Whether following a career in gynaecology, or becoming a general practitioner as the vast majority of us will do, knowledge of gynaecological malignancies is essential. Knowledge of screening processes, understanding results and recognising symptoms are all vital skills not only for passing exams but for future practice. This revision article will briefly cover all of these topics.
If you can only start by drilling two simple points into your memory then they should be these:
Causes around 1750 deaths per year in the UK
Using a pipelle (specialised catheter) to take a sample of the endometrium. The pipelle is inserted through the cervical os and advanced until the tip touches the fundus. The inner piston is then withdrawn to create suction/a vacuum. The endometrial sample is obtained by moving the pipelle up and down within the uterine cavity. As the cannula is rotated during removal, a strip of endometrium is peeled off and sucked into the syringe. This is usually repeated four times.
Visualisation of abnormal endometrium and improved uterine sampling
Not diagnostic, but thickened endometrium is suggestive/supportive. Endometiral thickness suggestive of cancer:
Stage 1) Body of uterus only
Stage 2) Stage 1 plus Cervical involvement
Stage 3) Further spread within pelvis
Stage 4) Spread outside pelvis (commonly bladder and/or bowel)
Causes around 1000 deaths a year in the UK
Stage 1) Cervix only (Stage 1a: microscopic, limited to the stroma, maximum depth of 5mm and width of 7mm. Stage 1b: Visible cervical lesions or large microscopic lesions)
Stage 2) Extended to vagina
Stage 3) Spread to (a)lower vagina or (b)pelvic wall
Stage 4) Spread to bladder or rectum (4b-distant organs)
Pre-malignant disease: Cervical intraepithelial neoplasia (CIN)
Cervical intra-epithelial disease (CIN) = The transformation and dysplasia of squamous cells on the surface of the cervix. Most cases of CIN do not progress, or are resolved by the action of the individual’s immune system. However a small proportion develop into cervical cancer if not treated before.
A more detailed description of Cervical Screening can be found here.
Causes around 4500 deaths a year in the UK (more than endometrial and cervical malignancies combined as it usually presents late once the disease has metastasised).
Symptoms are often vague such as abdominal discomfort or distention. Other possible symptoms include ascites and urinary frequency.
Stage 1) Only in ovaries
Stage 2) Beyond ovaries but only in pelvis
Stage 3) Involving retroperitoneal nodes/inguinal nodes/peritoneal implants outside pelvis
Stage 4) Distant metstases
Surgical de-bulking of the tumour followed by 6 months chemotherapy.
The 5-year survival is:
Can be preceeded by vulval intra-epithelial neoplasia which may present as vulval pruritus. This can be excised or treated with laser ablation.
Stage 1) If tumour<2cm and no nodal involvement treat with ‘triple incision' surgery
Stage 2) Treat by radical vulvectomy (=wide removal of vulva and inguinal nodes)
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