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3 REPRO > cancer > Flashcards

cancer Flashcards

1
Q

what is endometrial hyperplasia

A

an increase in the number of glands

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2
Q

what are the types of endometrial hyperplasia

A

simple
complex
(atypical)

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3
Q

what is an endometrial polyp made up of

A

stroma

glands

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4
Q

how does endometrial hyperplasia present

A

abnormal bleeding

  • dysfunctional uterine bleeding
  • post-menopausal bleeding
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5
Q

describe simple hyperplasia with regard to distribution, component, glands and cytology

A

distribution: general
component: glands and stroma
glands: dilated, not crowded
cytology: normal

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6
Q

describe complex hyperplasia with regard to distribution, component, glands and cytology

A

distribution: focal
component: glands
glands: crowded
cytology: normal

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7
Q

describe atypical hyperplasia with regard to distribution, component, glands and cytology

A

distribution: focal
component: glands
glands: crowded
cytology: atypical

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8
Q

what is the risk of atypical endometrial hyperplasia

A

progression to endometrial cancer

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9
Q

management of complex atypical hyperplasia

A

hysterectomy

high chance of existing/progression to cancer

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10
Q

when is peak incidence of endometrial carcinoma

A

50-60 years

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11
Q

what should you consider in women <40 presenting with endometrial cancer

A

underlying predisposition eg PCOS or Lynch syndrome

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12
Q

what is Lynch syndrome

A

hereditary nonpolyposis colorectal cancer

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13
Q

what is the precursor of endometrioid carcinoma

A

atypical hyperplasia

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14
Q

what is the precursor of serous carcinoma

A

serous intraepithelial carcinoma

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15
Q

what is the macroscopic appearance of endometrial carcinoma

A

large

polypoid

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16
Q

what is the microscopic diagnosis of endometrial carcinoma

A

most are well-differentiated adenocarcinomas

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17
Q

where does endometrial carcinoma spread

A

directly into myometrium and cervix
lymphatic
haematogenous

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18
Q

what is the most common type of endometrial carcinoma

A

endometrioid

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19
Q

which endometrial carcinoma is associated with unopposed oestrogen

A

endometrioid

not serous

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20
Q

why is obesity a risk for endometrial cancer

A

adipocytes express aromatase that converts ovarian androgens into oestrogens, which induce endometrial proliferation
lower levels of sex hormone-binding globulin so higher unbound, active oestrogen

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21
Q

what type of inheritance does Lynch syndrome display

A

autosomal dominant

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22
Q

microscopic characteristics of serous carcinoma

A

complex papillary and/or glandular architecture with diffuse, marked nuclear pleomorphism

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23
Q

which cancer might present early with extrauterine disease

A

serous carcinoma

spreads along the Fallopian tube mucosa and peritoneal surfaces

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24
Q

what is prognosis of endometrial carcinoma dependent on

A

stage
histological grade
depth of myometrial invasion

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25
Q

how to grade endometrioid carcinoma

A

grade 1 = 5% or less solid growth
grade 2 = 6-50% solid growth
grade 3 = >50% solid growth

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26
Q

stage I endometrial cancer

A 
IA = no or <50% myometrial invasion 
IB = invasion equal to of >50% of myometrium
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27
Q

stage II endometrial cancer

A

tumour invades cervical stroma

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28
Q

stage III endometrial cancer

A 
III = local and/or regional tumour spread
IIIA = tumour invades serosa of uterus and/or adnexae
IIIB = vaginal and/or parametrical involvement 
IIIC = metastases to pelvic and/or para-aortic lymph nodes
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29
Q

stage IV endometrial cancer

A 
IVA = tumour invades bladder and/or bowel mucosa 
IVB = distant metastases
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30
Q

common mets with endometrial stroll sarcoma

A

ovary or lung

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31
Q

common abnormality of the myometrium

A

leiomyoma (fibroid)

associated with menorrhagia and infertility

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32
Q

what are the layers of the normal ectocervix

A 
exfoliating cells 
superficial cells 
intermediate cells 
parabasal cels 
basal cells 
basement membrane
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33
Q

what is the transformation zone of the cervix

A

squamo-columnar junction between ectocervical (squamous) and endocervical (columnar) epithelia

