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Year 2 RE > Pathology of the female reproductive tract part 3 > Flashcards

Pathology of the female reproductive tract part 3 Flashcards

1
Q

What are some of the key reasons why endometrial cancer has been steadily increasing and is now the most common gynaecological cancer in the UK?

A
  • increasing age
  • obesity
  • nulliparity (no births) due to lack of renewal of endometrium
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2
Q

There are 2 types of endometrial cancer, what are they?

A
  • type 1 = endometrioid adenocarcinomas linked to estrogen
  • type 2 = not linked to excess oestrogen
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3
Q

There are 2 types of endometrial cancer:

  • type 1 = endometrioid adenocarcinomas (glandular) linked to estrogen
  • type 2 = not linked to excess oestrogen

Which is more common and more severe?

A
  • type 1 is more common = 80-90% of cases
  • type 2 is more aggressive with worse prognosis
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4
Q

What is a adenocarcinomas?

A
  • adeno = latin for gland
  • carcinoma = latin for epithelial cells
  • cancer that develops in the glands that line your organs
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5
Q

Type 1 endometrial cancer, which are adenocarcinomas (cancer of glandular cells in endometrium) begins as which of the following:

1 - atypical hyperplasia
2 - atypical metaplasia
3 - typical hyperplasia
4 - typical metaplasia

A

1 - atypical hyperplasia

- essentially abnormal hyperplasia

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6
Q

Type 1 endometrial cancer, which are adenocarcinomas (cancer of glandular cells in endometrium) begins as atypical hyperplasia (abnormal hyperplasia) and is driven by the unopposed production of which hormone?

A
  • estrogen
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7
Q

The slide below shows type 1 endometrial cancer. What is the defining feature of this image that confirms type 1 endometrial cancer?

A
  • increased cell number
  • atypia (loss of normal glandular (appearance)
  • increased nucleus size
  • increased nuclear to cytoplasm ratio
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8
Q

Type 2 endometrial cancers are generally those that are not estrogen dependent. What 5 types of cancers can these be?

A
  • serous (smooth tissue membrane of mesothelium lining)
  • clear cell
  • mucinous
  • squamous
  • sarcoma (cancer in connective tissue)
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9
Q

Type 2 endometrial cancers are generally those that are not estrogen dependent. They generally occur in which of the following:

1 - hyperplasia endometrium
2 - atrophic endometrium
3 - metaplastic endometrium
4 - dysplastic endometrium

A

2 - atrophic endometrium

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10
Q

Type 2 endometrial cancers are generally those that are not estrogen dependent. Which genetic mutation drives this type of cancer?

1 - Rb
2 - p53
3 - BCRA
4 - NUS3

A

2 p53 gene

- tumour suppressing gene doesn’t work so tumour develops

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11
Q

The grading of type 2 endometrial cancers, those generally are not estrogen dependent. They can be staged on a level of 1-3. What is the staging based upon?

1 - how much tissue is affected
2 - where the affected tissue is
3 - how similar tissue is to healthy tissue

A

3 - how similar tissue is to healthy tissue

  • Well differentiated- Grade 1
  • Moderately differentiated- Grade 2
  • Poorly differentiated- Grade 3
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12
Q

If a patient has been confirmed as having endometrial cancer they will generally be referred to a multidisciplinary clinic. What investigations will they need prior to being referred to a multidisciplinary clinic?

1 - ultrasound, MRI, biopsy, histology scoring
2 - blood test, MRI, biopsy, histology scoring
3 - genetic testing, MRI, biopsy, histology scoring
4 - ultrasound, MRI, genetic testing, histology scoring

A

1 - ultrasound, MRI, biopsy, histology scoring

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13
Q

What would be the treatment for a patient with endometrial cancer stage 1 grade 1 and stage 2 grade 2?

1 - MRI and monitor
2 - colposcopy
3 - total abdominal hysterectomy and oophprectomy with pelvis examination
4 - hysterectomy

A

3 - total abdominal hysterectomy and oophprectomy with pelvis examination

  • bilateral oophorectomy (removal of ovaries)
  • careful pelvic inspection (staging helps identify risk of metastasis)
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14
Q

What risk is of stage 1-3 of endometrial cancer?

1 - low
2 - intermediate
3 - high
4 - severe

A

2 - intermediate

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15
Q

What would be the treatment for a patient with endometrial cancer stage 1 grade 3?

1 - MRI and monitor
2 - colposcopy
3 - radical hysterectomy and oophprectomy with pelvis examination
4 - radical hysterectomy, oophprectomy, pelvic and para lymph node dissection and radiotherapy

A

4 - radical hysterectomy, oophprectomy, pelvic and para lymph node dissection and radiotherapy

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16
Q

What are the 3 methods to do for hysterectomy?

A

1 - laparoscopic
2 - open abdominal
3 - robotics
UTERUS IS REMOVED VAGINALLY THOUGH

17
Q

Cervical cancer incidence is declining, what are the main reasons for this?

A
  • smear screening roll out

- diagnosis is earlier

18
Q

The prevalence of human papillomavirus (HPV) has been reducing between 2008 and now. What is the main reason for this?

A
  • vaccination (ideally prior to exposure to HPV)
  • targets HPV strains 16 and 18 using Cervarix
  • new HPV vaccine Gardasil targets HPV strains 6, 11, 16 and 18 (changed in 2012)
19
Q

What are the 3 main treatment options for a patient with a confirmed diagnosis of cervical cancer?

A
  • surgery
  • chemotherapy
  • radiotherapy (local radiation)
20
Q

What cell type is associated with aprox 80% of all cervical cancers?

A
  • squamous epithelial cells
21
Q

In staging of cervical cancer (except for very early staging of disease) how is staging of cervical cancer performed?

A
  • cystoscopy (camera into the bladder) as cervical cancer can spread easily
  • patient will be anaesthetised
  • spread to bladder is important to determine staging and spread
22
Q

What imaging modality is used to assess the parametrium and the pelvic and para-aortic lymph nodes?

A
  • MRI
23
Q

What is the 5 year survival rate of someone with cervical caner?

A
  • 60%

- follow up 6 monthly then annually for 5 years following treatment

24
Q

The 5 year survival rate of someone with cervical caner is 60%. When is recurrence most likely?

A
  • within 3 years
25
Q

Is cervical cancer common in pregnancy?

A
  • no

Year 2 RE (53 decks)

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