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PRIYA REPRO > Gynaecological oncology > Flashcards

Gynaecological oncology Flashcards

1
Q

what are the 3 layers of the uterus?

A

perimetrium, myometrium and endometrium

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2
Q

what is the function of the broad ligament?

A

holds the uterus in it’s midline position

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3
Q

what is the round ligament?

A

an embryological remnant

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4
Q

what is the normal position of the uterus?

A

anteverted and anteflexed

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5
Q

what are thr 4 parts of the fallopian tubes?

A

isthmus, ampulla, infundibulum, fibbriae

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6
Q

which group are most likely to get endometrial cancer?

A

post-menopausal women

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7
Q

what are the risk factors for endometrial malignancy?

A

high levels of oestrogen
PCOS, late menopause, nulliparity, obesity, unopposed oestrogen HRT, tamoxifen, carbohydrate intolerance, and oestrogen secerting tumours
having never used the oral contraceptive pill

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8
Q

symptoms of endometrial cancer?

A
  • abnormal uterine bleeding (post menopausal bleeding is malignancy until proven otherwise)
  • vaginal discharge
  • pain (mets)
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9
Q

4 investigations of endometrial cancer?

A
  • TVUS
  • endometrial biopsy
  • dilation and curettage (GA, cervix is dilated to allow a curette to scrape the endometrium which can then be sent for histological analysis)
  • hysteroscopy (allows visualisation of the uterine cavity, enabling biopsy / curetagge to be performed)
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10
Q

what is the treatment for endometrial hyperplasia?

A
  • progesterone for young women
  • minera IUD
  • hysterectomy
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11
Q

what is seen macroscopically in endometrial carcinoma?

A

large uterus

polypoid

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12
Q

which type (1 or 2) endometrial cancer is most common?

A

type 1

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13
Q

describe type 1 endometrial carcinoma?

A 
endometrioid 
most common (80%) 
usually diagnosed shortly after the menopause 
oestrogen dependent and diagnosed at an early stage
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14
Q

what are the precursors / mutations associated with type 1 endometrial carcinoma?

A

atypical hyperplasia
PTEN, KRAS, PIK3CA
microsatellite instability
lynch syndrome

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15
Q

who gets type 2 endometrial carcinoma?

A

older women

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16
Q

describe type 2 endometrial carcinoma?

A

serous and clear cell

observed in older women and has a much poorer prognosis (more aggressive)

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17
Q

what are the mutations / precursors associated with type 2 endometrial carcinoma?

A

TP53 mutation

precursor lesion = serous endometrial intraepithelial carcinoma

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18
Q

why may type 2 endometrial carcinoma present with extrauterine disease?

A

spreads along fallopian tube mucosa and peritoneal surfaces

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19
Q

what does T2 endometrial carcinoma look like on histology?

A

complex papillary and/or glandular architecture with diffuse, marled nuclear pleomorphism

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20
Q

what is an endometrial sarcoma?

A

rare
arises from endometrial stroma
locally aggressive + poor prognosis

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21
Q

what may the first presentation of endometrial sarcoma be?

A

lung or ovary symptoms as mets

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22
Q

what is a carcinosarcoma?

A

mixed tumour with malignant epithelial and stromal elements
<5% of uterine malignancies
presence of rhabdomyosarcomatous = worst prognosis

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23
Q

FIGO stage 1 description

A 
1A = confined to uterus, no or <1/2 myometrial involvement 
1B = confined to uterus, >1/2 myometrial invasion
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24
Q

