Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproduction > Gynaecological Cancers > Flashcards

Gynaecological Cancers Flashcards

1
Q

What does cervical screening look for

A

It is now a primary HPV screen
All samples are first tested for hrHPV
If no HPV is found no cytology is needed and women are recalled for screening in 3-5 years
If HPV is found ‘reflex’ cytology is done ( on the same sample)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the symptoms of cervical cancer

A

Unusual vaginal discharge or bleeding
Inc. bleeding after sex/between periods
Dyspareunia
In early stages it is asymptomatic and therefore picked up by screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What ages are offered cervical screening

A

Women aged 25 – 64 years old
Every 3 years, 25 - 49 years
Every 5 years, 50 – 64 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where do you take the smear sample from

A

The transformation zone of the cervix - most likely to be abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most common cause of cervical cancer

A

HPV
Types 16 and 18 are the highest risks - cause around 70% of cases

Types 6, 11 and others can lead to low grade abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which gynae cancers does obesity increase the risk of

A

Womb and Ovarian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does endometrial hyperplasia present

A

Abnormal bleeding - either dysfunctional or post-menopausal
Can be simple, complex or pre-cancerous
Often benign but must always be investigated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What type of hyperplasia are most endometrial cancers

A

Usually complex with disordered nuclei - precursor lesion

The glands become fused

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe simple endometrial hyperplasia

A

General distribution
Made up of glands and stroma
Glands are dilated and have irregular shape but not crowded
Normal cytology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe complex endometrial hyperplasia

A

Focal distribution
Made up of glands
Glands are crowded (not much stroma between them)
Normal cytology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe atypical endometrial hyperplasia

A 
Focal distribution 
Made up of glands 
Glands are crowded 
Atypical cytology 
This is the stage just before cancer - very high risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which age group typically gets endometrial carcinoma

A

Peak incidence 50-60

Uncommon in women under 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which gynae conditions can predispose to endometrial cancer

A

Polycystic ovary syndrome and Lynch syndrome

This increases the risk in younger women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the two main types of endometrial carcinoma

A

Endometrioid carcinoma
Related to unopposed oestrogen

Serous carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does endometrial carcinoma spread

A

Directly into myometrium and cervix
Lymphatic
Haematogenous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do you investigate endometrial carcinoma

A

Do a pipelle or a hysteroscopy

If high grade you can then do a scan to assess for spread

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which type of carcinoma is Lynch syndrome associated with

A

Endometrioid carcinoma - type 1

Due to germline mutation of mismatch repair genes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why does obesity increase risk of endometrial cancer

A

Adipose tissue can convert ovarian androgens into oestrogens
Oestrogen drives the endometrial proliferation
The more fat cells you have the more oestrogen you have

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does being post-menopausal affect oestrogen driven proliferation

A

In post menopausal women there is no progesterone release to stop the proliferation – just constant oestrogen stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is Lynch Syndrome

A

It is a genetic disorder caused by a defective DNA mismatch repair gene
Autosomal dominant
It is a cancer predisposition syndrome - high risk of colorectal, endometrial and increases chance of ovarian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What annual tests are offered to those with Lynch syndrome

A

Endometrial pipelles every year to check for cancer

Annual colonoscopies to look for colorectal cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How can you tell if a tumour is caused by Lynch syndrome

A

Immunohistochemistry staining of the tumour for mismatch repair proteins
They also show microsatellite instability
This can help diagnose the syndrome and lead to genetic counselling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which type of endometrial cancer is more aggressive

A

Type II
Serous and clear cell type
Spreads to the peritoneum quickly which makes it harder to treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does serous endometrial cancer spread

A

Spreads along fallopian tube mucosa and peritoneal surfaces

Can present with extrauterine disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the characteristics of serous endometrial carcinoma

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How do you grade endometrioid carcinoma by architecture

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How do you grade serous carcinoma

A

not formally graded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How do you grade endometrial cancer by spread

A

Stage I = Tumour confined to the uterus
II = Tumour invades cervical stroma
III = local and/or regional tumour spread
IV = Tumour invades bladder and or bowel mucosa (IVA) and/or distant metastases (IVB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Describe endometrial stromal sarcoma

