Brainscape's Knowledge GenomeTM

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


See full index

Repro > Gynaecological Tumours > Flashcards

Gynaecological Tumours Flashcards

1
Q

How common are vulval tumours and who do they affect the most?

A

Uncommon (approx 3% of female genital cancers)

2/3rds in women over 60

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

What are the types of vulval tumours?

A

Squamous cell carcinoma - most common
Extramammary Paget’s disease
Basal cell carcinoma
Malignant melanoma

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

Risk factors for vulval squamous cell carcinoma?

A

Same for cervical carcinomas:

  • HPV
  • intercourse
  • early marriage
  • early first pregnancy
  • multiple births
  • many partners
  • promiscuous partner
  • long term use of OCP
  • partner with carcinoma of the penis
  • low socio-economic class
  • smoking
  • immunosuppression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the usual causes of squamous cell carcinoma of the vulva in older and younger women?

A

70s - long standing inflammatory and hyperplastic conditions of the vulva eg lichen sclerosis

50s - usually HPV and risk factors same as cervical carcinoma

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

What is the precursor to squamous neoplastic lesions of the vulva?

A

Vulvar intraepithelial neoplasia (VIN)

-atypical squamous cells within the epidermis (no invasion)

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

Which lymph nodes does vulval squamous cell carcinoma spread to?

Where else?

A

Inguinal, pelvic, iliac and para-aortic lymph node

Lungs and liver

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

Survival if a lesion of vulval squamous cell carcinoma is less than 2cm?
Following which procedures?

A

90% 5 year survival

Vulvectomy and lymphadenectomy

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

Where includes gynaecological tumours?

A 
Cervix
Endometrium
Myometrium
Ovary
Vulva
Tumours of gestation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the two important viruses causing cervical carcinoma?

A

HPV 16

HPV 18

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

How do the viruses cause squamous cell carcinoma?

A

Infect immature metaplastic squamous cells in the transformation zone
Produce viral proteins which interfere with activity of tumour suppressor genes - inability to repair damaged DNA and increase proliferation of cells

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

Risk factors for CIN and cervical carcinoma?

A 
Sexual intercourse
Early first marriage
Early first pregnancy
Multiple births
Many partners
Promiscuous partner
Long term use of OCP
Partner with carcinoma of penis
Low socio-economic class
Smoking
Immunosuppression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why is cervical screening so successful?

A

Cervix accessible to visual examination and sampling
Slow progression from precursor lesions to invasive cancers
Pap test detects precursor lesions and low stage cancers
Allows early diagnosis and curative therapy

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

How is the cervical screening done?

A

Cells from transformation zone are scraped off, stained with Papanicolaou stain and examined microscopically

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

When is cervical screening done?

A

Starts age 25
Every three years until 50
Every 5 years from 50-65

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

What happens if the result of cervical screening is abnormal?

A

Referred for colposcopy (visualisation of cervix) and biopsy

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

For how many years does the vaccine against HPV protect for?

A

Up to 10 years

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

What is cervical intraepithelial neoplasia?

A

Dysplasia of squamous cells within the cervical epithelium, induced by infection with high risk HPVs

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

What is dysplasia?

A

Enlargement of an organ/tissue by the proliferation of cells of an abnormal type - early stage in development of cancer

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

What are the CIN stages?

What is the outcome of each one?

A

CIN I - most regress spontaneously and a small % progress to..
CIN II
CIN III - carcinoma in situ - 10% progress to invasive carcinoma in 2-10 years, 30% regress

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

How long does it take to go from CIN I to CIN III

A

7 years

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

What is the management of each CIN stage?

A

CIN I - follow-up or cryotherapy

CIN II and III - superficial excision

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

Average age of presentation of cervical carcinoma?

A

45

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

What are the most common types of cervical carcinomas?

A

80% squamous cell carcinoma

15% adenocarcinoma

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

Where can cervical carcinoma spread to?

A

Para-cervical soft tissues, bladder, ureters, rectum, vagina

Lymph nodes - para-cervical, pelvic, para-aortic
Distally

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

How does cervical carcinoma usually present?

A

Screening abnormality

Postcoital, intermenstrual or postmenopausal vaginal bleeding

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

Treatment of cervical carcinoma?

A

Microinvasive - cervical cone excision - 100% survival

Invasive - hysterectomy, lymph node dissection, radiation and chemotherapy - 62% 10 year survival

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

What is the endometrium made up of?

A

Glands with a cellular stroma

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

What is the frequent precursor to endometrial carcinoma?

