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Semester 4 > Repro 12 > Flashcards

Repro 12 Flashcards

1
Q

What type of cancer are most carcinomas of the cervix?

A

Squamous

Adenocarcinoma 25-30%

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2
Q

What is required for cervical changes to be malignant?

A

HPV

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3
Q

What is CIN?

A

Cervical intraepithelial neoplasia.

Grade given based on mitotic activity, nuclear pleomorphism/hyperchromasia and nuclear/cytoplasmic ratio

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4
Q

What are the aetiology factors associated with carcinoma of the cervix?

A 
Lifestyle - Number of sexual partners, promiscuity, low social class, smoking
Immunocompromised
OCP
Number of pregnancies
Familial
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5
Q

What is the aim of cervical screening?

A

Detect the pre-invasive lesion and to excise the involved area completely before a tumour can develop

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6
Q

Why is exfoliative cytology adequate for cervical screening?

A

Cells at surface level always affected no matter what CIN stage

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7
Q

What does cervical screening detect?

A

Cells with abnormally enlarged nuclei possessing abnormal chromatin

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8
Q

When are women referred for colposcopy?

A

Abnormal cells and HPV positive

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9
Q

What chemical is used in colposcopy?

A

Diluted acetic acid

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10
Q

How are abnormal cells commonly existed for biopsy?

A

Diathermy

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11
Q

How often and at what age are women screened for cervical cancer?

A

3 years age 25-50

5years age 50-65

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12
Q

What features determine the prognosis of carcinoma of the cervix?

A

Spread - depth of invasion, size (much more important that differentiation)

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13
Q

Where do cervical carcinomas tend to spread?

A

Iliac and aortic lymph nodes initially before wider systemic dissemination
Local - ureters, bladder, rectum (extemely distressing with pain and fistula formation)

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14
Q

Who receives the vaccination for HPV?

A

12-13 year old girls (not effective if already exposed)

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15
Q

What is the most common type of vulval tumour?

A

Squamous carcinoma

Rarer - adenocarcinoma, basal cell and malignant melanoma

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16
Q

What is the cause of vulval tumour?

A

HPV in pre-menopausal women
In older women, the causative agent is unknown but are probably related to chronic irritation and longstanding dermatoses such as lichen sclerosis and squamous hyperplasia

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17
Q

How might vulval squamous cell carcinoma present?

A 
Scaly red patch
Sore 
Itchy
White
Incidental finding in 30%
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18
Q

Where do vulval carcinomas commonly spread to?

A

locally and metastasise to the inguinal lymph nodes

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19
Q

Can vuval sqaumous cell carcinoma be cured?

A

Yes if caught early - vulvectomy

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20
Q

Describe extramammary Paget’s disease?

A 
Commonly found in the vulva
Grows downwards
24-30% associated with invasive neoplasm
0.2% vulval carcinoma
Average age 63
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21
Q

How does vulval basal cell carcinoma present?

A

Pearly white/pigmented nodule

Ulcerated

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22
Q

Does vulval basal cell carcinoma have a positive prognosis?

A

Deeply infiltrative if neglected
Does not metastasise
Vulvectomy does not work

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23
Q

What is the common treatment of vulval squamous carcinomas?

A

Vulvectomy

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24
Q

Who commonly develops endometrial adenocarcinoma?

A

Perimenopausal and older women

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25
Q

What causes endometrial adenocarcinoma?

A

Unopposed oestrogen:

  • obesity
  • exogenous oestrogen administration
  • hormone-secreting tumour
  • late menopause/early menarche (long reproductive lifespan)
  • Tamoxifen
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26
Q

What types of cancer may occur in the endometrium?

A

Adenocarcinoma
Adenosquamous
Malignant stroma

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27
Q

What does the prognosis of endometrial adenocarcinoma depend on?

A

Grade

Spread in the myometrium

28
Q

Where does endometrial adenocarcinoma commonly spread to?

A 
Invades myometrium and cervix
Bladder
Rectum
Through peritoneal cavity
Regional lymph nodes
Adnex
29
Q

When might adjuvant therapy be required to treat endothelial adenocarcinoma?

A

With involvement of more than half the myometrium depth

30
Q

Who is endometrial carcinoma easier to treat in?

A

Younger women with type I (hormone related) as hormone dependent tumours are generally simpler to treat

31
Q

Describe type II endometrial carcinoma.

A 
Occurs in older women
Not hormone related
High grade
Spontaneous
Clear cell
Uterine serous papillary
32
Q

Describe the histology of endometrial adenocarcinoma.

A

Glands
Malignant epithelium
Squamous areas sometimes

33
Q

What are fibroids?

A

Benign tumours of uterine smooth muscle

Leiomyomas. Can be single but more commonly multiple leiomyomas

34
Q

What are the symptoms of fibroids?

