Cancer Flashcards
Causes of abnormal uterine bleeding?
- endometritis
- polyp
- adenomyosis
- leiomyoma
- endometrial hyperplasia
What is endometrial hyperplasia? And what are the different types?
- increase in the number of cells in an organ or tissue
- simple
- complex
- atypical
Peak incidence for endometrial carcinoma?
- age 50-60yrs
What must you consider in endometrial carcinoma in the young?
- consider underlying predisposition
- PCOS
- Lynch syndrome
How is obesity linked to endometrial carcinoma?
- Adiopocytes -> increased oestrogen
- insulin action altered -> proliferation
2 main types of endometrial carcinoma?
- type 1 (endometroid carcinoma and mucinous)
- type 2 (serous carcinoma and clear cell)
Endometriod carcinoma precursor?
- atypical hyperplasia
Causes of endometrioid carcinoma?
- unopposed oestrogen excess
- obesity
- PTEN, KRAS mutation
- Lynch syndrome
Symptoms of endometrial carcinoma?
- abnormal bleeding
Typical spread of endometrial carcinoma?
- direction -> myometrium
- lymphatic
- vascular
What is Lynch syndrome and what are its risks?
- hereditary non-polyposis colorectal cancer syndrome
- risk: colorectal cancer, endometrial cancer
Explain type 2 endometrial cancer?
- serous carcinoma
- clear cell carcinoma
- not associated with oestrogen excess
- = TP53 mutation
Name 2 other endometrial carcinomas that aren’t type 1 or 2?
- endometrial stromal sarcoma
- carcinosacroma
Name a benign abnormality of the myometrium?
- leiomyoma
- aka. fibroids
Name a malignant smooth muscle tumour of the uterus?
- leiomyosarcoma
Methods of hysterectomy?
- open
- laparoscopic
- robotic
Benefits of minimal access surgery?
- lesser risk of bleeding and infection
- enchanted recovery
- reduced VTE risk
Fertility preserving cervical cancer treatments?
- LLETZ/Cone biopsy
- trachelectomy
Non-fertility sparing treatment of cervical cancer?
- hysterectomy
- radical hysterectomy
What is a radical hysterectomy?
- Hysterectomy + bilateral salpingo-oophorectomy +/- pelvic node dissection
What is the management of ovarian cancer?
- CT
- RMI score
- staging lapotomy
- radical debulking and pelvic clearance
What is radical debulking and pelvic clearance?
- hysterectomy + bilateral salpingo-oophorectomy + infracolic omentectomy
Treatment of vulval cancer?
- wide local excision
- 1cm free bargain
Commonest type of ovarian cyst?
- follicular
- seen in PCOS
- Thin walled, lined by granulosa cells
What is endometriosis?
- endometrial glands and stroma outside the uterine body
Risk of malignancy in endometriosis?
- endometrioid carcinoma
Commonest type of ovarian cancer?
- epithelial (adenocarcinoma: serous, mutinous, endometriosis/clear cell)
Endometrioid adenocarcinoma of the ovary is a associated with what condition?
- endometriosis
- Lynch syndrome
Types of ovarian tumours?
- epithelial
- germ cell
- sex cord
- metastatic
Explain a Brenner tumour?
- ovarian
- usually benign
- tumour of transitional type epithelium (bladder, urethra)
Epithelial tumours of the ovary can be classed as what?
- benign
- borderline
- malignant
Commonest germ cell tumour of the ovary and its presentation?
- mature teratoma
- sebum, hair, teeth
3 main types of sex-cord tumours in the ovary?
- fibroids
- granulosa cell
- sertoli-leydig
Granulosa tumours of the ovaries are seen with what?
- increased oestrogen
Sertoli-leydig cells of the ovary cause what?
- rare
- androgen production
What staging is used for ovarian cancers and describe the rough outline?
- FIGO staging
1 a = 1 ovary 1 b = both ovaries 1 c = ovary surface involvement 2 a = uterus or tubes involved 2 b = pelvic organ involvement 3 a = seeding outside true pelvis 3 b = gross outside pelvis = 2cm 3 c = gross outside pelvis > 2cm 4 = distant metastasis
What must be considered in bilateral ovarian cancer?
- metastatic origin?
Commonest site for an ectopic pregnancy?
- Fallopian tubes
What cell type is the ectocervix?
- stratified squamous epithelium
What cell type is the endocervix?
- single layer of glandular columnar epithelium
During a smear test what is sampled?
- exfoliating cells from the transformation zone, between endocervix and ectocervix
What is cervitis and its causes?
- irritation of the cervix
- chlamydia
- HSV
Risk factors for CIN?
- Persistence of high risk HPV
- Long term oral contraceptives
- smoking
- immunosuppression
Koilocytosis is what?
- virally infected cells on histology
- seen in Genital warts and CIN
Timeline for the development of CIN?
- 6mnths - 5yrs
Timeline for development of cervical cancer?
- 5-20yrs
Whirls of keratin on histology of the cervical transformation zone, indicates?
- cervical cancer
Cervical intraepithelial neoplasia is what?
- dysplasia at the transformation zone
How will CIN appear on microscopy?
- delay in maturation of cells
- increased nucleus:cytoplasm
- mitotic figures
How is CIN staged?
- CIN 1 = Less than 1/3
- CIN 2 = 2/3
- CIN 3 = full thickness (carcinoma in situ)
Majority of cervical cancers develop from what?
- pre-existing CIN
How are cervical cancers staged?
- FIGO
Commonest cell type for a cervical cancer?
- squamous cell
Symptoms of CIN
- Asymptomatic
Symptoms of cervical cancer
- abnormal bleeding
- pelvic pain
- haematuria
Precurosor of adenocarcinoma of the cervix?
- cervical glandular intraepithelial neoplasia (CGIN)
Background history with someone with vulval intraepithelial neoplasia?
- inflammatory dermatosis e.g. lichen sclerosis
- HPV
Vulva intraepithelial neoplasia may develop into?
- SCC
Lichen sclerosis has a risk of what?
- vulval scc
Symptoms of Vulval padgets disease?
- crusting rash
- painful
Name HPV driven neoplasia?
- cervical intraepithelial neoplasia
- cervical glandular intraepithelial neoplasia
- vulvar intraepithelial neoplasia
- vaginal intraepithelial neoplasia
- anal intraepithelial neoplasia