FIGO stage 2 description

A

cervical stromal invasion but not beyond uterus

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25
FIGO stage 3 description
``` IIIA = tumour invades serosa or adnexa IIIB = vaginal and/or parametrial involvement IIIC1 = pelvic node involvement IIIC2 = para-aortic involvement ```
26
FIGO stage 4 description
``` IVA = tumour invasion bladder and/or bowel mucosa IVB = distant mets including abdominal mets and/or inguinal lymph nodes ```
27
how are tumours based on their architecture?
Grade 1 - 5% or less solid growth Grade 2 = 6-50% solid growth Grade 3 = >50% solid growth
28
what are the treatment options for endometrial carcinomas?
- hysterectomy and bilateral salpingo-oophorectomy (usually laparoscopic) - lymphadenectomy maybe
29
what are the symptoms of leiiomyoma (fibroid) ?
common | menorrhagia and infertility
30
what are the symptoms of leiomyosarcoma?
rare most common uterine sarcoma women >50 abnormal vaginal bleeding, palpable pelvic mass and pelvic pain
31
what are the genetic predispositions to ovarian neoplasms?
- first degree relatives (5-25%) - HPNCC (lynch syndrome) - BRACA1 and BRACA2 (10-50%) - endometriosis
32
what actually happens in endometrial hyperplasia?
increased number of endometrial cells, leading to a thick endometrium
33
what can be seen on histology in endometrial hyperplasia?
increase in the gland - to - stromal ratio
34
treatment for endometrial hyperplasia?
- progesterone (in young women) - minera IUD - hysterectomy
35
what can be seen macroscopically in endometrial carcinoma?
large uterus | polypoid
36
which age groups get ovarian cancer?
>75s
37
what are the most common type of ovarian tumours?
epithelial tumours (arise from surface epithelium)
38
which 3 classes are epithelial ovarian tumours grouped into?
benign, borderline and malignant (except serous tumours which are grouped into high and low grade)
39
what does a borderline tumour mean?
it doesn't invade the stroma but does illustrate malignant charachteristics prognosis is far better than malignant tumours
40
what are the 5 different types of epithelial tumours?
``` serous mucinous endometrioid clear cell urothelial-like ```
41
what is the most common type of ovarian cancer within the epithelial tumour bracket?
serous tumours
42
what are the 2 distinct entities with precursor lesions for serous tumours?
- high grade serous carcinoma (serous tubal intraepithelial carcinoma (SITU) ) - low grade serous carcinoma (serous borderline tumour)
43
which serous tumours make up 20% of benign ovarian tumours?
serous cystadenomas (uniocular cysts filled with serous fluid)
44
what are mucinous tumours?
20% of ovarian neoplasms (often benign) malignant tumours are found bilaterally (benign - only one ovary is affected) multioculated and contain mucinous fluid
45
what is rarely found in mucinous tumours?
pseudomyxoma peritonei (characterised by a gelatinous tumour in the peritoneal cavity)
46
what are endometrioid tumours?
``` usually malignant (but often present at an early stage) histologically similar to endometrial cancer association with lynch syndrome ```
47
30% of women with endometrioid tumours also have what?
primary tumour in the endometrium
48
what are clear cell tumours?
almost all are malignant associated with ovarian endometriosis (although this development is rare) assocaited with lynch syndrome
49
what are urothelial-liek tumours / Brenner?
rarely malignant | a tumour of transitional epithelium
50
what percent of ovarian neoplasms are caused by sex cord tumours?
<5%
51
what are the 3 types of sex cord / stromal cell tumours?
granulosa cell thecoma / fibroma sertoli / leydig cell
52
what are granulosa cell tumours?
- low grade but potentially malignant | - 75% secrete sex hormones --> precocious pseudopuberty, abnormal menstrual bleeding / postmenopausal bleeding
53
what do granulosa cell tumours contain?
cells with coffee bean nuclei and gland-like spaced called call-exner bodies
54
what are thecoma / fibroma tumours?
benign contain a variety of cells such as theca or fibrobalstic - type cells may produce oestrgen causing uterine bleeding - meigs syndrome can result
55
what is meig's syndrome?
ascites and pleural effusion
56
what are sertoli / leydig cell tumours?
rare occur in young women (20s) unilateral usually nonfunctional but can be androgenic if tumour contains leydig cells, stroma-derived fibroblasts may also be seen
57
what percentage of ovarian neoplasms do germ cell tumours account for?
20-25% ovarian neoplasms | affects young children and young women
58
what are the 4 germ cell tumours?
teratoma dysgerminoma endodermal sinus or yolk sac tumour choriocarcinoma
59
what is a teratoma?
common + benign contains elements from all 3 germ cell layers mature teratomas may contain hair / teeth / epithelium / sebum "dermoid cyst" immature teratomas are rare
60
what is the most common malignant germ cell tumour?
dysgerminoma
61
what is a dysgerminoma?
associated with gonadoblastoma in gonadal dysgenesis | the level of hCG may be increased
62
what is an endometrial sinus or yolk sac tumour?
presents with sudden pelvic mass hCG levels normal increased AFP sebum levels 20% of women diagnosed will also have a teratoma
63
what is a choriocarcinoma?
secretes hCG so patients may present wit precocious pseudopuberty poor prognosis
64
which tool is used to separate benign and malignant lesions?
risk of malignancy index | RMI = USS score x menopausal score xCA125
65
what is CA125 and what is it raised in?
raised in 80% of cancers but also in endometriosis, peritonitis, pregnancy, pancreatitis, ascites and others
66
what is CEA and what is it raised in?
carcino-embryonic antigen raised in ovarian cancer (especially in mucinour tumours) mainly used to exclude mets from a GI primary cancer
67
what is AFP and when is it raised?
germ cell tumours | markers used to indicate response to therapy
68
what is CIN? (cervical intraepithelial neoplasia)
preinvasive phase of squamous cervical cancer
69
what are the risks for developing CIN?
no condoms early first sexual activity many sexual partners
70
which strains of HPV cause CIN?
16 + 18
71
what is CGIN?
cervical glandular intraepithelial neoplasia | the preinvasive phase of endocervical adenocarcinoma
72
what is the endocervix lined with?
columnar epithelium
73
what is the ectocervix lined with?
squamous epithelium
74
what is the transformation zone?
when the eco and endocervix meet
75
why does the TZ alter in life?
in repsone to preganancy, menarche and menopause
76
when does columnar to squamous epithelial occur and what does it result it?
if part of the endocervix everts allowing the chemical environment of the proximal vagina to reach the oclumnar epithelial results in the cells being in a less stable state
77
where may CIN develop?
at the TZ (this is the area targeted for cytology when taking a cervical smear)
78
what are abnormalities of cervical smear classified by?
degree of dyskaryosis
79
what does koilocytosis indicate?
HPV infection
80
when would a woman be referred for a colposcopy?
if dyskarysis is moderate or severe | or mild + HPV positive
81
what can be visualised on colposcopy?
- squamocolumnar junction - abnormal epithelium contains more protein and less glycogen than normal epithelium, meaning that when acetic acid is applied, they appear white in colour + are easily identifiable
82
how to treat CIN?
excision at time of colposcopy or after biopsy | large loop excision of hte TZ (LLETZ)
83
where does cervical cancer spread to (nodes) ?
pelvis and para-aortic
84
which chemo drugs are used in cervical malignancies?
cisplatin (40mg.m2 weekly) | carboplatin / paclitaxel

PRIYA REPRO (15 decks)

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