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34
Q

when does the position of the transformation zone alter

A

menarche
pregnancy
menopause

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35
Q

what is cervical erosion

A

exposure of delicate endocervical epithelium to acid environment of vagina leads to physiological squamous metaplasia

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36
Q

what is a nabothian follicle

A

mucus-filled cyst on surface of the cervix

caused by stratified squamous epithelium of the ectocervix growing over the columnar epithelium of the endocervix

37
Q

examples of inflammatory pathology of the cervix

A 
cervicitis (diffuse)
cervical polyp (localised inflammatory growth)
38
Q

what are risk factors for CIN/cervical cancer

A 
high risk HPV viruses (16, 18, etc)
many sexual partners 
vulnerability of SC junction in early reproductive age (age at first intercourse, long term use of OC, non-use of barrier contraceptives)
smoking 
immunosuppression
39
Q

which types of HPV cause genital warts

A

6 and 11

40
Q

microscopic description of genital warts

A

thickened papillomatous squamous epithelium with cytoplasmic vacuolation (koilocytoss)

41
Q

which types of HPV are associated with CIN

A

16 and 18

42
Q

microscopic appearance of CIN

A

infected epithelium remains flat but may show koilocytosis

43
Q

how long does it take to progress from HPV infection to high grade CIN

A

6 months - 3 years

44
Q

how long does it take to progress from high grade CIN to invasive cancer

A

5-20 years

45
Q

how is CIN detected

A

cervical screening

46
Q

where does CIN occur

A

transformation zone

47
Q

what is koilocytosis indicative of

A

HPV infection

48
Q

what is CIN I

A

basal 1/3 of epithelium occupied by abnormal cells
raised number of mitotic figures in lower 1/3
surface cells are quite mature, but nuclei slightly abnormal

49
Q

what is CIN II

A

abnormal cells extend to middle 1/3
mitoses in middle 1/3
abnormal mitotic figures

50
Q

what is CIN III

A

abnormal cell occupy full thickness of epithelium

mitoses, often abnormal, in upper 1/3

51
Q

stage 1 of invasive cervical squamous carcinoma

A

stage 1A1 - depth up to 3 mm, width up to 7 mm
stage 1A2 - depth up to 5 mm, width up to 7 mm
stage 1B - confined to cervix

52
Q

stage 2 of invasive cervical squamous carcinoma

A

spread to adjacent organs (vagina, uterus etc)

53
Q

stage 3 of invasive cervical squamous carcinoma

A

involvement of pelvic wall

54
Q

stage 4 of invasive cervical squamous carcinoma

A

stage 4A - involvement of bladder or rectum

stage 4B - extra-pelvic involvement

55
Q

symptoms of invasive cervical carcinoma

A

abnormal bleeding (post-coital, post-menopausal, brownish or blood stained discharge, contact bleeding)
pelvic pain
haematuria/UTI
ureteric obstruction/renal failure

56
Q

what is classed as local spread of squamous cervical carcinoma

A

uterine body, vagina, bladder, ureters, rectum

57
Q

what is CGIN

A

cervical glandular intraepithelial neoplasia

58
Q

what is CGIN the precursor of

A

endocervical adenocarcinoma

59
Q

endocervical adenocarcinoma vs cervical squamous carcinoma; worse prognosis?

