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Y4: O&G > cOGText: Gynae Oncology > Flashcards

cOGText: Gynae Oncology Flashcards

1
Q

The female reproductive system lies within which two areas?

What components are contained within each area?

A
  • Pelvic cavity: ovaries, uterine tubes, uterus and superior part of the vagina
  • Perineum: inferior part of the vagina, perineal muscles, Bartholin’s glands, clitoris and labia
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2
Q
A

levator ani

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3
Q
  1. The uterus has which three layers?
  2. It is held in position by a number of strong ligaments, ____ fascia and the muscles of the pelvic floor (e.g. ___ ___).
  3. It also has a ____ ligament (maintains the uterus in its midline position) and a ____ ligament (is an embryological remnant).
  4. The uterus is usually positioned how?
A
  1. perimetrium, myometrium and endometrium
  2. endopelvic, lavator ani
  3. broad, round
  4. anteverted and anteflexed.
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4
Q
  1. The fallopian tubes extend on each side of the uterus, within the upper border of the ____ ligament.
  2. The tube can be divided into which 4 parts?
  3. The fimbriae open into the ____ cavity.
  4. The ovaries are almond shaped and are located laterally in the pelvic cavity. ____ is released into the peritoneal cavity to be received by the fimbriae of the uterine tube.
A
  1. broad
  2. isthmus, ampulla, infundibulum, and fimbriae
  3. peritoneal
  4. Ovum
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5
Q
  1. The cervix holds the walls of the vagina apart forming a ____
  2. The fornix is made up of which 4 parts?
A
  1. fornix
  2. anterior, posterior and two lateral sides
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6
Q
  1. Most uterine malignancies arise from the _____, the most common being ______.
  2. Endometrial cancer is the fourth most common malignancy in women in the UK, with 90% diagnoses occurring in what group of women?
A
  1. endometrium, adenocarcinomas
  2. post-menopausal
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7
Q

Uterine neoplasia

  1. Aetiology unknown but high levels of _____ are considered to increase the risk of developing an endometrial malignancy.
  2. Factors which may increase oestrogen levels in the body include …?
  3. T/F: therefore, the incidence of endometrial cancer is higher in women who have used the oral contraceptive pill
A
  1. oestrogen
  2. PCOS, late menopause, nulliparity, obesity, unopposed oestrogen HRT, tamoxifen, carbohydrate intolerance and oestrogen-secreting tumours (granulosa/theca cell ovarian tumours).
  3. false - is in fact lower
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8
Q

Common presenting symptoms of uterine neoplasia?

A
  • Abnormal uterine bleeding (main symptom of endometrial malignancy)
  • Vaginal discharge e.g. blood/watery/purulent (less common)
  • Pain (rare in early stage, may indicate metastases)
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9
Q

what sort of ‘Abnormal uterine bleeding’ may indicate endometrial malignancy?

A
  • Postmenopausal bleeding is malignancy until proven otherwise
  • Any irregular bleeding in premenopausal women over 40 should be investigated, especially if the patient has risk factors
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10
Q

T/F: Spread of endometrial cancer is usually direct

A

True - and can involve the myometrium, cervix, fallopian tubes, and local tissue.

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11
Q

What are the 4 main investigations for endometrial cancer? (inc. which is first line)

A
  • Trans vaginal ultrasound (usually first line) - measures endometrial thickness in postmenopausal women: smooth, regular endometrium with a thickness <4mm = endometrial malignancy unlikely
  • Endometrial biopsy - sample of tissue collected for histological analysis
  • Dilatation and curettage - carried out under GA, often combined with hysteroscopy: the cervix is dilated to allow a curette to scrape the endometrium which can then be sent for histological analysis
  • Hysteroscopy - allows visualization of the uterine cavity, enabling biopsy/curettage to be performed
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12
Q

Endometrial hyperplasia

  1. what ees eet
  2. Usually diagnosed how?
  3. It may occur due to persistent _____ stimulation
  4. Presents with abnormal _____
  5. Can be simple, complex or ____
  6. Simple hyperplasia without atypia is usually seen in what groups of women?
  7. Atypical hyperplasia can progress to endometrial _____
  8. ______ is a treatment used for hyperplasia in young women
  9. Due to its delivery of progesterone to the endometrium, which device is often a treatment used in premenopausal women
  10. In atypical hyperplasia, _____ is recommended
A
  1. Increased number of endometrial cells leading to a thick endometrium
  2. by biopsy: histologically there is an increase in the gland-to-stromal ratio
  3. oestrogen
  4. bleeding
  5. atypical
  6. anovulatory teenagers and perimenopausal women
  7. carcinoma
  8. Progestogens
  9. the Mirena intrauterine devic
  10. hysterectomy
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13
Q

