Clinical- Week 6 Flashcards
1
Q
compare the characteristics of the glands in simple, complex and atypical endometrial hyperplasia?
A
simple- dilated glands
complex- crowded glands
atypical- crowded glands
2
Q
what type of carcinomas are most endometrial carcinomas?
A
well differentiated adenocarcinomas
3
Q
why do folliular cysts occur?
A
due to ovulation not occuring
4
Q
what are the types of cervical intraepithelial neoplasia?
A
CIN 1, 2, 3
3 being the worst
5
Q
what are the disadvantages of cyst aspiration for ovarian cysts?
A
- will recur
- if it turns out to be malignant, you are spilling it out into the peritoneal cavity
6
Q
compare the distribution of simple, complex and atypical endometrial hyperplasia?
A
simple- general
complex- focal
atypical- focal
7
Q
which area of the cervix is most vulnerable to HPV infection and therefore cervical cancer?
A
transformation zone (squamocolumnar junction)
8
Q
when is fibroid degeneration seen?
A
pregnancy, peri-menopause
9
Q
are uterine fibroids more common in pre or post menopausal women?
A
premenopausal
10
Q
where do endometrial stromal sarcomas originate from?
A
endometrial stroma
11
Q
what are the 7 main risk factors for endometrial cancer?
A
-age
-obesity/diabetes
-high -oestrogen/endometral hyperplasia
-PCOS
-nulliparity
lynch syndrome/HNPCC
-tamoxifen
12
Q
why might you not be able to use oestrogens for atrophic vaginitis?
A
pre-existing/previous breast cancer
13
Q
what is the treatment for vulval lichen sclerosus?
A
- steroid ointment
2. tacrolimus
14
Q
what is the treatment for choriocarcinoma?
A
chemotherapy- often 100% cure
15
Q
what are the 4 tumours which tend to metastasise to the ovaries?
A
breast, stomach, pancreas, colon
16
Q
which type of mole (complete or partial) is more likely to develop into a choriocarcinoma?
A
complete
17
Q
for pelvic masses, which is preferred- CT/US guided tissue biopsy or aspiration for cytolody?
A
CT/US guided tissue biopsy
18
Q
what is the average age for a dysgerminoma?
A
22
19
Q
how do endometrial hyperplasias present?
A
abnormal bleeding
DUB or PMB
20
Q
what happens to the levels of sex hormone binding globulin and insulin binding globulin in obese women?
A
reduces level of binding globulins (increased active hormone)
21
Q
what are the 6 main physical symptoms of menopause?
A
hot flushes night sweats insomnia palpitations joint aches headaches
22
Q
what mutation is found commonly in type 2 endometrial carcinomas (serous)?
A
TP53 mutation and overexpression
23
Q
which endometrial carcinoma is related to unopposed oestrogen?
A
type 1 endometrioid tumours
24
Q
if a primary ovarian tumour contains granulosa cells, what hormones may be secreted?
what may this cause?
A
oestrogens
-precocious puberty, PMB
25
what are the 2 groups of functional ovarian cysts?
follicular cysts
| luteal cysts
26
what does aromatase (found in adipocytes) do to ovarian androgens? how does this link obesity to endometrial cancer
converts them to oestrogens which induce endometrial proliferation
27
what cells are follicular cells lined with?
granulosa cells
28
what cancer risk is increased in endometriosis?
endometrial carcinoma
29
how are epithelial ovarian tumours classified?
benign
borderline
malignant
[except serous carcinoma- high grade or low grade]
30
what are the 3 layers of the uterus?
endometrium
myometrium
peritoneum
31
what are the 5 main psychologial symptoms of menopause?
```
mood swings
irritability
anxiety
difficulty concentrating
forgetfulness
```
32
when do endometrial polyps most commonly occur?
around/after menopause
33
how do ovarian tumours tend to present?
non-specific
| bloating, abdominal distension
34
what is the very top area of the uterus called?
fundus
35
what are the treatment options for ovarian cysts?
