Gynaecological tumours Flashcards
ovarian Ca risk factors?
FH-BRCA1 or 2 gene mutations, ?FH of breast or ovarian Ca
HNPCC (Lynch syndrome)
many ovulations-early menarche, late menopause, nulliparity
HRT
clinical features of ovarian cancer?
abdo bloating and distension abdo or pelvic pain early satiety urgency diarrhoea weight loss
3 cardinal features of meig’s syndrome?
benign ovarian tumour (fibroma or fibroma-like tumour) ascites pleural effusion (exudate) *Lights criteria if borderline pleural fluid protein (25-35g/L)
most common benign ovarian tumour in young women? (under 30 years)
dermoid cyst (teratoma)
with which ovarian tumours is torsion more likely?
teratomas (dermoid cysts)
what is dyskaryosis?
this refers to an abnormality of the nucleus
can be identified under the microscope from a cervical smear
mild, moderate and severe types
what is CIN?
cervical intraepithelial neoplasia
describes how far abnormal cells have gone into the surface layer of the cervix
CIN 1=1/3 of the thickness of the surface layer of the cervix is affected
CIN 2=2/3 of the thickness of the surface layer of the cervix
CIN 3=full thickness of the surface layer of the cervix is affected (CIS)
RFs for endometrial cancer?
- nulliparity
- late menopause (past age of 52)
- obesity
- endometrial hyperplasia
- HNPCC
- oestrogen secreting ovarian tumours-granulosa cell tumours
- PCOS-anovulatory cycles so not producing corpus luteum with subsequent progesterone production, so prolonged periods of unopposed oestrogen
- type 2 DM
- tamoxifen
- oestrogen only HRT
- ?immunosuppression and infection
significance of endometrial hyperplasia?
precursor to endometrial cancer
management of endometrial hyperplasia without atypia?
less than 5% will progress to endometrial cancer over 20 years
- minimise RFs e.g. lose weight, stop HRT
- may be managed with observation alone with f/u endometrial biopsies
- progestogen tment indicated in women who fail to regress spontaneously with observation alone and in those with abnormal uterine bleeding e.g. LNG-IUS or oral progestogens for minimum 6 mnths to cause histological regression.
- hysterectomy can be offered if progression to atypical disease on f/u, no histological regression after 12mnths of treatment, endometrial hyperplasia relapse after completing progestogen tment, peristence of bleeding symptoms.
management of atypical endometrial hyperplasia?
total hysterectomy due to risk of underlying malignancy or progression to cancer. preferably lap approach so that shorter hosp stay, quicker recovery + less post op pain.
if wish to maintain fertility, or pt unsuitable for surgery, offer LNG-IUS 1st line, oral progestogens 2nd line.
if postmenopausal should offer bilateral salpingo-oopherectomy, if premenopausal should consider, to reduce risk of future ovarian malignancy.
complications of lichen sclerosis?
- vulval cancer (4%)
- dysparenunia
- dysuria
- distress associated with itch and discomfort
why does PCOS increase your risk of endometrial cancer?
anovulatory cycles, so prolonged time of unopposed oestrogen exposure as not producing the corpus luteum so not producing progesterone
why might hCG be raised outside of pregnancy?
ovarian germ cell tumours
seminomatous and non seminomatous testicular tumours
what are the internal and external cervical os?
external cervical os is the external opening of the cervix, between the ectocervix (stratified squamous NK epithelium) and the vagina
internal cervical os=between the endocervix (simple columnar) and the body of the uterus
what name is given to the boundary between endocervix and ectocervix?
=SCJ-squamocolumnar junction
the transformation zone-area for cervical smears, is where columnar epithelium is undergoing squamous metaplasia, and is between the SCJ as it was before puberty and where it was at its lowest point during puberty.
what is a cervical ectropion?
columnar epithelium present on the vaginal surface of the cervix (ectocervix)
undergoes squamous metaplasia, transforming to stratitifed squamous epithelium
o/e: may be erythematous around the external cervical os as vascular columnar epithelium
can be excess secretion of mucus as columnar epithelium contains mucus secreting glands, and may be *post coital bleeding as delicate blood vessels in columnar epithelium.
risk associated with increased levels of oestrogen e.g. young women, COCP-may stop if troublesome symptoms, or if very severe then ablation therapy may be used.
histological subtype of cervical cancer that is most common?
squamous cell carcinoma (80%)
if cells of endocervix affected (columnar) then this would be a cervical adenocarcinoma (more than 10%)
also small cell and lymphomas
when does the SCJ migrate out of the external cervical os?
during puberty and pregnancy
cervical cancer symptoms?
PV bleeding-intermenstrual-may occur after micturition or defecation, postcoital, postmenopausal
dyspareunia
smelly vaginal discharge
pelvic pain
urinary symptoms, chronic urinary frequency
painless haematuria
altered bowel habit
leg oedema, pain and hydronephrosis leading to CKD
treatment options for cervical carcinoma in situ (CIS/CIN III)?
laser therapy cryotherapy cone biopsy large loop excision of transformation zone (LLETZ) (wire and electrical current used)-increased risk of premature labour and low birthweight baby hysterectomy
problems in pregnancy associated with a large loop excision of the transformation zone?
risk of premature labour*
risk of late miscarriage
cervical cancer risk factors?
HPV-subtypes 16 and 18 smoking young age FH multiple sexual partners, infection with both HIV and chlamydia lack of barrier contraception use COCP low SE class immunosuppression e.g. HIV, post transplant non attendance at cervical screening
stage of cervical cancer if it has spread outside of the cervix, and what treatment is given for this?
stage 2
stage 2A-spread into top of vagina
stage 2B-spread up into tissues around cervix
2A-surgery (hysterectomy) or chemoradiotherapy
2B-chemoradiotherapy
treatment options for stage 1 cervical cancer?
surgery or radiotherapy-brachytherapy or external
surgery-usually hysterectomy, but a radical trachelectomy-cervix and upper 1/3 of the vagina removed, but internal cervical os is left behind, and patient still able to get pregnant., can be used if small stage 1 cervical cancer.
stage 1B2-might have chemoradiotherapy.