A

Endometrial hyperplasia

-increased gland to stroma ratio

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

What is endometrial hyperplasia associated with?

A

Annovulation
Increased oestrogen from endogenous sources eg adipose tissue
Exogenous oestrogen

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

How is endometrial carcinoma treated?

A

If complex and atypical, hysterectomy

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

What age does endometrial adenocarcinoma affect?

A

55-75, unusual before 40

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

Usual presentation of endometrial adenocarcinoma?

A

Irregular or postmenopausal vaginal bleeding

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

How common is endometrial adenocarcinoma?

A

Very common - most common invasive cancer of female genital tract
75% 10 year survival

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

What can endometrial carcinoma be classed as?

A

Polypoid or infiltrative

35
Q

What are the two most common types of endometrial adenocarcinoma?

A

Endometrioid endometrial adenocarcinoma
-associated with unopposed oestrigen and obesity

Serous carinoma

36
Q

Give pathophysiology of endometrioid endometrial adenocarcinoma and how it spreads

A

Mimics proliferative glands
Arises in setting of endometrial hyperplasia

Spreads by myometrial invasion and direct extension to adjacent structures - local lymph nodes and distal sites

37
Q

Features of serous endometrial adenocarcinoma carcinoma?

A

Poorly differentiated, aggressive, worse prognosis

38
Q

How does serous endometrial adenocarcinoma spread?

A

Exfoliates
Travels through Fallopian tubes
Implants on peritoneal surfaces and grows

39
Q

What are fibroids?

A

Uterine leiomyoma
Benign tumour of myometrium (uterine smooth muscle)
Often multiple
Range from tiny to massive

40
Q

Symptoms of fibroids?

A

Asymptomatic
Heavy/painful periods
Urinary frequency due to bladder compression
Infertility

41
Q

What does uterine leiomyoma look like?

A

Well circumscribed, round, firm, whitish, well differentiated
Bundles of smooth muscle - resembles normal myometrium

42
Q

How common is leiomyosarcoma and who does it affect?

A

40-60 years

Uncommon

43
Q

Where do uterine leiomyosarcomas usually metastasise to?

A

Lungs

-highly malignant

44
Q

Are most ovarian tumours benign or malignant?

A

80% are benign

45
Q

When do most benign ovarian tumours occur?

When do most malignant tumours occur?

A

Benign: 20-45 years
Malignant: 45-65 years

46
Q

Why is prognosis of ovarian tumours poor?

A

Usually spread beyond the ovary by the time of presentation - few symptoms

47
Q

When do non-functional (don’t produce hormones) ovarian tumours usually give symptoms?

What symptoms do they produce?

A

When they become large, invade adjacent structures and metastasise

Abdominal pain
Abdominal distension
Urinary and GI symptoms
Ascites due to malignant spread through peritoneum

48
Q

What hormonal problems can ovarian tumours cause?

A

Menstrual disturbances

Inappropriate sex hormones

49
Q

Where do most malignant ovarian tumours spread to?

A

Regional nodes
Liver and lungs
50% to other ovary

50
Q

What is used to diagnose and monitor disease recurrence of ovarian cancer?

A

CA-125

Possible future screening test

51
Q

What are the general classifications of ovarian tumours?

A 
Müllerian epithelium (including endometriosis)
Germ cells (pluripotent)
Sex-cord stromal cells (form the endocrine apparatus of the ovary)
Metastases to the ovary
52
Q

What are the three main histological types of ovarian Muüllerian epithelial tumours?
What can each be classified as?

A

Serous
Mucinous
Endometrioid

Benign, borderline or malignant

53
Q

Risk factors for ovarian epithelial tumours?

A

Nulliparity or low parity
Heritable mutations eg BRCA1&2
Smoking
Endometriosis

OCP protective (fewer ovulations)

54
Q

Why are serous Mullerian epithelial ovarian tumours commonly associated with ascites?

A

Often spread to peritoneal surfaces and omentum

55
Q

What do mucinous ovarian tumours usually look like?

A

Large, cystic masses
Filled with sticky, thick, mucinous fluid
Usually benign or borderline

56
Q

Give features of Mullerian epithelial endometrioid ovarian tumours

A

Contain tubular glands resembling endometrial glands
Can arise in endometriosis
Sometimes have associated endometrial endometrioid adenocarcinoma, probably arising separately

57
Q

What are the types of germ cell ovarian tumours?

