Gynaecological malignancies Flashcards
What are the two types of endometrial cancer?
Type I - endometrial adenocarcinomas
Type II - tumours of non-endometrioid histology
What causes endometrial cancer?
Long-term high oestrogen exposure
Which mutation is most strongly associated with type II endometrial cancers?
p53
Present in 90% of type II cancers
Why is pregnancy protective for endometrial cancer?
Progesterone is the main hormone in pregnancy and it is protective
What proportion of postmenopausal bleeding is due to endometrial cancer?
20-30%
What is menometrorrhagia?
Prolonged or excessive uterine bleeding that occurs irregularly
Which strains of HPV are most strongly associated with cervical cancer?
16 + 18
What are the two subtypes of cervical cancer?
Squamous cell carcinoma (80%)
Adenocarcinoma (20%)
What is the most common gynaecological malignancy?
Endometrial cancer
Which gynaecological cancer confers the highest mortality?
Ovarian
Which HPV strains are associated with genital warts?
6 + 11
What is the most common cause of postmenopausal bleeding?
Atrophic vaginitis
What are the features of a CIN 1 lesion?
Low grade
Mildly atypical cellular changes
Limited to the lower third of the epithelium
What are the features of a CIN 2 lesion?
High grade
Moderately atypical cellular changes
Confined to the basal two thirds of the epithelium
What are the features of a CIN 3 lesion?
High grade lesion
Severely atypical cellular changes
Encompasses greater than 2/3 of the epithelial thickness
What cell type is pathognomonic of HPV infection?
Koilocytes
Dysplastic squamous cells characterised by well-defined, clear, balloon-like, perinuclear halo and hyperchromasia
What strains of HPV are covered with Gardasil?
6, 11, 16, 18
What is a typical endometrial thickness for a postmenopausal woman?
<5mm
- Risk of carcinoma increases with endometrial thickness*
- Risk is very low if endometrial thickness is < 5mm*
When is liquid based cytology performed?
On all CST samples in which oncogenic HPV is detected
What is the follow up for patients with oncogenic HPV 16/18 detected on CST?
Colposcopy
What is the follow up for patients with oncogenic HPV (non-16/18) detected on CST?
Depends on liquid based cytology (ThinPrep)
Negative/pLSIL/LSIL: repeat in 1 year
pHSIL/HSIL: colposcopy
What CIN corresponds with a high grade squamous intraepithelial lesion (HSIL)?
2/3
What CIN corresponds with a low grade squamous intraepithelial lesion (LSIL)?
CIN 1
What is the most important risk factor for ovarian cancer?
Family history
BRAC1/2
What serum marker would you following in a patient with ovarian cancer?
CA-125
Name 3 genetic risk factors for developing ovarian cancer
- BRAC-1
- BRAC-2
- HNPCC (hereditary nonpolyposis colorectal cancer)
What is a hydatidiform mole?
Molar pregnancy
Benign trophoblastic disease (a benign presence of abnormal tissue derived from foetal cells)
What are the two types of molar pregnancy?
Complete (90%)
Partial (10%)
What is the pathophysiology of a complete molar pregnancy?
- Fertilisation of an egg which does not contain chromosomes → male (X) genetic material duplicates → XX
OR
2. Two sperm fertilise an empty egg → XX/XY
What is the pathophysiology of a partial molar pregnancy?
Dispermic fertilisation of an egg → XXX/XXY/XYY
How is a molar pregnancy treated?
D&C
Monitor hCG levels
What are the US features of a complete molar pregnancy?
Theca lutein cysts
hCG mimics LH and FSH
What are the ultrasound features of a partial molar pregnancy?
Foetal parts and abnormalities e.g., IUGR, hydrocephaly
Oligohydramnios
Enlarged placenta with “swiss cheese” appearance
What is CA-125 used to assess?
Ovarian cancer
What is the association between endometrial cancer and the COCP?
COCP decreases risk
Likely due to progesterone component which restricts endometrial hyperplasia
What is the definition of endometrial hyperplasia in a postmenopausal woman?
>4mm
Which type of physiological ovarian cyst is most likely to rupture?
Corpus luteal cyst
What is Meig’s syndrome?
