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Y3 Reproductive > Neoplasms (Par Breast Cancer) > Flashcards

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
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2
Q

What potential cause of a pelvic mass is associated with PID and pus?

A

Pyosalpinx

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3
Q

What potential cause of a pelvic mass occurs when a uterine tube is blocked? It is sometimes an incidental finding

A

Hydrosalpinx

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4
Q

Who receives cervical screening and how often?

A

Females
Age 25-49 every 3yr
Age 50-64 every 5yr

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5
Q

What is the procedure of cervical screening?

A

Visualise cervix with speculum

Brush sample at TZ for cytology

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6
Q

What is Gardasil?

A

HPV vaccine (against HPV 6, 11, 16, 18)

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7
Q

Who receives Gardasil?

A

Females in S1-S3

MSM under 45yr

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8
Q

Gardasil protects against all cervical cancer. T or F

A

False, doesn’t protect against 30%

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9
Q

Define dyskaryosis

A

Abnormal cervical cells

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10
Q

What does CIN stand for?

A

Cervical intraepithelial neoplasia
(VIN vulvar)
(VaIN vaginal)
(AIN anal)

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11
Q

What is intraepithelial neoplasia (such as CIN) associated with?

A

HPV

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12
Q

_____ exposure causes a ______ squamous ______ resulting in cervical erosion

A

ACID exposure causes a PHYSIOLOGICAL squamous METAPLASIA resulting in cervical erosion

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13
Q

What change on histology indicates the present of HPV?

A

Koilocytosis

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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
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15
Q

How long post HPV 16/18 infection does CIN occur?

A

6 months to 3 years

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16
Q

Are mitotic figures raised in CIN?

A

Yes

pleomorphism also present

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17
Q

What pathology term describes the change to the cells in CIN?

A

Dysplasia

also koilocytosis

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18
Q

How many grades of CIN are there?

A

3

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19
Q

What is grade 1 CIN?

A

Abnormal cells in basal ⅓ epithelium
Nuclei slightly abnormal
Mitotic figures less than ⅓

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20
Q

What is grade 2 CIN?

A

Abnormal cells extend to middle ⅓

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21
Q

What is grade 3 CIN?

A

Abnormal cells occupy full thickness epithelium, mitosis in upper ⅓.

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22
Q

What are the S+S of CIN?

A

Always asymptomatic

Detected at smear

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23
Q

Is CIN visible to the naked eye?

A

No

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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

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25
Q

CIN has a risk of progressing to what type of cancer?

A

Squamous cell carcinoma

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26
Q

What is the commonest cell type in cervical cancer?

A

Squamous cell carcinoma

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27
Q

What differentiates CIN from squamous cell carcinoma?

A

Squamous cell carcinomas invade basement membrane

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28
Q

What part of the cervix do squamous cell carcinomas arise?

A

Ectocervix transition zone

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29
Q

80% of females are infected with HPV 16 or 18 but most develop immunity. T or F

A

True

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30
Q

How long post CIN does squamous cervical carcinoma occur?

A

5-20 years

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31
Q

Squamous cervical carcinomas spread early to LN. T or F

A

True

to pelvic, para-aortic, obturator and internal iliac

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32
Q

Squamous cervical carcinomas spread early via the haematogenous route. T or F

A

False

but when do its to lung, liver, bone

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33
Q

What age range does squamous cervical cancer happen in?

A

Young

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34
Q

How does squamous cervical cancer present?

A 
Intermenstrual / post-coital bleeding 
Brown/red discharge
Dyspareunia
Haematuria
Pelvic pain

Or asymptomatic

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35
Q

A rare presentation of squamous cervical cancer is failure of what organ?

A

Renal failure

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36
Q

What staging system is used for gynae cancer?

A

FIGO

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37
Q

Following positive cytology form cervical screening, what the next step?

A

Biopsy?? Unsure

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38
Q

What imaging is used for local disease and what is used for distant mets in cervical cancer?

A

Local MR

Distant CT

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39
Q

What is adjuvant and neo-adjuvant therapy?

A

Neo-adjuvant pre surgery

Adjuvant post surgery

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40
Q

What is the management of squamous cervical carcinoma?

A

Radical hysterectomy +-

radio/chemo

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41
Q

What radio/chemo agents are used for squamous cervical cancers?

A

Cisplatin platinum

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42
Q

What is the 2nd commonest type of cervix cancer?