A

It is rare
Cells resemble endometrial stroma
Infiltrate myometrium and often lymphovascular spaces
Typically presents with abnormal uterine bleeding but initial presentation may be as metastasis (most commonly ovary or lung)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Which tumours can affect the myometrium

A

Leiomyoma (fibroid) - very common
May not cause issue if small but may cause menorrhagia, infertility if large

Leiomyosarcoma (rare) - the malignant version

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How do fibroids cause bleeding

A

If it lies right below the endometrium it can stretch it and lead to bleeding
Also harder for embryo to implant properly so can affect fertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How does a uterine leiomyosarcoma usually present

A

Most occur in women >50 years

Commonest symptoms abnormal vaginal bleeding, palpable pelvic mass and pelvic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the typical symptoms of ovarian pathology

A

Pain
Swelling
Endocrine effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Are you more concerned about solid or cystic ovarian tumours

A

Solid is more worrying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the different classifications of ovarian tumours

A

Epithelial

  • Serous- most common
  • Mucinous
  • Endometroid
  • Clear cell
  • Germ cell
  • Urothelial-like tumour - Brenner

Sex‐cord/stromal

  • Granulosa cell
  • Thecoma/Fibroma
  • Sertoli/Leydig

Germ

  • Teratoma
  • Dysgerminoma
  • Endodermal sinus or yolk sac tumour

Metastatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How are epithelial ovarian tumours catergorised

A

Benign = No cytological abnormalities, proliferative activity absent or scant and no stromal invasion

Borderline = cytological abnormalities, proliferative but no stromal invasion

Malignant -stromal invasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Describe a high grade serous carcinoma of the ovary

A

Most cases originate from the fallopian tube as a serous tubal intraepithelial carcinoma
It is more common than the low grade version
Can spread to peritoneum if cells from the tubes reach it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Describe a low grade serous carcinoma of the ovary

A

Serous borderline tumour is the precursor lesion
Less common than high grade
It is much less aggressive and managed with surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Which type of ovarian tumour is commonly seen with the BRCA mutation

A

High grade serous carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What conditions are associated with endometroid and clear cell ovarian carcinomas

A

Endometriosis of the ovary
Lynch syndrome

has a good prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How is ovarian cancer usually diagnosed

A

Often presents with ascites so can diagnosed by taking a sample of the cells from the fluid
Combined with a high CA125 (blood test) - raised in 80% of cases
Urgent pelvic ultrasound
Gold standard is a CT guided biopsy
CXR/CT chest can be used to identify any pleural effusion or chest disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How does an ovarian serous neoplasia appear

A

Benign: multicystic mass (thin serous watery fluid if pop them, no solid elements)

Borderline tumours will develop papillary structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Are most ovarian germ cell tumours benign or malignant

A

Vast majority are benign - very rare for them to become malignant
Also called a dermoid cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What cell types can be found in an mature ovarian tertatoma

A

They are cystic, containing sebum and hair
Can also contain skin, respiratory epithelium, gut, fat common
Contains elements from ectoderm, mesoderm and endoderm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the different types of ovarian germ cell tumours

A 
Mature teratoma - dermoid cyst 
Immature teratoma - rare
Dysgerminoma - most common malignant one
Yolk sac tumour
Choriocarcinoma
Mixed germ cell tumour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the most common malignant germ cell tumour of the ovaries

A

Dysgerminoma,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Describe an ovarian fibroma

A

Type of sex cord/stromal tumour
Made up of fibroid tissue and theca cells
It is usually benign
May produce oestrogen causing uterine bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Describe ovarian granulosa cell tumours

A

Type of sex cord/stromal tumour
All are potentially malignant
Can produce lots of oestrogen (have thickened endometrium and abdnormal/post menopausal bleeding)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Which cancers are the most common causes of mets in the ovaries

A 
Stomach
Colon
Breast
Endometrium 
Pancreas

If ovarian tumours are bilateral and small then you should consider mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How can you stage ovarian cancer by spread

A

I- confined to 1 or both ovaries

II-spread to other pelvic organs eg uterus, fallopian tubes

III- spread beyond the pelvis within the abdomen

IV- spread into other organs eg liver, lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How does ovarian cancer present