Triad of ascites, pleural effusion and benign ovarian tumour
What conditions must be met for medical (rather than surgical) treatment of ectopic pregnancy to be considered?
No significant pain
An unruptured ectopic pregnancy with an adnexal mass smaller than 35 mm
No visible heartbeat
Serum hCG level less than 1500 IU/litre
No intrauterine pregnancy (as confirmed on an ultrasound scan)
What are the clinical features of complete hydatidiform molar pregnancy?
Bleeding in first or early second trimester
Exaggerated symptoms of pregnancy e.g. hyperemesis
Uterus large for weeks of gestation
Very high serum levels of human chorionic gonadotropin (hCG)
Hypertension
Features of hyperthyroidism
Why are features of hyperthyroidism seen in complete hydatidiform molar pregnancy?
hCG can mimic thyroid-stimulating hormone (TSH) at the very high levels seen in complete hydatidiform molar pregnancy.
What would be seen on ultrasound of someone with complete hydatidiform molar pregnancy?
Molar pregnancy has a characteristic ‘bunches of grapes’ appearance on ultrasound.
What conditions must be met for medical (rather than surgical) treatment of ectopic pregnancy to be considered?
No significant pain
An unruptured ectopic pregnancy
Adnexal mass smaller than 35 mm
No visible heartbeat
Serum hCG level less than 1500 IU/litre
No intrauterine pregnancy (as confirmed on an ultrasound scan).
Hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome) is an autosomal dominant cancer syndrome involving defects in DNA mismatch repair. Which cancers are seen in this syndrome?
Colon
Endometrial
Ovarian
How many times is the swab twirled and dabbed in the CST?
Twirl: 3-5 times in the cervix
Dap: 5-10 times in the Thin Prep. Do not leave the head of the sampler in the vial
What is the risk of malignancy index?
Risk assessment tool for ovarian malignancy
Which ovarian cancer is frequently bilateral?
Serous cystadenoma/cystadenocarcinoma
Psammoma bodies are characteristic of which type of ovarian tumour?
Serous cystadeoma/cystadenocarcinoma
What is the most aggressive ovarian cancer?
Serous cystadenoma/adenocarcinoma
What is the prognosis for a mucinous ovarian tumour? (type of epithelial tumour)
75% benign
What is the most common malignant ovarian tumour in young women?
Dysgerminoma
What is the prognosis of most HPV infections?
Transient and clear within 1-2 years
Persists in up to 10% of women
What HPV strain is the 3rd most oncogenic for cervical cancer?
45
- 10% of cervical cancer*
- More likely to regress than 16 and 18*
What are 3 risk factors for vulvar cancer?
- HPV (16, 18, 33)
- Immunosuppression
- Smoking
- Precancerous lesions
- Vulvar dystrophy and vulvar/cervical intraepithelial neoplasia
What is the most common type of vulvar cancer?
Squamous cell carcinoma (>80%)
What are some of the clinical features of vulvar cancer?
Pruritis
Discolouration
Wart-like lesions
Vulvar bleeding or discolouration
Dysuria, dyspareunia
Lymphadenopathy
What is the most common site of vaginal cancer?
Upper 1/3 of the posterior vaginal wall
Which HPV strains are most strongly linked to vaginal and vulval cancer?
16, 18 and 33
What are some of the symptoms of vaginal cancer?
Vaginal bleeding
Vaginal ulceration
Contact bleeding
Malodourous discharge
Leukoplakia
What is the association between hormone replacement therapy and breast cancer?
Increased risk with oestrogen-progestin therapy
Reduced risk with oestrogen-only therapy
What are the types of ovarian cancer?
GEMS
G - Germ cell
E - Epithelial
M - Metastatic
S - Sex-cord stromal
What are some protective factors for ovarian cancer?
OCP
Pregnancy
Breastfeeding
Salpingectomy
Which women are eligible for a self-collected CST?
Overdue for > 2 years
Have never screened (must be > 30 years)
What is the most common type of ovarian cystadenoma?
Serous
(as opposed to mucinous)
Are BRCA1/2 oncogenes or tumour suppressor genes?
Tumour suppressor genes
