervix)

    • Endocervix = columnal epithelium

    • Ectocervix = squamous epithelium

  • Oestrogen causes eversion of part of the endocervix and the columnar cells undergo metaplasia to become squamous cells leading to increased risk of CIN

  • During cervical smear, cells are taken from both endo and ectocervix to look for dyskaryosis

    • Dyskaryosis = cytological dx

    • CIN = histological dx

  • Smear results may be normal or show mild (CINI)/mod (CINII)/severe (CINIII) dyskaryosis

  • 1/3 of cases of abnormal smear results will regress, 1/3 will stay the same, 1/3 will progress

  • In the UK, screening is recommended every 3 years between ages 25-65 years

  • If moderate/severe dyskaryosis is found, colposcopy is recommended

    • Uses microscope to look at cervix in more detail

    • Acetic acid can be applied to cervix

      • Stains abnormal areas white (due to raised intracellular protein and less glycogen)

    • Take punch biopsies for histology

  • If mild dyskaryosis – repeat smear in 4 months

Management of CIN

  • Loop excision: performed under LA in OPD. Risk of causing cervical incompetence/stenosis

  • Radical electrodiathermy: OPD procedure, can’t tell depth of tissue destruction

  • Cryotherapy

  • CO2 laser vaporization

  • Cone biopsy: used in CINIII, surgical excision under GA, risk of cervical incompetence + stenosis

  • Patient needs annual smears for 10 years

Cervical cancer

Aetiology

  • Arises from areas of CIN (30% of CINIII = invasive disease)

  • Is a cancer of sexually active women

    • Strong association with HPV 16+18

    • HPV thought to impair function of p53 gene (DNA repair)

  • Risk factors include

    • Multiple sexual partners

    • Early age of intercourse

    • No barrier contraception use

    • Prolonged COCP use in HPV +ve patients

    • High parity

    • HIV, other STDs

Pathology

  • Most are squamous cell carcinomas

    • Usually keratinizing

  • 10-25% are adenocarcinomas

  • Most commonly spread via lymphatics or local spread to vagina, pelvic walls, bladder etc

Oncological presentation

  • Symptoms

    • Post-coital bleeding

    • Inter-menstrual bleeding

    • Menorrhagia

    • Offensive vaginal discharge

  • May be incidental finding on cervical smear

  • Advanced disease may also present with

    • Backache

    • Leg pain

    • Oedema

    • Haematuria

    • Wt loss, anorexia, malaise

Investigations

  • Clinical examination, colposcopy, biopsy

  • USS, CT< MRI for staging (FIGO system)

Management

  • Depends on stage

  • Simple excision/cone biopsy

  • Radical hysterectomy + pelvic lymphadenectomy

  • Radical radiotherapy – external beam to pelvic, brachytherapy to vagina

    • May cause

      • Vaginal dryness

      • Cystitis

      • Proctitis

      • Vaginal stenosis

  • Chemotherapy

  • If recurrent – palliative

Ovarian Tumours

Any of the Ovary’s tissue can become neoplastic

Benign tumours (94%)

Usually cystic

  • Functional cysts (25%)

    • Enlarged/persistent follicular/corpus luteum cysts

    • So common they are considered normal if <5mm

    • May cause pain by

      • Rupture, failure to rupture at ovulation, bleeding

  • Serous...

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