Gynaecological neoplasms

Question 1

What is a teratoma?

Answer 1

A tumour with tissue or organ components resembling normal derivatives of more than one germ layer
Usually benign but can occasionally be malignant

Question 2

What are the two main types of ovarian cancer?

Answer 2

Serous carcinoma

Mucinous carcinoma

Question 3

What are the main risk factors for ovarian and endometrial carcinoma?

Answer 3

Nulliparity
Repeated ovulation (i.e. COCP reduces risk)
Genetic factors e.g. BRAC1/2
Unopposed oestrogen
Obesity, diabetes, PCOS
Increasing age

Question 4

How does ovarian cancer usually present?

Answer 4

Tends to present very late stage, with vague, non-specific symptoms

• indigestion, poor appetite
• altered bowel habit
• abdominal/pelvic mass
• bloating, discomfort, weight gain
• pelvic mass: causes pressure symptoms at a late stage

Question 5

What are the three main types of endometrial cancer?

Answer 5

Carcinoma
- Type 1: endometrial adenocarcinoma
- Type 2: endometrial serous/clear cell carcinoma
Uterine sarcoma

Question 6

How does endometrial cancer usually present?

Answer 6

Abnormal uterine bleeding

• post-menopausal bleeding
• menorrhagia
• vaginal discharge

Question 7

What are the main risk factors for vulval cancer?

Answer 7

Human papillomavirus (HPV) infection
Chronic dermatoses
Smoking
Immunosuppression
Previous malignancy

Question 8

What is VIN?

Answer 8

Vulva intraepithelial neoplasia - a pre-cancer

• multifocal
• unifocal

Question 9

What is the most common type of vulval cancer? Give three other types.

Answer 9

Squamous cell carcinoma
Other
 - basal cell carcinoma
 - melanoma
 - Bartholin's gland

Question 10

Describe the appearance/presentation of VIN?

Answer 10

Raised plaques
Nodules
Warty, keratotic appearance
Itch/irritation

Question 11

Describe the appearance/presentation of vulval cancer

Answer 11

Pain
Itch
Bleeding
Lump/ulcer

Question 12

How are gynaecological cancers diagnosed?

Answer 12

Biopsy

Question 13

What are the main treatment options for CIN?

Answer 13

Large loop excision of transformation zone (LLETZ)
Cold coagulation
Laser ablation

Question 14

What is the most common solid tumour in young males?

Answer 14

Testicular cancer

Question 15

What age range has peak incidence of testicular cancer?

Answer 15

15 - 40 years

Question 16

What are the risk factors for testicular cancer?

Answer 16

Cryptorchidism
Kleinfelter's syndrome (XXY)
Family history
Male infertility
Genetics; abnormalities on chromosome 12

Question 17

From what type of cells does testicular cancer most commonly arise?

Answer 17

Germ cells (95%)

Question 18

What is the most common type of prostate cancer?

Answer 18

Adenocarcinoma

Arising from peripheral zone of the prostate

Question 19

What are the most common sites for prostate cancer to metastasise to?

Answer 19

bone

lymph nodes

Question 20

What is the commonest male cancer?

Answer 20

Prostate cancer; 26% of all male cancers

Question 21

What are the risk factors for prostate cancer?

Answer 21

Increasing age
Family history
Ethnic origin (more common in black afro-Caribbean men)

Question 22

How is prostate cancer diagnosed?

Answer 22

Raised PSA
Digital rectal exam
Biopsy

Question 23

How is prostate cancer staged?

Answer 23

TNM staging and histological grading

Question 24

What is the most common form of penile cancer?

Answer 24

95% are squamous cell carcinoma

Question 25

Which male cancer is associated with HPV infection?

Answer 25

Penile cancer

Question 26

Describe the presentation of penile cancer

Answer 26

Lump, ulcer or erythematous lesion on the penis, usually on the glans
Itching/burning sensation
May cause urethral obstruction if it has invaded