A 
May be mass, swelling, pressure symptoms 
Malignant ascites - peritoneal spread 
Heartburn/indigestion
Early satiety
Weight loss/anorexia.
Bloating 
Change of bowel habit
SOB/ Pleural effusion
Leg oedema  or DVT
Very variable and non-specific
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What can lead to a raised CA125

A 
Ovarian cancer - 80% of cases 
Endometriosis
Peritonitis/infection
pregnancy
Pancreatitis
Ascites
Other cancers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

If CA125 is normal does it exclude cancer

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How can you treat germ cell ovarian tumours

A

Fertility sparing if needed - common in younger women

Then salpingoopherectomy +/- chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

How do you treat ovarian cancers (non-germ cell)

A

Chemo and Surgery
Surgery is usually in the form of debulking which is the process where tumour
deposits are removed as much as possible
Chemo used adjuvantly or first line in those unfit for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are the risk factors for cervical cancer

A 
HPV 
Smoking
Age of onset of intercourse
“High Risk” male
OCP - long term use 
Multiple partners
Immunosuppression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

How does cervical cancer present

A

Often asymptomatic and picked up on screening
Some women present with abnormal bleeding - post coital/menopausal
Pelvic pain
Haematuria / urinary infections
Some present with acute renal failure – will go to doctor feeling very acutely unwell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

How do you stage cervical cancer

A 
Stage 1a – microscopic
Stage 1b - visible lesion
Stage 2 a – vaginal involvement
2b -  parametrial involvement
Stage 3 - lower vagina or pelvic sidewall involved
Stage 4 - bladder/rectum or metastases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

How do you treat cervical cancer

A

Surgery - removal of the transition zone (early stage)
For further stage disease you would need a hysterectomy
Use combination of chemo and radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How is radiotherapy delivered in cervical cancer

A

Targeted to include tumour +/- nodes
Give fractions of the dose over several days – gives normal cells time to start repairing
Brachytherapy – give a very high dose to the cervix and use packing to push the bladder and rectum away from the source (internal treatment)

61
Q

How can you mark the tumour location for delivering treatment

A

Can place gold marker seeds into the tumour to mark the edges
Planning CT is done in the same position as they will receive the treatment in
They are given pinpoint tattoos to mark out the targets so that it can be accurately found each day

62
Q

What is neoadjuvant chemotherapy

A

Given before the definitive treatment to try and shrink the tumour

63
Q

What is concomitant chemotherapy

A

Given alongside radiotherapy and sensitises the tumour

64
Q

Which drugs are used in the treatment of ovarian cancer

A

Cisplatin

Carboplatin/paclitaxol

65
Q

What is the mainstay of endometrial cancer treatment

A

Surgery - total hysterectomy and potentially salpingoopherectomy
Only use chemo/radio if the patient is inoperable
Also used adjuvantly

66
Q

What can cause endometrial cancer

A

Obesity
Oestrogens – HRT, Tamoxifen
Genetic - HNPCC

67
Q

WHat is the most common site of recurrence of endometrial cancer post-hysterectomy

A

The top of the vaginal vault

Therefore this area is often directly treated with radiotherapy

68
Q

Who is most at risk of ovarian cancer

A 
Women over 50 
Nullparity or low parity 
Delayed pregnancy 
Family history of breast or ovarian cancer
BRCA
69
Q

is it useful to screen everyone for ovarian cancer

A

No evidence that screening the general population is useful
Only screen those at high risk (FH or BRCA)
Can have an oophorectomy to reduce risk

70
Q

What test should be offered to women with a high RMI

A

CT of the abdomen and pelvis

71
Q

How does ovarian cancer spread

A

Peritoneal seeding within pelvis → abdominal cavity
Common for it to spread to omentum and even the underside of the diaphragm
para-aortic node metastases are a fairly common finding
Haematogenous spread → liver, lungs, brain

72
Q

What are the symptom burdens of gynae cancer

A 
Pain
Nausea/ vomiting 
Constipation 
Bleeding  
Treatment related side effects 
Altered body image 
Fertility issues 
Worry and fear
73
Q

