Malignant Gynaeocological Pathology

Question 1

What % of women with post-menopausal bleeding will have endometrial cancer?

Answer 1

10%

Question 2

Name the staging system for endometrial cancer

Answer 2

FIGO system

Question 3

What % of endometrial cancer is endometrioid (resembles normal glands)?

Answer 3

80%

Question 4

State the risk factors for endometrioid endometrial cancer

Answer 4

Obesity, anovulatory amenorrhoea (e.g. PCOS), nulliparity, early menarche, late menopause, tamoxifen, diabetes mellitus, hypertension

Question 5

Which type of cancer are most endometrioid endometrial cancers?

Answer 5

85% are adenocarcinomas

Question 6

Name three types of non-endometrioid endometrial cancer

Answer 6

Papillary, serous, clear cell

Question 7

Which group is at greatest risk of non-endometrioid endometrial cancer?

Answer 7

Elderly women with endometrial atrophy

Question 8

Which type of vulval cancer is associated with usual-type vulval intraepithelial neoplasia?

Answer 8

Warty/basaloid squamous cell carcinoma

Question 9

Which type of vulval cancer is associated with differentiated-type vulval intraepithelial neoplasia?

Answer 9

Keratinising squamous cell carcinoma

Question 10

What does vulval carcinoma usually originate from?

Answer 10

Pre-existing skin abnormalities - either vulval intraepithelial neoplasia or Paget’s of the vulva

Question 11

What is Paget’s disease of the vulva?

Answer 11

Adenocarcinoma in situ

Question 12

Which gynaeocological malignancy carries the greatest mortality?

Answer 12

Ovarian carcinoma

Question 13

State the 3 types of ovarian cancer and their frequency

Answer 13

Epithelial (70%), germ cell (20%), stromal (10%)

Question 14

Define FIGO stage 1 ovarian carcinoma

Answer 14

Limited to the ovaries

Question 15

Define FIGO stage 2 ovarian carcinoma

Answer 15

Limited to the pelvis

Question 16

Name at least 3 subtypes of epithelial ovarian cancer

Answer 16

Serous cystadenocarcinoma, mucinous cystadenocarcinoma, endometrioid, clear cell

Question 17

State 3 subtypes of germ cell ovarian cancer

Answer 17

Dysgerminoma, teratoma, choriocarcinoma

Question 18

State 3 subtypes of stromal ovarian cancer

Answer 18

Fibroma, granulosa-theca cell tumour, Sertoli-Leydig cell tumour

Question 19

Define FIGO stage 3 ovarian carcinoma

Answer 19

Limited to abdomen, including regional lymph node metastases

Question 20

Define FIGO stage 4 ovarian carcinoma

Answer 20

Distant metastases outside the abdominal cavity

Question 21

Describe the features of serous ovarian tumours

Answer 21

Range from benign cystadenomas to malignant, mimic tubular columnar epithelium, psammoma bodies common, affect women aged 30-40

Question 22

Describe the features of mucinous ovarian tumours

Answer 22

Range from benign mucinous cystadenomas to malignant, mucin secreting cells, similar to either endocervical mucosa or intestine (may be metastatic from appendix). No psammma bodies. Most common oestrogen-secreting tumour, affect younger women

Question 23

Describe the features of endometrioid ovarian carcinoma

Answer 23

Mimics the endometrium and forms tubular glands, main RF is endometriosis, usually malignant, may co-exist with endometrial carcinoma

Question 24

Describe the features of clear cell ovarian carcinoma

Answer 24

Abundant clear cytoplasm containing glycogen, hobnail appearance, poor prognosis

Question 25

Describe the features of dysgerminomas

Answer 25

Female counterpart of testicular seminoma. Rare but the most common ovarian malignancy in young women, radiosensitive

Question 26

Describe the features of ovarian teratomas

Answer 26

Differentiation towards somatic structures. 95% are mature and benign - usually cystic, with differentiation of germ cells into mature tissues (e.g. skin, hair, bone, cartilage, teeth). Often bilateral. Asymptomatic.
5% immature and malignant - usually solid, secrete AFP

Question 27

Describe the features of ovarian choriocarcinomas

Answer 27

Malignant HCG-secreting tumours

Question 28

Describe the features of fibromas

Answer 28

Non-secretory stromal tumours. 50% associated with Meig’s syndrome (ascites and pleural effusion)

Question 29

Describe the features of granulosa-theca cell tumours

Answer 29

Oestrogen (E2)-secreting tumours causing irregular menstrual cycles, breast enlargement, endometrial and breast cancer

Question 30

Describe the features of Sertoli-Leydig cell tumours

Answer 30

Androgen-secreting tumours causing breast atrophy and virilisation (hirsutism, deepened voice, enlarged clitoris)

Question 31

State the age groups at risk of cervical cancer

Answer 31

30-39 years and >70 years

Question 32

State the most common type of cervical cancer

Answer 32

Squamous cell carcinoma (70-80%)

Question 33

Describe the clinical features of cervical cancer

Answer 33

Post-coital bleeding, intermenstrual bleeding, postmenopausal bleeding, discharge, pain

Question 34

Describe stage 1a cervical cancer

Answer 34

Limited to cervix, <7mm wide (only visible by microscopy)

Question 35

Describe stage 1b cervical cancer

Answer 35

Limited to cervix, >7mm wide/ clinically visible

Question 36

Describe stage 2 cervical cancer

Answer 36

Extended beyond cervix but not to pelvic side wall or lower

Question 37

Describe stage 3 cervical cancer

Answer 37

Extension to pelvic side wall and/or lower 1/3 of vagina

Question 38

Describe stage 4 cervical cancer

Answer 38

Extension beyond true pelvis or involvement or bladder or bowel mucosa

Question 39

State the management options for stage 1a cervical cancer

Answer 39

Fertility desired: cone biopsy with negative margins

Fertility not desired: hysterectomy with or without pelvic lymph node clearance

Question 40

State the management options for stage 2 or 3 cervical cancer

Answer 40

Radiotherapy with concurrent chemotherapy (cisplatin)