Neoplasms (Par Breast Cancer) Flashcards
1
Q
What are some causes of a pelvic mass that aren’t a gynae neoplasm
A
Pregnancy Retention Constipation Caecal carcinoma Others
2
Q
What potential cause of a pelvic mass is associated with PID and pus?
A
Pyosalpinx
3
Q
What potential cause of a pelvic mass occurs when a uterine tube is blocked? It is sometimes an incidental finding
A
Hydrosalpinx
4
Q
Who receives cervical screening and how often?
A
Females
Age 25-49 every 3yr
Age 50-64 every 5yr
5
Q
What is the procedure of cervical screening?
A
Visualise cervix with speculum
Brush sample at TZ for cytology
6
Q
What is Gardasil?
A
HPV vaccine (against HPV 6, 11, 16, 18)
7
Q
Who receives Gardasil?
A
Females in S1-S3
MSM under 45yr
8
Q
Gardasil protects against all cervical cancer. T or F
A
False, doesn’t protect against 30%
9
Q
Define dyskaryosis
A
Abnormal cervical cells
10
Q
What does CIN stand for?
A
Cervical intraepithelial neoplasia
(VIN vulvar)
(VaIN vaginal)
(AIN anal)
11
Q
What is intraepithelial neoplasia (such as CIN) associated with?
A
HPV
12
Q
_____ exposure causes a ______ squamous ______ resulting in cervical erosion
A
ACID exposure causes a PHYSIOLOGICAL squamous METAPLASIA resulting in cervical erosion
13
Q
What change on histology indicates the present of HPV?
A
Koilocytosis
14
Q
Risk factors for CIN:
- [Many/few] sexual partners
- [Young/old] age of first sexual encounter
- [Using/not using] OCP
- Smoking
A
Risk factors for CIN:
- MANY sexual partners
- YOUNG age of first sexual encounter
- (long term) USING OCP
- Smoking
15
Q
How long post HPV 16/18 infection does CIN occur?
A
6 months to 3 years
16
Q
Are mitotic figures raised in CIN?
A
Yes
pleomorphism also present
17
Q
What pathology term describes the change to the cells in CIN?
A
Dysplasia
also koilocytosis
18
Q
How many grades of CIN are there?
A
3
19
Q
What is grade 1 CIN?
A
Abnormal cells in basal ⅓ epithelium
Nuclei slightly abnormal
Mitotic figures less than ⅓
20
Q
What is grade 2 CIN?
A
Abnormal cells extend to middle ⅓
21
Q
What is grade 3 CIN?
A
Abnormal cells occupy full thickness epithelium, mitosis in upper ⅓.
22
Q
What are the S+S of CIN?
A
Always asymptomatic
Detected at smear
23
Q
Is CIN visible to the naked eye?
A
No
24
Q
What is the management of CIN?
A
Grade 2 or 3 = LLETZ loop diathermy
Grade 1 = low risk progression so just normal screening
25
CIN has a risk of progressing to what type of cancer?
Squamous cell carcinoma
26
What is the commonest cell type in cervical cancer?
Squamous cell carcinoma
27
What differentiates CIN from squamous cell carcinoma?
Squamous cell carcinomas invade basement membrane
28
What part of the cervix do squamous cell carcinomas arise?
Ectocervix transition zone
29
80% of females are infected with HPV 16 or 18 but most develop immunity. T or F
True
30
How long post CIN does squamous cervical carcinoma occur?
5-20 years
31
Squamous cervical carcinomas spread early to LN. T or F
True
| to pelvic, para-aortic, obturator and internal iliac
32
Squamous cervical carcinomas spread early via the haematogenous route. T or F
False
| but when do its to lung, liver, bone
33
What age range does squamous cervical cancer happen in?
Young
34
How does squamous cervical cancer present?
```
Intermenstrual / post-coital bleeding
Brown/red discharge
Dyspareunia
Haematuria
Pelvic pain
```
Or asymptomatic
35
A rare presentation of squamous cervical cancer is failure of what organ?
Renal failure
36
What staging system is used for gynae cancer?
FIGO
37
Following positive cytology form cervical screening, what the next step?