Which drugs can be used to treat vomiting triggered by the GI tract

A

Metoclopramide, Levomepromazine, Ondansetron, Dexamethasone

74
Q

Which drugs can be used to treat vomiting triggered by the chemoreceptors

A

Haloperidol, Levomepromazine, Ondansetron

75
Q

Which drugs can be used to treat vomiting triggered by motion (vestibular system)

A

Cyclizine, Levomepromazine, Hyoscine

76
Q

Which drugs can be used to treat vomiting triggered by the cerebral cortex (emotions, smell etc)

A

Dexamethasone, Aprepitant, Benzodiazepines

77
Q

How can cancer cause nausea and vomiting

A 
Compression / irritation by tumour = raised ICP
Anxiety
Chemotherapy/Radiotherapy Induced 
Impaired gastric emptying 
Metabolic disturbance
78
Q

How can you manage cancer induced N&V

A 
Trial anti-emetics 
Small meals 
Keep bowels moving 
Calm environments 
Acupressure bands
79
Q

What is a malignant bowel obstruction

A

Clinical evidence of bowel obstruction in the setting of a diagnosis of intra-abdominal cancer
Occurs with abdominal cancers – either primary or spread from another place (most commonly ovarian)

80
Q

How does a malignant bowel obstruction present

A 
Nausea
Vomiting
Pain - Continuous or Colicky		
Anorexia/thirst
Systemic symptoms from underlying cancer
Reduced then absent bowel motions/flatus
Paradoxical diarrhoea - as will still have secretions from below obstruction 
Gradual onset
81
Q

How do you manage malignant bowel obstructions

A

If they have obstruction in one area you can treat them surgically and cut out the offending area and reconnect
Advances cancer not suitable for this
Manage these cases medically – break the secretion/distention cycle
Use anti-emetics and pro-kinetics (encourage the bowel to move) – metoclopramide does both
Can also use steroids and anti-secretory agents

82
Q

How long does it take for a HPV infection to progress to cancer

A

HPV infection to high grade CIN takes 6 months - 3 years

High Grade CIN to invasive cancer takes 5 -20 years

83
Q

What is Cervical Intraepithelial Neoplasia (CIN)

A

Pre-invasive stage of cervical cancer - dysplasia of the squamous cells
Occurs at the transformation zone
Asymptomatic
Detected on screening

84
Q

How is CIN graded

A

CIN I - Basal 1/3 of epithelium occupied by abnormal cells.
Surface quite normal but nuclei slightly abnormal

CIN II - Abnormal cells extend to middle 1/3
Abnormal mitotic figures

CIN III - Abnormal cells occupy full thickness of epithelium.
Mitoses, often abnormal, in upper 1/3.
This is the most severe change

85
Q

What is the most common malignant cervical tumour

A

Invasive Squamous Carcinoma

It develops from pre-existing CIN so can be prevented by screening

86
Q

How does cervical squamous carcinoma spread

A

Local- uterine body, vagina, bladder, ureters, rectum
Lymphatic - early spread to pelvic, para-aortic nodes
Haematogenous - late spread to liver, lungs, bone

87
Q

What is Cervical Glandular Intraepithelial Neoplasia (CGIN)

A

Origin from endocervical epithelium
CGIN is preinvasive phase of endocervical adenocarcinoma
More difficult to diagnose on cervical smear than squamous

88
Q

Which type of cervical cancer has the worse prognosis

A

Endocervical Adenocarcinoma has a worse prognosis than squamous carcinoma

89
Q

What can lead to cervical adenocarcinoma

A

Higher S.E. Class
Later onset of sexual activity
Smoking
HPV again incriminated, particularly HPV18.

90
Q

Which types of cancer can affect the vagina

A

Vaginal intraepithelial neoplasia
Squamous carcinoma - seen in elderly
Melanoma: Rare. May appear as a polyp.