A

Most are teratomas - benign
Other types are malignant
-non-gestational choriocarcinoma (aggressive and often fatal, produces human chorionic gonadotropin)
-yolk sac (produces alpha-fetoprotein)

58
Q

Three groups of ovarian teratomas?

A

Mature (benign) - most common

Immature (malignant) - rare, composed of tissues resembling immature fetal tissue)

Monodermal (highly specialised - one cell type)

59
Q

Who do ovarian teratomas usually occur in?

A

Young women usually

60
Q

What do teratomas often contain?

A 
Cystic
-hair
-sebaceous material
-teeth
AKA dermoid cysts as they often have skin-like structures

Also tissue from other germ layers

  • cartilage
  • bone
  • thyroid
  • neural tissue
61
Q

Common types of monodermal ovarian tumours?

A

Struma ovarii

  • benign
  • composed of mature thyroid tissue
  • hyperthyroidism

Carcinoid

  • malignant
  • can be function producing 5HT (serotonin) and can cause carcinoid syndrome
62
Q

Where are ovarian sex-cord stromal tumours derived from?

A

Ovarian stroma derived from sex cords of the embryonic gonad

63
Q

What do sex cords normally give rise to?

A

Sertoli and Leydig cells in testes

Granulosa and theca cells in the ovaries

64
Q

What can sex cord stromal tumours cause?

A

Feminising if from granulosa/theca cell

Masculinising if from Leydig cells

65
Q

Who do granulosa cell tumours usually occur in?

A

Post-menopausal women

66
Q

What are the signs and symptoms of granulosa cell tumours?

A

Produce lots of oestrogen

  • precocious puberty in pre-pubertal girls
  • adults - associated with endometrial hyperplasia, endometrial carcinoma, breast disease
67
Q

What problems can Sertoli-Leydig cell tumours produce?

A 
In children - block normal female sexual development
Women - defeminisation and masculisation
-breast atrophy
-amenorrhoea
-sterility
-hair loss
-hirsutism with male hair distribution
-clitoral hypertrophy
-voice changes
68
Q

When is the peak incidence of Sertoli-Leydig cell tumours?

A

Teens/twenties

69
Q

Where do metastases to the ovaries usually come from?

A

Mullerian tumours

  • uterus
  • Fallopian tubes
  • contralateral ovary
  • pelvic peritoneum

Sometimes GI

  • colon
  • stomach
  • biliary tract
  • pancreas
  • appendix

Breast

Krukenberg tumour - drops down from stomach

70
Q

What is gestational trophoblastic disease?

A

Tumours and tumour-like conditions which show proliferation of placental tissue

71
Q

Types of gestational trophoblastic disease?

A 
Hydatidiform mole (growing mass of tissue in the uterus due to abnormal conception)
Invasive mole (tumorous growth associated with gestation)
Choriocarcinoma
72
Q

What is a hydatidiform mole?

A

Cystic swellings of chorionic villi and trophoblastic proliferation

73
Q

Presentation of a hydatidiform mole?

A

Diagnosed in early pregnancy with ultrasound scan

Miscarriage

74
Q

Highest risk group of hydatidiform mole?

A

Extremes of repro life

  • teens
  • 40-50 years
75
Q

Types of hydatidiform mole?

A

complete

partial

76
Q

What do hydatidiform moles look like?

A

Friable mass of thin-walled, translucent, grape-like structures = swollen oedematous villi

77
Q

How is a hydatidiform mole treated?

A

Curettage followed by HCG monitoring - if HCG doesn’t fall, may indicate an invasive mole (rarely happens)

78
Q

What is an invasive mole?

A

Mole that penetrates or perforates uterine wall

Locally destructive - can cause uterine rupture requiring hysterectomy

79
Q

Symptoms and signs of an invasive mole?

A

Vaginal bleeding and uterine enlargement

Persistently elevated HCG

80
Q

How is an invasive mole treated?

A

Chemotherapy

81
Q

What is a gestational choriocarcinoma?

A

Malignant neoplasm of trophoblastic cells derived from previously normal or abnormal pregnancy, with no villi present
Rapidly invasive, metastasises widely but responds well to chemo

82
Q

How can non-gestational choriocarcinomas arise?

A

From germ cells in the ovary or in the mediastinum

83
Q

How does gestational choriocarcinoma present?

A

Vaginal spotting

High HCG levels

84
Q

How is gestational choriocarcinoma treated?

A

Uterine excavation and chemotherapy

-high cure rate

Repro (31 decks)

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