Biopsy?? Unsure
38
What imaging is used for local disease and what is used for distant mets in cervical cancer?
Local MR
| Distant CT
39
What is adjuvant and neo-adjuvant therapy?
Neo-adjuvant pre surgery
| Adjuvant post surgery
40
What is the management of squamous cervical carcinoma?
Radical hysterectomy +-
| radio/chemo
41
What radio/chemo agents are used for squamous cervical cancers?
Cisplatin platinum
42
What is the 2nd commonest type of cervix cancer?
Adenocarcinoma
43
Where in the cervix do adenocarcinomas arise?
Endocervix
44
What has the worse prognosis, cervix adenocarcinomas or squamous carcinomas?
Adenocarcinomas
| Screening is also less effective in adenocarcinomas
45
What do adenocarcinomas of the cervix arise from?
CGIN
| endocervical glandular intra-epithelial neoplasia
46
What virus are adenocarcinomas of the cervix associated with?
HPV 18
47
Are cervical polyps pre-malignant?
No
48
How do endometrial polyps present?
DUB
49
How is endometrial hyperplasia classified?
| 2 methods
Simple vs complex
| Atypical vs typical
50
What is the cause of endometrial hyperplasia?
Persistent estrogen stimulation
51
Crowded glands is characteristic of what types of endometrial hyperplasia?
Complex and atypical
52
Dilated glands + stroma is characteristic of what type of endometrial hyperplasia?
Simple
53
In simple and complex endometrial hyperplasia, how is cytology?
Normal in both
54
What is the management of complex endometrial hyperplasia?
IUS
55
How is cytology in atypical endometrial hyperplasia?
Abnormal
56
What is the management of atypical endometrial hyperplasia?
Hysterectomy
57
What are the 2 stereotypical risk factors for endometrial cancer?
Obese + post-menopausal
| Other RF include PCOS and E only HRT
58
Why is obesity a risk factor for endometrial cancer?
Adipocytes contain aromatase which converts androgens to estrogen
No progesterone to shut proliferate
Hence unopposed estrogen
59
What are the 2 types of endometrial carcinomas?
I endometroid mucinous
| II serous
60
What is the management of endometrial carcinomas?
Hysterectomy + bilateral salpingectomy + radio +-chemo
61
What cell type do endometrial carcinomas of the uterus arise from?
Adenocarcinoma
62
What is the peak age range of endometrial carcinomas?
50-60 years
63
Endometrial carcinoma is a patient under 40 years is rare, there is likely a predisposing factor such as ....
Lynch syndrome
(AKA HNPCC)
PCOS
64
What is the main presenting complaint in endometrial carcinomas?
Abnormal bleeding esp. post-menopausal
65
What is the 1st line Ix for endometrial carcinomas?
TVUS measure endometrial thickness
| biopsy if thickened
66
What imaging is used for endometrial carcinomas Ix?
Local spread - MR
| Lung met - chest CT
67
What genetic syndrome has a mismatch repair proteins and microsatellite instability?
Lynch syndrome
| AKA HNPCC
68
What cancers is Lynch syndrome (AKA HNPCC) associated with?
Mainly endometrial and colorectal
| Less commonly ovarian
69
"A well circumscribed smooth muscle tumour of the myometrium" describes a _____
Fibroid
70
What is the other name for fibroids?
Leiomyoma
71
Fibroids are often present in multiples. T or F
True
72
Where are fibroids most commonly?
Uterine body
73
Fibroids are always benign. T or F
False, very rarely leiomyosarcoma
74
How can fibroids present?
Menorrhagia, dysmenorrhea, subfertile
75
Fibroids are most common in women [under/over] 40 y.o.
over
76
What test is diagnostic of fibroids?
US
77
What is the management of asymptomatic fibroids?
Monitor size
78
What is the 1st line Mx of fibroids causing menorrhagia?
Traxenamic acid during menses
| POP
79
What is the 2nd line Mx of fibroids causing menorrhagia?
Offer hysterectomy (if family full) or myomectomy or resection
80
What is the name of the rare complication of fibroids that occurs in pregnancy or perimenopausally and causes acute nausea and vomiting?
