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Gynaecological Cancers Notes

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This is an extract of our Gynaecological Cancers document, which we sell as part of our Gynaecology Notes collection written by the top tier of University Of Leicester students.

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Endometrial carcinoma Type 1 disease Type 2 disease
- Common
- Older patients
- Oestrogen dependent
- Non-oestrogen dependent
- Earlier diagnosis
- Poorer prognosis
- Premalignant hyperplasia
- No pre-malignant stage
- Receptor +ve
- Rapid progression
- Better outcome 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

COCP and progesterones are protective

Presentation
- Usually presents after menopause
- Pre-menopausal o Irregular abnormal bleeding
- Post-menopausal o Bleeding (10% with PMB have malignancy) - initially lights but increases o Discharge Pathology
- Endometrial hyperplasia o Pre-malignant stage o Classified into simple, complex +
atypical
? Atypical = risk for malignancy
- Endometrial carcinoma o Can be adenocarcinoma, papillary, o Adenosquamous or clear cell

Diagnosis
- Pipelle biopsy (often preceded by TV USS - looks for endometrium >5mm)
- Hysteroscopy

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

o o o

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) o Endocervix = columnal epithelium o 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 o Dyskaryosis = cytological dx o 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 2565 years If moderate/severe dyskaryosis is found, colposcopy is recommended o Uses microscope to look at cervix in more detail o Acetic acid can be applied to cervix
? Stains abnormal areas white (due to raised intracellular protein and less glycogen) o Take punch biopsies for histology If mild dyskaryosis - repeat smear in 4 months

Management of CINLoop 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

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