A

Adenocarcinoma

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43
Q

Where in the cervix do adenocarcinomas arise?

A

Endocervix

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44
Q

What has the worse prognosis, cervix adenocarcinomas or squamous carcinomas?

A

Adenocarcinomas

Screening is also less effective in adenocarcinomas

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45
Q

What do adenocarcinomas of the cervix arise from?

A

CGIN

endocervical glandular intra-epithelial neoplasia

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46
Q

What virus are adenocarcinomas of the cervix associated with?

A

HPV 18

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47
Q

Are cervical polyps pre-malignant?

A

No

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48
Q

How do endometrial polyps present?

A

DUB

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49
Q

How is endometrial hyperplasia classified?

2 methods

A

Simple vs complex

Atypical vs typical

50
Q

What is the cause of endometrial hyperplasia?

A

Persistent estrogen stimulation

51
Q

Crowded glands is characteristic of what types of endometrial hyperplasia?

A

Complex and atypical

52
Q

Dilated glands + stroma is characteristic of what type of endometrial hyperplasia?

A

Simple

53
Q

In simple and complex endometrial hyperplasia, how is cytology?

A

Normal in both

54
Q

What is the management of complex endometrial hyperplasia?

A

IUS

55
Q

How is cytology in atypical endometrial hyperplasia?

A

Abnormal

56
Q

What is the management of atypical endometrial hyperplasia?

A

Hysterectomy

57
Q

What are the 2 stereotypical risk factors for endometrial cancer?

A

Obese + post-menopausal

Other RF include PCOS and E only HRT

58
Q

Why is obesity a risk factor for endometrial cancer?

A

Adipocytes contain aromatase which converts androgens to estrogen
No progesterone to shut proliferate
Hence unopposed estrogen

59
Q

What are the 2 types of endometrial carcinomas?

A

I endometroid mucinous

II serous

60
Q

What is the management of endometrial carcinomas?

A

Hysterectomy + bilateral salpingectomy + radio +-chemo

61
Q

What cell type do endometrial carcinomas of the uterus arise from?

A

Adenocarcinoma

62
Q

What is the peak age range of endometrial carcinomas?

A

50-60 years

63
Q

Endometrial carcinoma is a patient under 40 years is rare, there is likely a predisposing factor such as ….

A

Lynch syndrome
(AKA HNPCC)
PCOS

64
Q

What is the main presenting complaint in endometrial carcinomas?

A

Abnormal bleeding esp. post-menopausal

65
Q

What is the 1st line Ix for endometrial carcinomas?

A

TVUS measure endometrial thickness

biopsy if thickened

66
Q

What imaging is used for endometrial carcinomas Ix?

A

Local spread - MR

Lung met - chest CT

67
Q

What genetic syndrome has a mismatch repair proteins and microsatellite instability?

A

Lynch syndrome

AKA HNPCC

68
Q

What cancers is Lynch syndrome (AKA HNPCC) associated with?

A

Mainly endometrial and colorectal

Less commonly ovarian

69
Q

“A well circumscribed smooth muscle tumour of the myometrium” describes a _____

A

Fibroid

70
Q

What is the other name for fibroids?

A

Leiomyoma

71
Q

Fibroids are often present in multiples. T or F

A

True

72
Q

Where are fibroids most commonly?

A

Uterine body

73
Q

Fibroids are always benign. T or F

A

False, very rarely leiomyosarcoma

74
Q

How can fibroids present?

A

Menorrhagia, dysmenorrhea, subfertile

75
Q

Fibroids are most common in women [under/over] 40 y.o.

A

over

76
Q

What test is diagnostic of fibroids?

A

US

77
Q

What is the management of asymptomatic fibroids?

A

Monitor size

78
Q

What is the 1st line Mx of fibroids causing menorrhagia?

A

Traxenamic acid during menses

POP

79
Q

What is the 2nd line Mx of fibroids causing menorrhagia?

A

Offer hysterectomy (if family full) or myomectomy or resection

80
Q

What is the name of the rare complication of fibroids that occurs in pregnancy or perimenopausally and causes acute nausea and vomiting?

A

Red degeneration

torsion

81
Q

What is the name of the type of uterine cancer where stroma is present in the endometrium? PC bleeding. The management involves anti-estrogens

A

Endometrial stromal sarcoma

82
Q

Are ovarian teratomas benign or malignant?