Red degeneration
| torsion
81
What is the name of the type of uterine cancer where stroma is present in the endometrium? PC bleeding. The management involves anti-estrogens
Endometrial stromal sarcoma
82
Are ovarian teratomas benign or malignant?
Benign
83
What are ovarian teratomas also known as?
Dermoid cyst
84
What cell type do ovarian teratomas arise from?
```
Germ cell
(Ectoderm, mesoderm and endoderm)
(Hence different tissue types, mostly fat)
```
85
Ovarian teratomas are difficult to see on US. T or F
True
| different densities
86
What are ovarian simple cysts also known as?
Functional cysts
87
Functional aka simple ovarian cysts are usually an incidental finding. T or F
True
| rarely can rupture
88
What is the pathology behind functional aka simple ovarian cysts?
Ovulation related follicular/luteal
89
Are Brenner's tumour of the ovary benign or malignant?
Benign
90
What cell type do Brenner's tumour of the ovary arise from?
Transitional epithelium
91
Are endometriotic cysts epithelial or stromal?
Epithelial
92
What is the name of the ovarian growth described?
- Occur in absence of ovulation
- Thin and small
- Originate from granulosa cells
- Self limiting
- Associated with PCOS
```
Follicular cysts
(Occur since follicle doesn’t rupture in absence of ovulation)
```
93
What is the name of the ovarian growth described?
- Multilocular
- Originate from mucinous / serous epithelial cells
- If symptomatic require removal or drainage
Cystoadenoma
94
What are the commonest cancers that metastasise to ovaries?
Breast, pancreas, stomach, colon
| A red flag is small and bilateral tumours
95
What is the name of the rare malignant germ cell tumour of the ovary?
Hint: most common in young adults
Dysgerminoma
96
What is the clinical significance of dysgerminomas that distinguishes them from other ovarian malignancies?
Produce hormones - such as HCG (so can cause a false positive pregnancy)
97
What type of ovarian cancer is associated with Lynch AKA HNPCC syndrome?
Clear cell
98
What age range is ovarian cancer most common in?
Post-menopausal
99
BRCA 1 and 2 are associated with ovarian cancer. T or F
True
100
Multiparity is a risk factor for ovarian cancer. T or F
False
| Nulliparity is a risk factor
101
Ovarian cancer typically present early. T or F
False, presents late (insidious)
102
Patients with BRCA mutations are offered a salpingo-oophorectomy. What specific medication must these patients be started on subsequently and for how long?
HRT until age of menopause
103
What are the 2 types of ovarian cancer?
Serous and mucinous
104
What type of ovarian cancer is associated with BRCA mutations?
Serous
105
What type of malignancy is ovarian cancer?
Adenocarcinoma
| Cystoadenocarcinoma
106
What are the main symptoms of ovarian cancer?
```
Bloating
Early satiety
Bowel > frequency
Pelvic pain
SOB
Heartburn
```
(Also leg edema, malignant pleural effusions, weight loss)
107
Where are the commonest places for ovarian cancer to metastasise?
Peritoneum omentum and liver
| Rarer LN and lung
108
What is the name of the ovarian cancer tumour marker?
CA125
109
What is the name of the tumour marker used to exclude a met from a GI primary in a malignant ovarian lesion?
CEA
110
What imaging is done for ovarian cancers?
TAUS, TVUS, CT
111
What test is the definitive Dx of ovarian cancer?
Biopsy
112
What is the management of stage 1 or 2 ovarian cancer?
Debulking surgery: remove ovaries + uterus + omentum +-LN
113
What is the management stage 3 or 4 ovarian cancer?
Chemo carboplatin / paclitaxel
114
What is FIGO stage 1?
Confined within specific organ
115
What is FIGO stage 2?
Invades local structure
116
What is FIGO stage 3?
LN
| Or peritoneal met in ovarian cancer
117
What is FIGO stage 4?
Distant met
118
What is the triad of Meigs syndrome?
Benign ovarian fibroma + ascites + pleural effusion
119
What type of stromal sex cord ovarian tumour is always malignant, secretes estrogen and can cause precocious puberty or PMB?
Granulosa cell
120
What type of stromal sex cord ovarian tumour secretes androgens cause hirsutism and female virilisation?
Theca cell