- conservative
- cyst aspiration
- cystectomy
- oophrectomy
36
what is salpingitis?
inflammation of the fallopian tube (usually due to infection)
37
what are the 2 main grous of endometrial carcinoma?
type 1- endometrioid carcinoma
| type 2- serous carcinoma
38
what 3 cancers do people with lynch syndrome have an increased risk of?
colorectal cancer
endometrial cancer
ovarian cancer
39
what is the treatment of atrophic vaginitis?
topical oestrogen therapy
| lubricants
40
what is the treatment of a functional ovarian cyst?
usually resolve spontaneously
41
what classifies as late menopause?
menopause after 54 years old
42
what is the area of the uterus where the fallopian tubes insert?
the cornu
43
what is a paratubal cyst?
a small, close fluid filled sac near the fallopian tube/ovary (embryological remnants)
44
what is the main function of CEA tumour marker?
used to exclude the cause of ovarian cancer to be secondary mets from GI primary
45
where do most ovarian tumours arise from?
epithelium
| ie serous- looks like fallopian tube epithelium, endometrioid- endometrium, mucinous- cervical epithelium
46
what is brachytherapy?
cancer treatment- place radioactive source beside tumour (reduces exposure to surrounding tissues)
47
why should large ovarian cysts be operated on?
because of the complications:
rupture or torsion
-needing emergency surgery
48
what tumour markers are often present in ovarian cancer?
```
CA 125
carcino-embryonic antigen (CEA)
[HCG
AFP
if below 40]
```
49
compare the cytology of simple, complex and atypical endometrial hyperplasia?
simple- normal
complex- normal
atypical- atypical
50
how long does a hot flush period usually last?
3-5 minutes
51
why does the OCP decrease risk of ovarian cancer?
due to prevention of ovulation (which causes trauma(
52
compare the components involved in simple, complex and atypical endometrial hyperplasia?
simple- glands and stroma
complex- glands
atypical- glands
53
what type of benign ovarian tumour has a whole variety of different materials in them? (ie teeth, bones etc)
teratoma
54
how do patients with complete or partial moles present?
pregnancy with large for dates
55
how do uterine tumours (or fibroids) tend to present?
```
abnormal bleeding
infertility
menhorragia
pelvic mass
pain/tenderness
```
56
in addition to US what investigation may you also do for suspected ovarian cancer?
CT
57
what infiltrate of immune cells are present in endometriosis due to the need to phagocyte haemosiderin?
macrophages
58
what is the precursor for serous sendometrial carcinoma?
serous intraepithelial carcinoma
59
what is the treatment for asymptomatic fibroids?
no treatment
60
what type of cancers are automatically screened for the BRCA gene? (in terms of type of cancer, not location)
serous epithelial cancers
61
what is the triad of meig's syndrome?
ascites
pleural effusion
primary benign ovarian tumour (eg fibroma)
62
what drugs can be used in the chemotherapy treatment of cervical cancer?
cisplatin
| carboplatin/paclitaxel
63
women with BRCA1 or 2 genes should be offered what surgical treatment prophylactially?
salpingo-oophrectomy
64
what is the precursor to cervical squamous carcinoma?
cervical intraepithelial neoplasia
65
describe the HCG levels of a patient with a molar pregnancy compared to a viable pregnancy?
HCG levels in molar pregnancy are much higher
66
what type of inheritance is lynch syndrome?
autosomal dominant
67
what are 'chocolate cysts' on the ovaries caused by?
endometriosis (endometriomas)
68
how do you calculate the risk of malignancy index for ovarian cancer?
menopausal status x serum Ca125 x US score
69
what is the average age of menopause?
51 years old
70
in PCOS, what type of cysts are formed in the ovaries?
follicular cysts
71
deep dyspareunia in a patient with endometriosis indicates what?
endometriosis within pouch of douglas
72
what are the 3 types of endometrial hyperplasia?
simple
complex
atypical (precursor of carcinoma)
73
what is an ovarian dermoid cyst?
a benign cystic teratoma of the ovary (arises from germ cells)
74
describe complete, optimal and suboptimal debulking of a tumour?
complete- no tumour left
optimal- less than 1cm left
suboptimal- more than 1cm left
75
what is the gold standard investigation for ovarian cancer?
CT guided biopsy
76
why can ovarian cancer cause shortness of breath?
due to pleural effusion
77
what are the 7 main risk factors for ovarian cancer?
- nulliparity
- higher social class
- early menarche and late menopause
- BRCA (esp type 1) gene
- endometriosis
- obesity
- IUD
78
what is the diagnostic investigation for suspected fibroids?