Endometrial carcinoma

  1. Peak incidence ____ years
  2. Usually what kind?
  3. Macroscopic appearance?
  4. Variety of histological appearances - including?
  5. How does it spread?
    6.
A
  1. 50-60
  2. adenocarcinoma
  3. large uterus, polypoid
  4. Purely glandular, Areas of squamous differentiation, Papillary, Clear cell pattern
  5. Usually direct into the myometrium and cervix. Hematogenous or lymphatic spread can occur. Prognosis is related to stage
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14
Q

name the 2 types of endometrial cancer

which is more common?

A

Type I (Endometrioid) - most common (80%)

Type II (serous, and clear cell)

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15
Q

Endometrial cancer Type I (Endometrioid)

  1. most common (__%)
  2. usually diagnosed shortly after ____
  3. It is _____ dependent
  4. T/F: is often diagnosed at an early stage
  5. Precursor lesion?
  6. Associated with which mutations?
  7. Microsatellite instability – germline mutation of mismatch repair genes (____ syndrome)
A
  1. 80
  2. the menopause
  3. oestrogen
  4. true
  5. atypical hyperplasia
  6. PTEN, KRAS, PIK3CA
  7. Lynch
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16
Q

Endometrial cancer type II (serous, and clear cell)

  1. Usually observed in YOUNGER/ OLDER women and has a much BETTER/ POORER prognosis
  2. T/F: it is not associated with unopposed oestrogen
  3. Associated mutation?
  4. Precursor lesion?
  5. Spreads how?
  6. Histologically serous carcinoma is characterised by a complex ____ and/or _____ architecture with diffuse, marked nuclear pleomorphism
  7. T/F: usually requires more extensive surgery than Type 1
A
  1. older, poorer (as it is more aggressive and develops much more rapidly)
  2. true
  3. TP53
  4. serous endometrial intraepithelial carcinomas
  5. along fallopian tube mucosa and peritoneal surfaces so may present with extrauterine disease
  6. papillary, glandular
  7. true - and adjuvant chemo/radiotherapy is used more frequently
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17
Q

Endometrial sarcoma (rare)

  1. Arises from endometrial ____
  2. Risk of metastasis and prognosis?
  3. ____ is most important prognostic factor
A
  1. stroma
  2. Locally aggressive and metastasizes early. Initial presentation may be as metastasis (lung or ovary). Poor prognosis
  3. Stage
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18
Q

Carcinosarcoma (<5% of uterine malignancies)

  1. Mixed tumours with malignant ____ and ____ elements
  2. Presence of _____ component has the worst prognosis
  3. Poor outcome
A
  1. epithelial and stromal
  2. rhabdomyosarcomatous
19
Q

Prognostic factors for endometrial cancer?

A
  • Histological type
  • Histological differentiation
  • Stage of disease
  • Myometrial invasion
  • Peritoneal cytology
  • Lymph node metastasis
  • Adnexal metastasis
20
Q

T/F: Endometrial cancer often has a good prognosis as it is usually confined to the uterus at presentation

A

true

21
Q

which criteria is usually used for staging endometrial carcinoma?

A

FIGO (International Federation of Gynaecology and Obstetrics)

add a card on how to stage

22
Q

What kind of imaging will be performed prior to undergoing surgery - why?

A

Cross sectional imaging (usually MRI) - to investigate lymph nodes and the degree of involvement of local tissues.

23
Q

Endometrial tmours are graded based on their architecture

  1. Grade 1 =
  2. Grade 2 =
  3. Grade 3 =
A
  1. ≤ 5% solid growth
  2. 6-50% solid growth
  3. >50% solid growth
24
Q

Endometrial cancer: treatment

  1. Mainstay of treatment?
  2. ______ may be used as an adjuvant to prevent recurrence
  3. Radiotherapy or high dose ____ can also be used in patients who are not suitable for surgery
  4. In widespread disease, chemotherapy may be considered
A
  1. Surgical: Hysterectomy and bilateral salpingo-oophorectomy (usually laparoscopic). Ocasionally lymphadenectomy.
  2. Radiotherapy
  3. progestogens
25
Q