A

endocervical adenocarcinoma

60
Q

risk factors for cervical adenocarcinoma

A

higher socioeconomic class
later onset of sexual activity
smoking
HPV (18)

61
Q

where does vulvar invasive squamous carcinoma often spread

A

inguinal lymph nodes

important prognostic factor

62
Q

surgical treatment of vulvar invasive squamous carcinoma

A

radical vulvectomy and inguinal lymphadenectomy

63
Q

how does the presence of node involvement affect the prognosis of vulvar invasive squamous carcinoma

A

90% 5-year survival node negative

<60% 5 year survival node positive

64
Q

what is vulvar Paget’s disease

A

crusting rash affecting the vulva
tumour cells in epidermis contain mucin
mostly no underlying cancer, tumour arises from sweat gland in skin

65
Q

non-gynae causes of pelvic mass

A 
constipation
caecal carcinoma 
appendix abscess
diverticular abscess 
urinary retention 
retroperitoneal tumour
66
Q

causes of uterine mass

A

pregnancy
fibroids (most common)
endometrial cancer (usually present early so pelvic mass is unusual)
cervical cancer (pelvic mass = late presentation)

67
Q

what are leiomyomas

A

uterine fibroids

benign smooth muscle tumours

68
Q

presentation of uterine fibroids

A 
asymptomatic/incidental finding 
menorrhagia 
pelvic mass
pain/tenderness
'pressure' symptoms
69
Q

investigation of suspected fibroids

A

Hb if heavy bleeding
USS usually diagnostic
MRI for more precise localisation

70
Q

treatment of fibroids

A

expectant if asymptomatic
hysterectomy if no more children
(myomectomy, uterine artery embolisation, hysteroscopic resection)

71
Q

causes of tubal swellings

A

ectopic pregnancy
hydrosalpinx
pyosalpinx
paratubal cysts

72
Q

causes of ovarian mass

A

tumours/neoplastic
functional cysts
endometriotic cysts

73
Q

what are endometriotic cysts

A

blood filled cysts on ovaries associated with endometriosis

aka endometriomas/chocolate cysts

74
Q

symptoms of endometriotic cysts

A

severe dysmenorrhoea
premenstrual pain
dyspareunia
subfertility

75
Q

endometriotic cysts on examination

A

typically tender mass with nodularity and tenderness behind uterus

76
Q

primary ovarian tumours arising from surface epithelium

A 
serous 
mucinous 
endometrioid
clear cell
brenner 
benign = cystadenoma
malignant = cystuadenocarcinoma
77
Q

primary ovarian tumours arising from germ cells

A

benign cystic teratoma

malignant germ cell tumours (v rare)

78
Q

what might tumours arising from the stroma secrete

A

granulosa cell - oestrogens

theca/leydig cell - androgens

79
Q

what is meig’s syndrome

A

benign fibroma with pleural effusion

80
Q

where do secondary ovarian tumours often metastasise from

A

breast
pancreas
stomach
GI

81
Q

presentation of ovarian cancer

A 
mass
swelling 
pressure symptoms
heartburn/indigestion
early satiety 
weight loss/anorexia 
bloating 
bowel habits 
SIB/pleural effusion 
leg oedema/DVT
82
Q

genetic causes of ovarian cancer

A

BRCA 1 and 2
- breast and ovarian ca
HNPCC (Lynch syndrome)
- bowel, endometrial, ovarian

83
Q

risk factors for ovarian cancer

A

increasing age
nulliparity
FHx
(OCP protective)

84
Q

investigation of suspected ovarian Ca

A 
tumour markers (CA 125, Cancino-Embryonic Antigen (CEA))
USS to determine nature of cyst
CT to assess extra-ovarian disease
85
Q

in what other situations might CA 125 be raised

A 
endometriosis 
peritonitis/infection 
pregnancy 
pancreatitis 
ascites from any cause
other malignancy
86
Q

what its he main function of CEA

A

exclude mets from GI primary

87
Q

treatment of ovarian cyst/mass

A

removal/drainage if benign
removal of ovaries and uterus with removal/biopsy of omentum, debunking of tumour and complete examination of all peritoneal surfaces
chemo pre/post surgery

88
Q

is treatment of ovarian ca curative

A

unlikely unless confined to ovary at presentation

89
Q

history of pelvic mass

A 
speed of onset/duration of all Sx
mass/swelling/bloatedness 
pressure symptoms (bladder/bowel)
pain
menstrual Hx
cervical smear Hx
parity and fertility 
FHx
previous gynae and surgical Hx
ovarian Ca symptoms

3 REPRO (40 decks)

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