US
| MRI if you need precise location
79
what is cachexia?
wasting of the body due to serious chronic illness
80
what defines a malignant epithelial ovarian tumour?
stromal invasion
81
where is the most common metastatic spread from endometrial stromal sarcoma?
ovary and lung
82
what is atrophic vaginitis?
thinning of the tissues and decreased lubrication due to lack of oestrogen
83
has BRCA 1 or 2 got a higher risk of ovarian cancer?
BRCA 1
84
what pigment tends to be present in endometriosis?
haemosiderin
85
what is the commonest uterine mass?
uterine fibroids
86
in addition to US what investigation may you also do for suspected uterine mass?
MRI
87
what is the treatment for menorrhagia due to a fibroid smaller than 3cm?
1. IUS
2. hormonal treatment (eg COCP)
3. ullipristal acetate
88
what is the treatment of red degeneration of a uterine fibroid?
strong painkillers
| -should settle on itsown
89
what are the 2 types of uterine muscle wall tumours?
leiomyoma (uterine fibroids)
| leiomyosarcoma
90
what does an ovarian cancer look like on ultrasound? (3 points)
- complex cyst (some cystic and solid areas)
- increased vascularity
- papillary projections
91
what is the treatment for menorrhagia due to a fibroid greater than 3cm?
1. myomecomy
| 2. uterine artey embolisation
92
stopping which two forms of hormonal contraception can cause a period of time with raised FSH and LH?
combined OCP
| depot
93
what is the histology of most cervical carcinomas?
squamous carcinoma
94
what is the name of ovarian cancer staging?
FIGO staging
95
what is the surface of the ovaries covered with?
germinal epithelium (single layer of cuboidal cells)
96
what is pyosalpinx?
a fallopian tube filled with pus
97
if a primary ovarian tumour contains theca/leydig cells, what hormones may be secreted?
androgens
| -hirsuitism, virilisation
98
what is the chance that PMB is caused by endometrial cancer?
10%
99
on average, how long do menopausal women get hot flushes for?
2 years
100
is a fetus more likely to develop in a partial or complete mole?
partial
| no maternal DNA in complete
101
which is more common- endometriod carcinoma or serous carcinoma?
endometriod carcinoma
102
how do endometrial carcinomas generally present?
abnormal bleeding (PMB or irregular bleeding)
103
what is the treatment for endometrial carcinomas?
hysterectomy with bilateral salpingoophrectomy
| chemo/radiotherapy
104
what happens to the tunica aluginea as age increases?
density decreases
105
what is the most common malignant primitive germ cell tumour of the ovaries?
dysgerminoma
106
what classifies as early menopause?
menopause before 45 years old
107
what is the other term for Lynch syndrome?
Hereditary non-polyposis colorectal cancer (HNPCC)
108
what are the 4 highest risk HPV type?
16, 18, 31, 33
109
what ligament attaches the ovary laterally?
suspensory ligament
110
compare neoadjuvant treatment to adjuvant treatment?
neoadjuvant treatment given before the main treatment
111
what is the precursor for endometrioid carcinoma?
atypical endometrial hyperplasia
112
what is the upper part of the uterus called?
the corpus
113
do women with endometrial cancer tend to present premenopausally or postmenopausally?
post- menopause
114
what ligament attaches to the ovary to the uterus?
ovarian ligament
115
what is the most common site of an ectopic pregnancy?
fallopian tube
116
what is endometriosis?
endometrial glands and stroma outside the uterine body
117
what cells in the ovaries secrete oestrogens?
granulosa cells
118
what is the main advantage of cyst aspiration for ovarian cyst?
doesnt need general anaesthetic
119
what is a hydrosalpinx?
a distally blocked fallopian tube with serous or clear fluid
120
what is tamoxifen?
a selective oestrogen receptor modulator used in breast cancer (blocks oestrogen reeptors)
121
what is the presentation of red degeneration of a uterine fibroid?
severe lower abdominal pain
122
what is the treatment of uterine fibroids?
myomectomy
uterine artery embolisation
hysteroscopic resection
hysterectomy
123
what is red degeneration of a uterine fibroid?
a rare complication during pregnancy- haemorrhage in the centre of the fibroid due to fibroid outgrowing its blood supply
124
what is the threshold risk or malignancy index for ovarian cancer?
greater than 200
125
how do patients with endometriosis present?
pelvic pain
infertility
dysmenorrhoea
dyspareunia
126
what investigation should all women who present with PMB have?
transvaginal US
