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ESA 4 > Repro 12 > Flashcards

Repro 12 Flashcards

1
Q

vulval tumours are most commonly what type of cancer?

A

squamous carcinomas, carcinoma= malignant neoplasm of epithelial cells, so squamous= malignant neoplasm of squamous epithelial cells, with malignant= ability to metastasise

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2
Q

most common cause of vulval tumours in pre-menopausal women?

A

HPV

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3
Q

where does a vulval tumour caused by HPV metastasise to? to

A

inguinal LNs

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4
Q

what is vulval carcinoma in older women related to?

A

chronic irritation and longstanding dermatoses e.g. lichen sclerosus and squamous hyperplasia

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5
Q

most carcinomas of cervix are what type?

A

squamous

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6
Q

common aetiology of cervical carcinomas?

A

HPV

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7
Q

aim of cervical screening programme?

A

detect pre-invasive lesion and excise involved area completely before a tumour can develop

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8
Q

cells of pre-invasive lesion detected in cervical screening?

A

dyskaryotic cells= cells with abnormally enlarged nuclei possessing abnormal chromatin

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9
Q

what is prognosis of cervical carcinoma affected by?

A

size of tumour

depth of invasion

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10
Q

where does cervical carcinoma spread?

A

iliac and then aortic LNs, before wider systemic dissemination
local spread involves ureters, bladder and rectum, and is very distressing with pain and fistula formation

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11
Q

most probable aetiology in perimenopausal women of endometrial adenocarcinoma?

A

unopposed oestrogen from obesity, exogenous oestrogen administration, or a hormone-secreting tumour

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12
Q

symptoms of fibroids?

A

menorrhagia and intermenstrual bleeding, pain, discharge and infertility

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13
Q

malignant counterpart of fibroids?

A

leimyosarcoma

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14
Q

where might a leiomyosarcoma metastasise?

A

blood to lungs and then systemically

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15
Q

what do ovarian tumours cause by spreading through the abdomen?

A

ascites
intestinal obstruction
perforation
death

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16
Q

useful tumour markers in malignant germ cell tumours?

A

beta hCG

alpha fetoprotein

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17
Q

examples of malignant germ cell tumours?

A

dysgerminoma
yolk sac tumour
choriocarcinoma
embryonal carcinoma

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18
Q

what is a thecoma?

A

benign tumour derived from ovarian stroma

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19
Q

examples of a sex cord tumour?

A

granulosa cell tumour

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20
Q

consequences of rare sex cord stromal tumours secreting androgens?

A

defeminisation
masculinisation
amenorrhoea
infertility

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21
Q

what is a hydatidiform mole?

A

results from a chromosomal defect in the conceptus causing oedema of the placetal chorionic villi. Assoc. atypical trophoblastic hyperplasia and tumours have the propensity for myometrial penetration. May persisit, invade, metastasise and kill. sig. risk of development of choriocarcinoma

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22
Q

what is a choriocarcinoma?

A

malignant tumour of placenta composed of syncytio and cytotrophoblast without villi.

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23
Q

RFs for cervical cancer?

A

smoking
multiple sexual partners
multiple births
low SE class

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24
Q

macroscopic cervical carcinoma appearance?

