12.1 Gynae tumours Flashcards
Most common caner of the vulva?
Squamous carcinoma
Causative factor of vulva tumour in pre-menopausal women?
HPV 16 with invasion:
Vulvan intraepithelial neoplasia?
How does vulval intraepithelial neoplasia present
Brown patches around anus,
white patches around clitoris
Why is used to detect Vulval intraepithelial neoplasia?
Toludine blue dye
Acetic acid stains white
What is the causative factor in older women?
Chronic irritation
Longstanding skin disease - lichen sclerosis
Where does vulval carcinoma spread to?
Inguinal, pelvic, iliac and para-aortic lymph nodes
Lungs and liver
What is the cause of cervical carcinoma?
HPV 16/18 causing cervical intraepithelial neoplasia
Where does HPV infect?
Metaplastic squamous cell in transition zone. just above external os of cervix where mucus-secreting simple columnar become vagina stratified squamous, non K.
Interferes with TSG - inability to repair damaged protein and increased proliferation.
Give risk factors of cervical carcinoma?
Sexual intercourse
Early first marriage
Multiple births
Many partners
What is the aim of cervical screening? What is detected?
Detect pre-invasive lesion and excise area before tumour can develop.
Dyskaryotic cells (abnormal chromatin, enlarged nuclei)
What do cytological smears detect? What are the levels?
Cells scraped, stained and examined. (Dilute acetic acid white)
Cervical Intraepithelial Neoplasia (CIN) dysplasia of squamous cells within cervical epithelium. CIN I - regress spont. CIN 2 - superficial excision CIN III - superifical excision
Treatment before invasion is curative
Describe the screening programme.
25 -49 every 3 years
50-64 5 yearly
65+ not screened since 50/abnormality
Classify cervical cell carcinoma.
Squamous carcinoma
Also adenocarcinoma
Where do cervical carcinomas spread?
Local
Soft tissue, bladder ureter, rectum, vagina
Lymph
Iliac
Para-aortic
Then wider dissemination
What is the prognosis of cervical carcinoma dependent on?
How does it present?
How is it treated?
Depth of invasion and size of tumour
Stage and burden
Post-coital, intermenstrual, post-menopausal bleeding
Micro-invasice excision
Invasive
Hysterectomy,, raiation, chemo
What is endometrial hyperplasia? What is it associated with?
Precursor to endometrial carcinoma. Increased gland:stroma Associated with oestrogen: Anovulation Increased endogenous oestrogen (adipose) Exogensous oestrogen
Give the types of endometrial adenocarcinoma.
Endometrioid
Mimics proliferative glands
Unopposed oestrogen/obesity
Myometrial invasion and adjacent structures.
Serous
Poorly differentiated, worse prognosis
Travels through fallopian tubes - peritoneum
Risk factors for endometrial adenocarcinoma?
Obestiy, Early menarche
Late menopause
Few pregnancy.
Why are ovaries and fallopian tubes removed with hysterectomy?
Exclude the possibility of hormone producing tumour in ovaries and subsequent risk of neoplasia
Give 2 tumours of the myometrium
Fibroids
Leimyosarcoma
Descrie fibroids. Symptoms? Why do they regress after menopause?
Benign tumours of smooth muscles
Intermenstrual bleeding, pain, discharge.
Growth is oestrogen dependent so regress after menopause
Wel circumscribed firm and white
Describe lyomeiosarcoma.
Malignant fibroid Uncommon Increased mitotic activity Cellular atypia - pleomorphism Infiltrative growth Blood stream metastasis to lungs
Describe ovarian tumours. When do they produce symptoms? What are these?
Non-functional, produce symptoms when they become large and invade adjacent strucutres/metastasise: Abdo pain Distension Urinary/GI Menstrual disturbance Sex hormone
Where can ovarian tumours arise from?
Mullerian epithelium
Germ cells
SEx cord stroma
Metastases