Endometrial cancer: recurrence

  1. T/F: Most patients have good prognosis and the cancer will not recur
  2. Commonest site of recurrence?
  3. ____ should be considered in isolated vault recurrence if it has not previously been received.
  4. Otherwise, hormonal therapy (high dose ____ to slow the disease) and chemotherapy should be the treatment of choice.
A
  1. true
  2. The vault of the vagina
  3. Radiotherapy
  4. progestogens
26
Q

Abnormalities of the myometrium

Name 2 smooth muscle tumours that can arise here and describe their presentation

*

A
  1. Leiomyoma (fibroid). Common. Menorrhagia and infertility
  2. Leiomyosarcoma. Rare. Most common uterine sarcoma. Women >50. Symptoms: abnormal vaginal bleeding, palpable pelvic mass and pelvic pain. Poor prognosis (15-25% 5 year survival)
27
Q

Ovarian neoplasms

  1. Typical age for ovarian cancer?
  2. precursor lesions?
  3. The most common type of primary ovarian tumours?
A
  1. Ovariausually older women, peak = 75
  2. none known
  3. epithelial tumours (arise from surface epithelium) - 70%
28
Q

Ovarian cancer

  1. main risk factor?
  2. what factors reduce the risk?
  3. Genetic predisposition in 5-10% of cases. One 1st degree relative diagnosed <50 = a 5% risk to patient. Two 1st degree relatives diagnosed <50, the risk is increased to __%
  4. HNPCC (Lynch syndrome): Predisposition to which cancers?
  5. ____ and ____ genes are associated with a 10-50% risk of developing ovarian cancer
  6. Women with these genes should attend regular screening and may be offered bilateral _____ once their family is complete (note that this operation will not prevent a primary peritoneal carcinoma).
  7. T/F: endometriosis may increase risk of developing an ovarian malignancy
A
  1. The number of times a women ovulates is the main risk factor
  2. parity, breast feeding and using the COCP (reduces the number of times a women ovulates). NB: The longer the COCP is used, the lower the risk.
  3. 25
  4. bowel, endometrial, ovarian + other cancer
  5. BRCA1 and BRCA2
  6. oophorectomy
  7. true
29
Q

Epithelial ovarian tumours

  1. can be grouped into which three classes?
  2. Borderline tumour definition?
  3. Most common ovarian cancer (50%)?
  4. Two distinct types of serous tumours (+ precursor lesions)?
  5. Serous tumours also make up 20% of benign ovarian tumours e.g.?
A
  1. benign, borderline, malignant (except serous tumours which are grouped into high grade and low grade).
  2. does not invade the stroma but does illustrate malignant characteristics. Prognosis is far better compared to malignant tumours, however, late recurrence can occur.
  3. serous tumours
  4. High grade serous carcinoma (serous tubal intraepithelial carcinoma (STIC), Low grade serous carcinoma (serous borderline tumour)
  5. cystadenomas – uniocular cysts filled with serous fluid
30
Q

Cervical neoplasia

  • Screening tool has succesfully reduced incidence and mortality
  • The introduction of which vaccine has decreased these numbers even further
A

the human papilloma virus

31
Q
  1. Name the preinvasive phase of squamous cervical cancer.
  2. Risk factors for CIN/cervical cancer?
  3. have often had more what compared to women who do not develop the disease?
  4. HPV __ and HPV __ have been linked with developing the disease.
  5. These strains of HPV may act by indirectly damaging the action of ___, increasing the risk of CIN/cervical cancer.
A
  1. Cervical intraepithelial neoplasia (CIN)
  2. multiple sexual partners, lack of barrier protection during sex, starting intercourse at a younger age, prolonged use of the COCP in HPV+ women, smoking
  3. 16 and 18
  4. p53
32
Q
  1. Name the preinvasive phase of endocervical adenocarcinoma.
  2. Effectiveness of screening compared to squamous
  3. Adenocarcinoma makes up 5-25% of cervical cancer. Prognosis compared to squamous carcinoma?
  4. Risk factors?
A
  1. Cervical glandular intraepithelial neoplasia (CGIN)
  2. It is harder to diagnose on a cervical smear, making screening less effective
  3. worse prognosis
  4. later onset of sexual activity, smoking, HPV (particularly HPV 18), higher SE class
33
Q