A

ulcer
cervical expansion
nodule

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25
symptoms of squamous cell cervical carcinoma?
post-coital, intermenstrual bleeding or post menopausal bleeding
26
what is cervical intraepithelial neoplasia graded on?
mitotic activity nuclear pleomorphism/hyperchromasia nuclear to cytoplasmic ratio
27
when does cervical screening start?
age 25, then every 3 years till 50 5 years 50-65 Abnormal – referred for colposcopy- magnifying instrument to look at surface of cervix
28
malignant features of leiomyosarcoma?
mitoses atypia necrosis- as outgrows its blood supply infiltration
29
what do granulosa cell tumours usually secrete?
oestrogen
30
granulosa cell tumour histological appearance?
coffee bean nuclei | call-exner bodies
31
histology of leygig/steroid cell tumour?
abundant cytoplasm in cells arranged in pink sheets | crystals of Reinke
32
which cells are affected in cervical intraepithelial neoplasia, and how does this progress?
all cells at all levels abnormal= important as screening only looks at the surface layer, exfoliative cytology wouldn't work otherwise CIN I, II and III= carcinoma in-situ= most likely to invade and so progress to cancer
33
risk factors for type I endometrial adenocarcinoma?
``` unopposed oestrogen: early menarche late menopause obesity iatrogenic nulliparous- continuous cycling of endometrium with SF breakdown every month ```
34
what is type II endometrial adenocarcinoma?
clear cell and uterine serous papillary, high grade and arises spontaneously, post-menopause, cancer doens't have to grow very far to invade other structures as endometrium small and atrophied
35
endometrial adenocarcinoma macroscopic appearance?
soft, white, mushy invades myometrium and cervix spread to adnexa glands
36
what determines endometrial adenocarcinoma prognosis?
depth- myometrial thickness grade/type- hormone related tend to be better grade and prognosis assoc hyperplasia involvement of cervical stroma/adnexa
37
types of endometrial hyperplasia?
simple: cystic glands, abundant stroma complex: crowded, branched or budded glands complex with atypia: cytological features of malignancy of varying degrees
38
what are polyps in the uterus?
benign growths of endometrium
39
why can excessive bleeding and cramping occur with endometrial hyperplasia?
inflammatory response of uterus
40
why do fibroids cause menorrhagia?
increase area of endometrium that can bleed
41
what may ovarian neoplasms arise from?
metastases e.g. krukenberg tumour- from gastric cancer- virchow's node germ cells sex cord components e.g. granulosa cell tumour stroma surface epithelium- simple cuboidal
42
clinical presentation of ovarian neoplasms?
presents late no symptoms of precursor symptoms later confused with IBS: abdominal pain, bloating after meals hormonal: menstrual disturbances, inappropriate sex hormones late: ascites, obstruction, perforation and DEATH- transcoelomic spread through peritoneum
43
types of epithelial ovarian carcinoma?
``` serous mucinous endometrioid clear cell Brenner (transitional) All can be benign, malignant or borderline- don't invade/spread but epithelial characteristics of malignant cells ```
44
where do mucinous ovarian tumours usually arise from?
usually metastasise from bowel and appendix | intestinal mucin secreting epithelium
45
why is combined OCP protective against ovarian cancer?
progesterone and oestrogen acting together inhibit ovulation and hence the destruction of the overlying epithelium of the ovaries and their subsequent regeneration process
46
what cancer might endometriosis increase the risk of?
endometrioid ovarian tumour- may occur in patient who has had a hysterectomy but is on HRT- oestrogen will allow growth of ectopic endometrial tissue
47
RFs for ovarian cancer?
``` BRCA1 and 2 genes in familial cases smoking obesity endometriosis prior cyst e.g. as a result of PID? ```
48
where do leydig cell tumours- a type of sex cord stromal tumour of the ovary arise?
hilum of ovary
49
symtpoms of a patient with an androgen secreting sex cord stomal tumour?
male pattern baldness clitoromegaly acne
50
what is meig's syndrome?
occurs with a thecoma: stromal cell tumour, ascitic fluid accumulation, unilateral fluid in thorax
51
why is there increasing incidence of vulval tumours?
ageing population | increased HPV transmission
52
examples of vulval tumours?
squamous carcinoma adenocarcinoma basal cell carcinoma malignant melanoma
53
why might a patient with a vulval carcinoma die from bleeding?
cancer involvement of femoral artery
54
characteristics of squamous vulval carcinomas?
keratotic warty ulcerated
55
characteristics of vulval intraepithelial neoplasia?
``` scaly red patch sore itchy white labia, perineum, perianal, incidental ```
56
histology of VIN?
abnormal maturation | mitotic activity above basal layer
57
characteristics of vulva basal cell carcinoma?
``` ulcerated pearly white or pigmented nodule mainly labia major- from LS folds deeply infiltrating if neglected doesn't metastasise ```
58
describe a hydatidiform mole
villous growth abnormality: villi swollen- oedema, as blood not being pumped by fetus through villi as fetus absent or abnormality
59
at risk groups of hydatidiform mole?
50 yr old women
60
where does a choriocarcinoma metastasise to?
genital tract, lungs and brain

ESA 4 (24 decks)

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