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24) Gynaecological Tumours Flashcards

1
Q

What is the main cause of cervical cancer?

A

High risk HPVs: HPV16, HPV18

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2
Q

Where does the HPV virus infect and what effects does it have?

A

Immature metaplastic squamous cells in transformation zone

Produces E6 and E7 proteins that interfere with TS genes

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3
Q

What is the transformation zone?

A

Area in cervix where there is metaplasia from glandular to squamous epithelium

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4
Q

What are some risk factors for cervical cancer?

A

Sex, long term OCP, low class, smoking, immunosuppression

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5
Q

Describe the screening procedure for cervical cancer:

A

Colposcopy to visualise cervix then scrap cells from TZ and stain. Can detect HPV DNA from cervical cells

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6
Q

Describe the screening programme for cervical cancer in the UK:

A

From 25 every 3 years until 50, then every 5 years from 50-65

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7
Q

What vaccine can be given to protect against cervical cancer? Who is it given to?

A

Gardasil to girls aged 12-13

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8
Q

What is cervical intraepithelial neoplasia?

A

Dysplasia of squamous cells in cervical epithelium, induced by HPV infection

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9
Q

How is CIN staged?

A

CIN I progressing to CIN II progressing to CIN III which can become invasive carcinoma

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10
Q

What is the treatment for CIN?

A

CIN I - cryotherapy

CIN II and III - superficial excision, removing TZ

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11
Q

What are the types of invasive cervical carcinoma?

A

Squamous cell carcinoma and adenocarcinoma

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12
Q

What is the average age of presentation with invasive cervical carcinoma?

A

45

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13
Q

Where is invasive cervical carcinoma likely to spread?

A

Cervical, pelvic and para-aortic nodes

Bladder, uterus , rectum and vagina

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14
Q

How is invasive cervical carcinoma treated?

A

Microinvasive - cervical cone excision

Invasive - hysterectomy, LN dissection (radio and chemo if advanced)

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15
Q

What is the typical presentation of invasive cervical carcinoma?

A

Screening abnormality or vaginal bleeding

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16
Q

What is the precursor to endometrial adenocarcinoma?

A

Endometrial hyperplasia

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17
Q

What are some causes of endometrial adenocarcinoma?

A

Prolonged oestrogen: anovulation, adipose causing oestrogen secretion (obesity) and exogenous oestrogen

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18
Q

How does endometrial adenocarcinoma present and at what ages?

A

Usually 55-75

Irregular or post-menopausal vaginal bleeding

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19
Q

What is the treatment for endometrial adenocarcinoma?

A

Hysterectomy

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20
Q

What are the types of endometrial adenocarcinoma?

A

Endometrioid, serous carcinoma

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21
Q

Describe endometrioid endometrial adenocarcinoma: (include where it spreads)

A

Mimics proliferative glands

Spread by myometrial invasion to cervix, bladder and rectum, local LNs and distant sites

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22
Q

Describe serous endometrial adenocarcinoma: (include where it spreads)

A

Poorly differentiated, exfoliates and travels through Fallopian tubes to peritoneal surfaces

23
Q

What are some tumours of the myometrium?

A

Leiomyoma (fibroids)

Leiomyosarcoma

24
Q

How does leiomyoma present?

A

Heavy/painful periods, urinary frequency, infertility (can be asymptomatic)

25
When is leiomyosarcoma likely to present?
40-60
26
Where does leiomyosarcoma commonly metastasise to?
Lungs
27
When do ovarian tumours commonly present?
Benign: 20-45 Malignant: 45-65
28
Generally, how do ovarian tumours present?
Abdominal pain, distension, urinary and GIT symptoms, ascites, intestinal obstruction
29
What is the marker for ovarian tumours?
Serum CA-125
30
How can ovarian tumours be classified?
Mullerian epithelium Germ cells Sex cord stromal cells Metastasis
31
What are the types of epithelial ovarian tumours?
Serous, mucinous or endometrioid
32
What are the risk factors for developing epithelial ovarian tumours?
Nulliparity, OCP is protective, heritable mutations (BRCA), smoking, endometriosis
33
Describe serous epithelial ovarian tumours:
Spread to peritoneal surfaces and omentum, associated with ascites
34
Describe mucinous epithelial ovarian tumours:
Large, cystic mass with sticky fluid, often benign or borderline
35
Describe endometrioid epithelial ovarian tumours:
With tubular glands like endometrium, can be due to endometriosis
36
What is pseudomyoxma peritonei?
Originating from appendix, cancer cells that produce mucus and mucinous ascites. Often involves the ovaries and colon
37
What are the types of germ cell ovarian tumours?
Mature, immature (malignant) and monodermal teratomas, non-gestational choriocarcinoma
38
Describe a mature teratoma:
Contain hair, sebaceous material and sometimes teeth, often in young women
39
What is struma ovarii?
Teratoma composed of thyroid tissue can cause hyperthyroidism
40
What are some examples of sex cord-stromal tumours?
Sertoli-Leydig tumours, granulosa tumours, theca tumours
41
What are the features of granulosa tumours?
Large amount of oestrogen produced so can cause endometrial and breast disease (mainly post-menopausal) If in pre pubertal girls - precocious puberty
42
What are the features of Sertoli-Leydig tumours?
``` In children can block female development In adults (teens or 20s): breast atrophy, amenorrhoea, hirsutism, voice changes ```
43
Where are metastasis to ovary commonly from?
Mullerian tumours: uterus, fallopian tubes, other ovary, peritoneum GIT including colon, stomach, pancreas
44
Describe the causes of vulval tumours:
HPV16, occur in 6th decade | Long standing inflammation and hyperplasia, occur in 8th decade
45
Where do vulval tumours spread?
Inguinal, pelvic, iliac and para-aortic nodes | Lung and liver
46
What is the treatment for vulval tumours?
Vulvectomy and lymphadenectomy
47
Give examples of tumours of gestation:
Hydatidiform mole (complete or partial), invasive mole and choriocarcinoma
48
What is hydatidiform mole?
Cystic swelling of chorionic villi and trophoblastic proliferation
49
In what groups does hydatidiform mole commonly present?
Teens and 40-50
50
What is gestational choriocarcinoma?
Malignant neoplasm of trophoblastic cells, associated with abortion and complete moles
51
How does gestational choriocarcinoma present?
Vaginal spotting and high hCG levels
52
How is gestational choriocarcinoma treated?
Uterine evacuation and responds well to chemo
53
How is hydatidiform mole treated?
Curettage and hCG monitoring

Reproductive System (24 decks)

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