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Reproductive System > 24) Gynaecological Tumours > Flashcards

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
Q

When is leiomyosarcoma likely to present?

A

40-60

26
Q

Where does leiomyosarcoma commonly metastasise to?

A

Lungs

27
Q

When do ovarian tumours commonly present?

A

Benign: 20-45
Malignant: 45-65

28
Q

Generally, how do ovarian tumours present?

A

Abdominal pain, distension, urinary and GIT symptoms, ascites, intestinal obstruction

29
Q

What is the marker for ovarian tumours?

A

Serum CA-125

30
Q

How can ovarian tumours be classified?

A

Mullerian epithelium
Germ cells
Sex cord stromal cells
Metastasis

31
Q

What are the types of epithelial ovarian tumours?

A

Serous, mucinous or endometrioid

32
Q

What are the risk factors for developing epithelial ovarian tumours?

A

Nulliparity, OCP is protective, heritable mutations (BRCA), smoking, endometriosis

33
Q

Describe serous epithelial ovarian tumours:

A

Spread to peritoneal surfaces and omentum, associated with ascites

34
Q

Describe mucinous epithelial ovarian tumours:

A

Large, cystic mass with sticky fluid, often benign or borderline

35
Q

Describe endometrioid epithelial ovarian tumours:

A

With tubular glands like endometrium, can be due to endometriosis

36
Q

What is pseudomyoxma peritonei?

A

Originating from appendix, cancer cells that produce mucus and mucinous ascites. Often involves the ovaries and colon

37
Q

What are the types of germ cell ovarian tumours?

A

Mature, immature (malignant) and monodermal teratomas, non-gestational choriocarcinoma

38
Q

Describe a mature teratoma:

A

Contain hair, sebaceous material and sometimes teeth, often in young women

39
Q

What is struma ovarii?

A

Teratoma composed of thyroid tissue can cause hyperthyroidism

40
Q

What are some examples of sex cord-stromal tumours?

A

Sertoli-Leydig tumours, granulosa tumours, theca tumours

41
Q

What are the features of granulosa tumours?

A

Large amount of oestrogen produced so can cause endometrial and breast disease (mainly post-menopausal)
If in pre pubertal girls - precocious puberty

42
Q

What are the features of Sertoli-Leydig tumours?

A 
In children can block female development 
In adults (teens or 20s): breast atrophy, amenorrhoea, hirsutism, voice changes
43
Q

Where are metastasis to ovary commonly from?

A

Mullerian tumours: uterus, fallopian tubes, other ovary, peritoneum
GIT including colon, stomach, pancreas

44
Q

Describe the causes of vulval tumours:

A

HPV16, occur in 6th decade

Long standing inflammation and hyperplasia, occur in 8th decade

45
Q

Where do vulval tumours spread?

A

Inguinal, pelvic, iliac and para-aortic nodes

Lung and liver

46
Q

What is the treatment for vulval tumours?

A

Vulvectomy and lymphadenectomy

47
Q

Give examples of tumours of gestation:

A

Hydatidiform mole (complete or partial), invasive mole and choriocarcinoma

48
Q

What is hydatidiform mole?

A

Cystic swelling of chorionic villi and trophoblastic proliferation

49
Q

In what groups does hydatidiform mole commonly present?

A

Teens and 40-50

50
Q

What is gestational choriocarcinoma?

A

Malignant neoplasm of trophoblastic cells, associated with abortion and complete moles

51
Q

How does gestational choriocarcinoma present?

A

Vaginal spotting and high hCG levels

52
Q

How is gestational choriocarcinoma treated?

A

Uterine evacuation and responds well to chemo

53
Q

How is hydatidiform mole treated?

A

Curettage and hCG monitoring

Reproductive System (24 decks)

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