91
Q

How is HPV acquired

A

Direct physical contact - skin to skin, oral, genital
However, it is so common that you don’t need to go to a sexual health clinic and it isn’t considered an STD

8 out of 10 people carry HPV at some time in their life
Of those 9 out of 10 clear it within 2 years

92
Q

Smoking is a protective factor against which gynae cancer

A

endometrial

93
Q

Which types of cancer can affect the cervix

A

Squamous cell cancer of the Squamous epithelium - more common
Adenocarcinoma of the glandular epithelium - harder to detect

94
Q

What happens to the position of the transformation zone of the cervix as a woman ages

A

It moves upwards

95
Q

Most abnormal smears detect advanced cancer - true or false

A

False

Mostly pre-invasive disease which is easily treated

96
Q

What is colposcopy

A

Examination of the cervix under magnification using a colposcope
Solutions are used to help the colpscopist decide whether there is an abnormality i.e. CIN

97
Q

What test is required for a definitive diagnosis of cervical cancer

A

Histology

98
Q

How do you diagnose CIN

A

Colposcopically directed biopsy

Use a punch biopsy and AgNO3 for haemostasis

99
Q

How do you manage CIN I

A

Managed expectantly as 80% will resolve

Repeat smear in 1 year

100
Q

How do you manage CIN II

A

Usually treat

However selected cases can be managed expectantly if follow up guaranteed

101
Q

How do you manage CIN III

A

This requires treatment

Either by ablation or excision

102
Q

What are the advantages of cervical ablation

A

Simple, safe ,effective

103
Q

What are the disadvantages of cervical ablation

A

Need pre-treatment biopsy
i.e. first visit for biopsy
Second visit for treatment

Can’t use if
Lesion inside cervical canal
Any suspicion of cancer

104
Q

What are the advantages of cervical excision treatment

A

Whole lesion sent for pathology
One stop’ see & treat’
Can confidently exclude cancer from sample

105
Q

What are the disadvantages of cervical excision treatment

A

If it shortens the cervix there is an increased risk of pre-term labour in subsequent pregnancy
Probably more morbidity ( bleeding etc)
Local anaesthetic essential

106
Q

What is a LLETZ

A

Large loop excision of transformation zone

Treatment for CIN/ pre-cancerous cervical lesions

107
Q

What follow up is required after CIN treatment

A

‘ Test of cure’ = HPV test and cytology 6 months post treatment

Double negative -> very high NPV, back to routine recall
If HPV or cytology positive recall to colposcopy
If abnormal colposcopy – retreat
If normal colposcopy annual smears for 5 years

108
Q

How does HPV cause cancer

A

Person is infected with high-risk HPV types
HPV is integrated into the human genome
This leads to expression of viral genes which trigger the synthesis or upregulation of viral oncogenes - e6 and e7
Can damage the action of p53
Host cell immortilisation and malignant transformation

109
Q

The HPV screening test only tests for specific types = true or false

A

False

It is a test for all or any of the 14 high risk types. The test is not type specific.

110
Q

Which cancers can be caused by HPV

A 
Cervical 
Oropharygeal 
Anal 
Vulval 
Penile
111
Q

Who is offered the HPV vaccine

A

All S2 girls
Boys included since 2019
Adult MSM can be offered it through sexual health

112
Q

Which strains of HPV are covered by the vaccine

A

6/11/16/18

113
Q

If a smear comes back positive for HPV, what is the next step

A

Reflex cytology is performed on the same sample

114
Q

If both HPV and cytology come back positive on a smear, what happens next

A

The patient will be referred to colposcopy

115
Q

If HPV comes back positive on a smear but cytology is negative, what happens next

A

The woman will be screened again in a year

116
Q

HPV infection/carriage is usually aysmptomatic - true or false

A

True

Usually resolves spontaneously

117
Q

List factors which increase the levels of oestrogen in the body

A 
PCOS 
Late menopause 
Nulliparity 
Obesity 
Unapposed oestrogen HRT 
Tamoxifen 
Carbohydrate intolerance 
Oestrogen secreting tumours

Therefore they can increase risk of endometrial cancer

118
Q

How does endometrial cancer present

A

Abnormal vaginal bleeding - PMB, any irregular bleeding in women over 40
Vaginal discharge – blood/watery/purulent
Pain is rare in early stage of the disease and may indicate metastases

119
Q

What is assessed in a TVUS

A

Measures endometrial thickness
Smooth and regular endometrium with a thickness <4mm makes
endometrial malignancy unlikely

120
Q

How do you diagnose endometrial hyperplasia

A

Usually diagnosed by biopsy - increase in the gland-to-stromal ratio

121
Q

How do you treat endometrial hyperplasia

A

Progestogens - young women
Mirena IUS
In atypical hyperplasia, hysterectomy is recommended