A

Benign

83
Q

What are ovarian teratomas also known as?

A

Dermoid cyst

84
Q

What cell type do ovarian teratomas arise from?

A 
Germ cell 
(Ectoderm, mesoderm and endoderm)
(Hence different tissue types, mostly fat)
85
Q

Ovarian teratomas are difficult to see on US. T or F

A

True

different densities

86
Q

What are ovarian simple cysts also known as?

A

Functional cysts

87
Q

Functional aka simple ovarian cysts are usually an incidental finding. T or F

A

True

rarely can rupture

88
Q

What is the pathology behind functional aka simple ovarian cysts?

A

Ovulation related follicular/luteal

89
Q

Are Brenner’s tumour of the ovary benign or malignant?

A

Benign

90
Q

What cell type do Brenner’s tumour of the ovary arise from?

A

Transitional epithelium

91
Q

Are endometriotic cysts epithelial or stromal?

A

Epithelial

92
Q

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
A 
Follicular cysts
(Occur since follicle doesn’t rupture in absence of ovulation)
93
Q

What is the name of the ovarian growth described?

  • Multilocular
  • Originate from mucinous / serous epithelial cells
  • If symptomatic require removal or drainage
A

Cystoadenoma

94
Q

What are the commonest cancers that metastasise to ovaries?

A

Breast, pancreas, stomach, colon

A red flag is small and bilateral tumours

95
Q

What is the name of the rare malignant germ cell tumour of the ovary?
Hint: most common in young adults

A

Dysgerminoma

96
Q

What is the clinical significance of dysgerminomas that distinguishes them from other ovarian malignancies?

A

Produce hormones - such as HCG (so can cause a false positive pregnancy)

97
Q

What type of ovarian cancer is associated with Lynch AKA HNPCC syndrome?

A

Clear cell

98
Q

What age range is ovarian cancer most common in?

A

Post-menopausal

99
Q

BRCA 1 and 2 are associated with ovarian cancer. T or F

A

True

100
Q

Multiparity is a risk factor for ovarian cancer. T or F

A

False

Nulliparity is a risk factor

101
Q

Ovarian cancer typically present early. T or F

A

False, presents late (insidious)

102
Q

Patients with BRCA mutations are offered a salpingo-oophorectomy. What specific medication must these patients be started on subsequently and for how long?

A

HRT until age of menopause

103
Q

What are the 2 types of ovarian cancer?

A

Serous and mucinous

104
Q

What type of ovarian cancer is associated with BRCA mutations?

A

Serous

105
Q

What type of malignancy is ovarian cancer?

A

Adenocarcinoma

Cystoadenocarcinoma

106
Q

What are the main symptoms of ovarian cancer?

A 
Bloating
Early satiety
Bowel > frequency
Pelvic pain
SOB
Heartburn

(Also leg edema, malignant pleural effusions, weight loss)

107
Q

Where are the commonest places for ovarian cancer to metastasise?

A

Peritoneum omentum and liver

Rarer LN and lung

108
Q

What is the name of the ovarian cancer tumour marker?

A

CA125

109
Q

What is the name of the tumour marker used to exclude a met from a GI primary in a malignant ovarian lesion?

A

CEA

110
Q

What imaging is done for ovarian cancers?

A

TAUS, TVUS, CT

111
Q

What test is the definitive Dx of ovarian cancer?

A

Biopsy

112
Q

What is the management of stage 1 or 2 ovarian cancer?

A

Debulking surgery: remove ovaries + uterus + omentum +-LN

113
Q

What is the management stage 3 or 4 ovarian cancer?

A

Chemo carboplatin / paclitaxel

114
Q

What is FIGO stage 1?

A

Confined within specific organ

115
Q

What is FIGO stage 2?

A

Invades local structure

116
Q

What is FIGO stage 3?

A

LN

Or peritoneal met in ovarian cancer

117
Q

What is FIGO stage 4?

A

Distant met

118
Q

What is the triad of Meigs syndrome?

A

Benign ovarian fibroma + ascites + pleural effusion

119
Q

What type of stromal sex cord ovarian tumour is always malignant, secretes estrogen and can cause precocious puberty or PMB?

A

Granulosa cell

120
Q

What type of stromal sex cord ovarian tumour secretes androgens cause hirsutism and female virilisation?

A

Theca cell

Y3 Reproductive (28 decks)

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