Cervical cancer: screening

  1. UK recommends women between the ages of __ - __ to attend smear tests.
  2. From ____ years a smear test should be attended every 3 years
  3. and from ____ years it reduces to every 5 years.
A
  1. 25-65
  2. 25-49
  3. 50-65
34
Q
  1. The endocervix is lined by ___ ___ whereas the ectocervix is lined by ___ ___
  2. Where these two areas meet is termed the ‘___ ___’.
  3. The position of the ‘transformation zone’ can alter during life in response to what events?.
  4. If part of the endocervix everts allowing the chemical environment of the proximal vagina to reach the columnar epithelium, transformation of columnar epithelium cells into ___ ___ cells can occur.
  5. This leave the cells in a less stable state. The ‘transformation zone’ is the area where this metaplasia has occurred, and is where ____ may develop. Therefore, this is the area which is targeted when taking a sample for cytology in a cervical smear.
A
  1. columnar epithelium; squamous epithelium
  2. transformation zone
  3. pregnancy, menarche and menopause
  4. squamous epithelium
  5. CIN
    6.
35
Q
  1. T/F: CIN is not visible to the naked eye on examination and women will be asymptomatic
  2. Abnormalities on cervical smear are classified by degree of ____, which is a cytological diagnosis.
  3. Dyskaryosis is a ____ diagnosis and is grouped into which 3 grades?
  4. CIN, however, is a ____ diagnosis and is grouped into which three grades?
  5. Histological grading is based on which three factors?
  6. Often ____ (indicates HPV infection) is also present.
  7. The degree of CIN often correlates with the degree of ____
A
  1. True - meaning CIN is only detected by cervical screening
  2. dyskaryosis
  3. cytological; severe, moderate and low grade
  4. histological; grade I, II and II
  5. Delay in maturation/differentiation, nuclear abnormalities and excess mitotic activity.
  6. koilocytosis
  7. dyskaryosis
36
Q
  1. CIN I definition?
  2. CIN II?
  3. CIN III?
A
  1. abnormal cells occupying a third of the basal epithelium
  2. abnormal cells extended to the middle third
  3. abnormal cells full thickness of epithelium
37
Q
  1. Overall around a __% of CIN cases will progress to the next degree classification, __% will show no changes, and __% will regress.
  2. T/F: cervical smears are also able to detect infection.
A
  1. 33, 33, 33
  2. true
38
Q

what is the recommended investigation in women who have significant dyskaryosis detected on cervical smear?

A

Colposcopy

39
Q
  1. When will a women be referred for colposcopy following a cervical smear?
  2. When is the woman returned to routine screening without referral?
A
  1. if the dyskaryosis is moderate or severe; if the dyskaryosis is mild but high risk HPV is detected
  2. mild dyskaryosis, HPV negative
40
Q

Colposcopy: allows the cervix to be examined in more detail through the use of a speculum and microscope.

  1. The _____ junction must be visualized.
  2. Abnormal epithelium contains more ____ and less ____ than normal epithelium, meaning that when ___ ___ is applied they appear white in colour and are easily identifiable.
A
  1. squamocolumnar
  2. protein, glycogen, acetic acid
41
Q

Treatment of CIN

  1. There is a __% risk that untreated CIN III will lead to invasive disease over 5-20 years
  2. High grade CIN (CIN II/III) needs what treatment?
A
  1. 30
  2. usually large loop excision of the transformational zone (LLETZ). Ablation is another treatment option.
42
Q

How does cervical cancer usually present?

A
  • blood: post-coital/ intermenstrual bleeding, menorrhagia
  • pain: pelvic pain
  • discharge: offensive vaginal discharge
  • Early cases may be asymptomatic
  • More advanced cases - backache, leg pain, haematuria, weight loss, anaemia, changes in bowel habit
43
Q
  1. 75-95% of cervical cancers originate from what tissue.
  2. A number of subtypes exist which include … (inc most common)
A
  1. squamous
  2. keratinizing (most common), large cell, non-keratinizing, small cell
44
Q
  1. how does cervical cancer spread?
  2. Invasion past the cervix usually involves which structures?
  3. The risk of lymph node mets is based on ____ of disease and tumour size.
  4. Lymphatic spread usually results in metastases to the ____ and ____ nodes.
A
  1. spreads to adjacent structures and via the draining lymphatics. Rarely metastasizes through the blood.
  2. parametrium, upper vagina, pelvic sidewall, bladder and rectum.
  3. stage
  4. pelvic, para-aortic

Y4: O&G (14 decks)

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