122
Q

What is the precursor lesion to endometriod endometrial carcinoma

A

atypical hyperplasia

123
Q

List common mutations responsible for endometriod endometrial carcinoma

A

PTEN, KRAS, PIK3CA mutations
Microsatellite instability – germline mutation of mismatch repair
genes (Lynch syndrome)

124
Q

What is the precursor lesion to serous endometrial carcinoma

A

serous endometrial intraepithelial carcinoma

125
Q

List common mutations responsible for serous endometrial carcinoma

A

TP53 mutations

126
Q

What are the prognostic factors for endometrial cancer

A
  • Histological type
  • Histological differentiation
  • Stage of disease
  • Myometrial invasion
  • Peritoneal cytology
  • Lymph node metastasis
  • Adnexal metastasis
127
Q

Describe endometrial sarcoma

A

Rare
Arises from endometrial stroma
Locally aggressive and metastasizes early - Initial presentation may be as metastasis (lung or ovary)

128
Q

What is the most common site of recurrence of endometrial cancer

A

The vault of the vagina

129
Q

How do you treat a recurrence of endometrial cancer

A

Radiotherapy should be considered in isolated vault recurrence if it has not
previously been received.

Otherwise, hormonal therapy (high dose progestogens to
slow the disease) and chemotherapy should be the treatment of choice.

130
Q

List risk factors for ovarian cancer

A 
Low parity 
Genetics 
- 1st degree relatives affected
- Lynch Syndrome (HNPCC)
- BRCA 1 and 2 
Endometriosis
131
Q

What ovarian screening is offered to women with BRCA mutations

A

Regular screens
May be
offered bilateral oophorectomy once their family is complete

132
Q

BRCA1 and 2 mutations increase your risk of which types of cancer

A

Ovarian

Breast

133
Q

Lynch Syndrome (HNPCC) increases the risk of which types of cancer

A

Predisposition to bowel, endometrial, ovarian + other cancers
Ovarian - endometriod and clear cell in particular

134
Q

What is the peak age for ovarian cancer

A

75

Affects older women

135
Q

What is the most common type of primary ovarian tumour

A

Epithelial

Account for 70% of cases

136
Q

Describe mucinous ovarian tumours

A

Often benign but can be malignant
Benign typically unilateral whilst malignant is bi
Usually multiloculated and contain mucinous fluid
o Rarely, pseudomyxoma peritonei may also be present – characterized by a
gelatinous tumour in the peritoneal cavity

137
Q

Endometriod ovarian tumours are usually benign - true or false

A

False

They are usually malignant however they often present early

138
Q

Almost all clear cell ovarian tumours are malignant - true or false

A

True

139
Q

Which other conditions are associated with clear cell ovarian tumours

A

Endometriosis

Lynch syndrome - HNPCC

140
Q

How do ovarian yolk sac tumour present

A

Usually present with sudden pelvic mass

hCG levels are normal but alpha-fetoprotein sebum levels are increased

141
Q

Which types of ovarian tumours can secrete hcg

A

Choriocarcinoma

Sometimes dysgermioma

142
Q

Which US features are suggestive of ovarian cancer

A 
Complex mass with solid + cystic areas
Multi-loculated
Thick septations
Associated ascites
Bilateral disease.
143
Q

What is the treatment of choice for ovarian cancer relapse

A

Chemotherapy

144
Q

How do you treat benign ovarian tumours

A

Excision or drainage
- Often can’t distinguish between benign or malignant tumours and diagnosis occurs
after surgery has been performed

145
Q

How can CIN progress

A

33% of CIN cases will progress to the next degree classification, 33% will
show no changes, and 33% will regress

146
Q

CIN is not visible to the naked eye - true or false

A

True

Only picked up by smear or histology

147
Q

How might advanced cervical cancer present

A 
Backache
Leg pain
Haematuria
Weight loss
Anaemia
Changes in bowel habit
148
Q

How does cervical cancer spread

A

Cervical cancer spreads to adjacent structures and via the draining lymphatics.
It rarely
metastasizes through the blood

Reproduction (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions