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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
Q

FIGO stage 3 description

A 
IIIA = tumour invades serosa or adnexa 
IIIB = vaginal and/or parametrial involvement 
IIIC1 = pelvic node involvement 
IIIC2 = para-aortic involvement
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26
Q

FIGO stage 4 description

A 
IVA = tumour invasion bladder and/or bowel mucosa 
IVB = distant mets including abdominal mets and/or inguinal lymph nodes
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27
Q

how are tumours based on their architecture?

A

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

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28
Q

what are the treatment options for endometrial carcinomas?

A
  • hysterectomy and bilateral salpingo-oophorectomy (usually laparoscopic)
  • lymphadenectomy maybe
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29
Q

what are the symptoms of leiiomyoma (fibroid) ?

A

common

menorrhagia and infertility

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30
Q

what are the symptoms of leiomyosarcoma?

A

rare
most common uterine sarcoma
women >50
abnormal vaginal bleeding, palpable pelvic mass and pelvic pain

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31
Q

what are the genetic predispositions to ovarian neoplasms?

A
  • first degree relatives (5-25%)
  • HPNCC (lynch syndrome)
  • BRACA1 and BRACA2 (10-50%)
  • endometriosis
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32
Q

what actually happens in endometrial hyperplasia?

A

increased number of endometrial cells, leading to a thick endometrium

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33
Q

what can be seen on histology in endometrial hyperplasia?

A

increase in the gland - to - stromal ratio

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34
Q

treatment for endometrial hyperplasia?

A
  • progesterone (in young women)
  • minera IUD
  • hysterectomy
35
Q

what can be seen macroscopically in endometrial carcinoma?

A

large uterus

polypoid

36
Q

which age groups get ovarian cancer?

A

> 75s

37
Q

what are the most common type of ovarian tumours?

A

epithelial tumours (arise from surface epithelium)

38
Q

which 3 classes are epithelial ovarian tumours grouped into?

A

benign, borderline and malignant (except serous tumours which are grouped into high and low grade)

39
Q

what does a borderline tumour mean?

A

it doesn’t invade the stroma but does illustrate malignant charachteristics
prognosis is far better than malignant tumours

40
Q

what are the 5 different types of epithelial tumours?

A 
serous
mucinous
endometrioid
clear cell
urothelial-like
41
Q

what is the most common type of ovarian cancer within the epithelial tumour bracket?

A

serous tumours

42
Q

what are the 2 distinct entities with precursor lesions for serous tumours?

A
  • high grade serous carcinoma (serous tubal intraepithelial carcinoma (SITU) )
  • low grade serous carcinoma (serous borderline tumour)
43
Q

which serous tumours make up 20% of benign ovarian tumours?

A

serous cystadenomas (uniocular cysts filled with serous fluid)

44
Q

what are mucinous tumours?

A

20% of ovarian neoplasms (often benign)
malignant tumours are found bilaterally (benign - only one ovary is affected)
multioculated and contain mucinous fluid

45
Q

what is rarely found in mucinous tumours?

A

pseudomyxoma peritonei (characterised by a gelatinous tumour in the peritoneal cavity)

46
Q

what are endometrioid tumours?

A 
usually malignant (but often present at an early stage) 
histologically similar to endometrial cancer 
association with lynch syndrome
47
Q

30% of women with endometrioid tumours also have what?

A

primary tumour in the endometrium

48
Q

what are clear cell tumours?

A

almost all are malignant
associated with ovarian endometriosis (although this development is rare)
assocaited with lynch syndrome

49
Q

what are urothelial-liek tumours / Brenner?

A

rarely malignant

a tumour of transitional epithelium

50
Q

what percent of ovarian neoplasms are caused by sex cord tumours?

A

<5%

51
Q

what are the 3 types of sex cord / stromal cell tumours?

A

granulosa cell
thecoma / fibroma
sertoli / leydig cell

52
Q

what are granulosa cell tumours?

A
  • low grade but potentially malignant

- 75% secrete sex hormones –> precocious pseudopuberty, abnormal menstrual bleeding / postmenopausal bleeding

53
Q

what do granulosa cell tumours contain?

A

cells with coffee bean nuclei and gland-like spaced called call-exner bodies

54
Q

what are thecoma / fibroma tumours?

A

benign
contain a variety of cells such as theca or fibrobalstic - type cells
may produce oestrgen causing uterine bleeding
- meigs syndrome can result

55
Q

what is meig’s syndrome?

A

ascites and pleural effusion

56
Q

what are sertoli / leydig cell tumours?

A

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
Q

what percentage of ovarian neoplasms do germ cell tumours account for?

A

20-25% ovarian neoplasms

affects young children and young women

58
Q

what are the 4 germ cell tumours?

A

teratoma
dysgerminoma
endodermal sinus or yolk sac tumour
choriocarcinoma

59
Q

what is a teratoma?

A

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
Q

what is the most common malignant germ cell tumour?

A

dysgerminoma

61
Q

what is a dysgerminoma?

A

associated with gonadoblastoma in gonadal dysgenesis

the level of hCG may be increased

62
Q

what is an endometrial sinus or yolk sac tumour?

A

presents with sudden pelvic mass
hCG levels normal
increased AFP sebum levels
20% of women diagnosed will also have a teratoma

63
Q

what is a choriocarcinoma?

A

secretes hCG so patients may present wit precocious pseudopuberty
poor prognosis

64
Q

which tool is used to separate benign and malignant lesions?

A

risk of malignancy index

RMI = USS score x menopausal score xCA125

65
Q

what is CA125 and what is it raised in?

A

raised in 80% of cancers but also in endometriosis, peritonitis, pregnancy, pancreatitis, ascites and others

66
Q

what is CEA and what is it raised in?

A

carcino-embryonic antigen
raised in ovarian cancer (especially in mucinour tumours)
mainly used to exclude mets from a GI primary cancer

67
Q

what is AFP and when is it raised?

A

germ cell tumours

markers used to indicate response to therapy

68
Q

what is CIN? (cervical intraepithelial neoplasia)

A

preinvasive phase of squamous cervical cancer

69
Q

what are the risks for developing CIN?

A

no condoms
early first sexual activity
many sexual partners

70
Q

which strains of HPV cause CIN?

A

16 + 18

71
Q

what is CGIN?

A

cervical glandular intraepithelial neoplasia

the preinvasive phase of endocervical adenocarcinoma

72
Q

what is the endocervix lined with?

A

columnar epithelium

73
Q

what is the ectocervix lined with?

A

squamous epithelium

74
Q

what is the transformation zone?

A

when the eco and endocervix meet

75
Q

why does the TZ alter in life?

A

in repsone to preganancy, menarche and menopause

76
Q

when does columnar to squamous epithelial occur and what does it result it?

A

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
Q

where may CIN develop?

A

at the TZ (this is the area targeted for cytology when taking a cervical smear)

78
Q

what are abnormalities of cervical smear classified by?

A

degree of dyskaryosis

79
Q

what does koilocytosis indicate?

A

HPV infection

80
Q

when would a woman be referred for a colposcopy?

A

if dyskarysis is moderate or severe

or mild + HPV positive

81
Q

what can be visualised on colposcopy?

A
  • 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
Q

how to treat CIN?

A

excision at time of colposcopy or after biopsy

large loop excision of hte TZ (LLETZ)

83
Q

where does cervical cancer spread to (nodes) ?

A

pelvis and para-aortic

84
Q

which chemo drugs are used in cervical malignancies?

A

cisplatin (40mg.m2 weekly)

carboplatin / paclitaxel

PRIYA REPRO (15 decks)

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