A 
Heavy menstrual loss
Intermenstrual bleeding
Pain
Discharge
Infertility
35
Q

How do fibroids resolve?

A

Oestrogen dependent and usually regress after the menopause

36
Q

How do fibroids appear histologically?

A

Interlacing bundles of smooth muscle
Rounded ends to nuclei
Fibrotic or myloid stroma
Atypical types

37
Q

Compare leiomyoma and leiomyosarcoma.

A

Present with similar symptoms but leiomyosarcoma usually single

38
Q

What is the aetiology of leiomyosarcoma?

A

Unknown

39
Q

How do leiomyosarcoma appear histologically?

A

Massively increased mitotic activity
Cellular atypia
Infiltrative growth pattern

40
Q

Where do leiomyosarcomas metastasise to?

A

Lung by blood stream and systemically

41
Q

What is the aetiology of ovarian carcinoma?

A 
Super ovulation (IVF)
HRT
Smoking
Obesity
Endometriosis
Prior cysts
Talcum powder used to carry risk (asbestos)
42
Q

Where might tumours of the ovary arise from?

A

Epithelium (most common)
Stroma
Germ cells
Sex cord elements

43
Q

Why is there currently no screening for ovarian cancer?

A

No accepted pre-cursor lesion

Although, CA125 and ultrasonography is currently being investigated

44
Q

How does ovarian cancer tend to present?

A

Does not present until late
IBS symptoms initially
Spread within the abdomen where they can cause ascites, intestinal obstruction, perforation and death

45
Q

How are ovarian cancers typed?

A

Epithelium (serous, mucinous, endometrioid, transitional)

Benign, Low malignant potential or malignant

46
Q

What genes have been associated with ovarian cancer?

A

BRCA1 and 2 associated with familial ovarian epithelial carcinoma but this accounts for less than 1% of cases

47
Q

What is the most common type of germ cell tumour?

A

Mature (benign) cystic teratoma that contains skin, hair, teeth, bone and other tissue

48
Q

What is and immature germ cell tumour?

A

Malignant such as primitive neuroepithelium

Risk of intra abdominal spread and potential cause of death

49
Q

How should immature germ cell tumours be treated?

A

Chemo

50
Q

What other malignant germ cell tumours are there?

A

Dysgerminoma
Yolk sac tumour
Choriocarcinoma
Embryonal carcinomas

51
Q

How should dysgerminoma be treated?

A

Radiotherapy

52
Q

What is alpha-fetoprotein?

A

Plasma protein produced by the yolk sac - can be used to determine yolk sac tumours

53
Q

What is beta human chorionic gonadotrophin hormone?

A

Hormone secreted in pregnancy but also in certain cancers e.g. ovarian

54
Q

What are granulosa cell tumours?

A

Resemble the cells lining the ovarian follicle and are thus sex cord tumours

55
Q

What other diseases are associated with granulosa cell tumours and why?

A

Endometrial adenocarcinoma
Iso-sexual precocious puberty
Commonly produce oestrogens

56
Q

Where might granulosa cell tumours spread to and when might they recur?

A

Intra-abdominally

Can recur within 5 years or up to 20 years later

57
Q

What are thecomas?

A

Benign tumours derived from ovarian stroma. May also produce oestrogen and give rise to similar conditions as granulosa cell tumours

58
Q

What are fibromas?

A

Stromal tumours that cause pressure symptoms and sometimes ascites

59
Q

What is Meig’s syndrome and when is it commonly seen?

A

Ovarian tumour with ascites and pleural effusion that resolves after resection of the tumour. Most commonly produced by benign ovarian tumours

60
Q

Why can some tumours cause defeminisation?

A

Secrete androgens eg rare sex cord stromal tumours, Leydig cell tumours
Amenhorroea, masculinisation and infertility

61
Q

What are hydatidiform moles?

A

Gestational tumours from a chromosomal defect in the conceptus. Associated atypical trophoblastic hyperplasia and these tumours have the propensity for myometrial penetration

62
Q

What results from hydatidiform moles?

A

Oedema of the placental chorionic villi.
May persist, invade, metastasise and kill
Significant risk of development of choriocarcinoma and placental site trophoblastic tumour

63
Q

What is choriocarcinoma and where might it metastasise to?

A

A malignant tumour of placenta composed of syncytio and cytotrophoblast without villi
Genital tract, lungs and brain

64
Q

What is placental site trophoblastic tumour?

A

A rare variant of trophoblastic malignancy resembling intermediate trophoblast

65
Q

What is a complete hydatidiform mole?

A

Diploid chromosomal defect.
Most villi involved, with or without vessels
Atypical trophoblastic proliferation
p57 negative

66
Q

What is partial hydatidiform mole?

A 
Partial triploid (1 egg, 2 sperm) 
Some normal villi 
Geographical profile
Epithelial inclusion
Circumferential proliferation
p57 positive

Semester 4 (21 decks)

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