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3rd year > Repro - tumours (including breast) > Flashcards

Repro - tumours (including breast) Flashcards

1
Q

metastatic ovarian tumours commonly originate from what organs?

A

breast
pancreas
stomach
GI

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2
Q

what are functional cysts

A

a sac that forms on the surface of the ovary during or after ovulation

rarely >5cm

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3
Q

what are the symptoms of a functional cysts

A

usually asymptomatic
may be menstrual disturbance/bleeding
can rupture and cause pain

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4
Q

what is the treatment of a functional cyst

A

resolve spontaneously

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5
Q

what is a Endometriotic Cyst? describe them

A

this is endometrium in the wrong place causing blood filled cysts on the ovaries

they have a “chocolate” appearance

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6
Q

what are the symptoms of Endometriotic Cysts

A

severe dysmenorrhoea
premenstrual pain/painful sex
sub-fertility

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7
Q

what is a dermoid cyst? what is it also known as?

A

aka cystic tertoma

this is a tumour which may contain teeth, sebaceous material, hair, thyroid tissue etc

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8
Q

what investigation is done for a dermoid cyst? what can be seen?

A

CT

rim calcification with fat located inside

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9
Q

what are the types of ovarian cancer

A

epithelial cell tumours (90%)

germ/granulosa cell tumours

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10
Q

what are the risk factors for ovarian cancer

A

> 50 yrs
no/few children or delayed pregnancy
BRCA1 or BRCA 2

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11
Q

what are the symptoms of ovarian cancer

A 
persistent ascites/bloating 
early satiety/difficulty eating 
persistent abdo/pelvic pain 
bladder dysfunction 
pelvic mass
plural effusion causing SOB
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12
Q

what are the investigations of ovarian cancer

A

CA125 blood serum = raised
pelvic ultrasound
CT guided biopsy = gold standard

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13
Q

what are the stages of ovarian cancer

A 
I = 1 or both ovaries 
II = other pelvic organs
III = beyond pelvic within abdomen 
IV = spread to other organs
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14
Q

what is the treatment of ovarian cancer

A

gold standard = surgery (+ chemo if above stage IA)

fertility conserving treatment if stage I or II

chemo = carboplatin +/- paclitaxel

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15
Q

what is the prophylactic treatment to prevent ovarian cancer in BRCA1/2

A

oophorectomy + removal of fallopian tubes

hormone replacement required after

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16
Q

what is Cervical Intraepithelial Neoplasia

A

pre-invasive stage of cervical cancer that occurs at the transformation zone

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17
Q

what causes Cervical Intraepithelial Neoplasia

A

dysplasia of cervical squamous cells

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18
Q

what are the risk factors for Cervical Intraepithelial Neoplasia

A

HPV
smoking
immunosuppression

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19
Q

what are the 3 stages of Cervical Intraepithelial Neoplasia

A 
1 = basal 1/3rd abnormal cells
2 = 2/3rds abnormal cells
3 = full thickness abnormal cells
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20
Q

what are the symptoms of Cervical Intraepithelial Neoplasia

A

asymptomatic

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21
Q

what is the treatment of Cervical Intraepithelial Neoplasia

A

stage 1 = monitor

stage 2 or 3 = remove lesion (cautery, LLETZ, etc)

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22
Q

what are the two types of cervical cancer

A

cervical adenocarcinoma

cervical squamous carcinoma

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23
Q

what is the most common type of cervical cancer

A

cervical squamous carcinoma

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24
Q

what is the pre-malignant stage of cervical squamous carcinoma

A

Cervical Intraepithelial Neoplasia

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25
Q

what are the stages of cervical squamous carcinoma

A

Stage 1= Low risk of lymph node metastases
- A1= depth up to 3mm, width up to 7mm
- A2 = depth up to 5mm, width up to 7mm
- B = confined to the cervix (visible lesion)

Stage 2 = spread to adjacent organs
- A = vaginal involvement
- B = Local spread: uterine body, bladder, ureters, rectum

Stage 3 = involvement of pelvic wall or lower vagina

Stage 4 = distant metastases or involvement of rectum or bladder.

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26
Q

what are the symptoms of cervical squamous carcinoma

A

early stages = none

bleeding after sex/ after menopause
pelvic pain
haematuria/UTIs
ureteric obstruction

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27
Q

what is the treatment of cervical squamous carcinoma

A

surgery (fertility sparing)
radiotherapy
chemotherapy

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28
Q

what is Cervical Glandular intraepithelial Neoplasia (CGIN)

A

pre-invasive stage of cervical adenocarcinoma

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29
Q

where does Cervical Glandular intraepithelial Neoplasia originate

A

cervical epithelium

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30
Q

what are the risk factors for

Cervical Adenocarcinoma

A

smoking

HPV (18)

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31
Q

what is the treatment of

Cervical Adenocarcinoma

A

surgery (fertility sparing)
radiotherapy
chemotherapy

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32
Q

what is the pre-invasive stage of Cervical Adenocarcinoma

A

Cervical Glandular intraepithelial Neoplasia

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33
Q

who is usually affected by endometrial carcinoma? if they are young what should you consider?

A

50-60yrs old

if young consider PCOS or lynch syndrome

34
Q

what are the risk factors for endometrial carcinoma

A

obesity

oestrogen = HRT, tamoxifen

35
Q

what is lynch syndrome? what is its mode of inheritance?

A

hereditary non-polyposis colorectal cancer

autosomal dominant

36
Q

what are the symptoms of endometrial carcinoma

A

abnormal bleeding

37
Q

what are the two types of endometrial cancer

A

endometrioid

serous

38
Q

what is endometrioid endometrial cancer related to? what are the precursors to it?

A

related to unopposed oestrogen

precursors: hyperplasia, lynch syndrome

39
Q

what is the precursor to serous endometrial cancer

A

serous endometrial intraepithelial carcinoma

TP53 is often mutated

40
Q

what are the grades of endometrial cancer

A

1 = 5% or less solid growth
2 = 6-50% solid growth
3 >50% solid growth

serous carcinoma is not formally graded

41
Q

what is adenomyosis

A

endometrial glands and stroma within the myometrium

42
Q

what is cacrinosarcoma, what does it look like?

A

Mixed tumour with malignant epithelial and stroma elements

large, bulky tumour which fills the cavity and commonly protrudes through the cervical canal

43
Q

what is an Endometrial stromal sarcoma

A

tumour arising from endometrial stroke

44
Q

what is Vulvar Intraepithelial Neoplasia (VaIN)

A

precancerous lesion to Vulvar Invasive Squamous Carcinoma

45
Q

what are the risk factors for Vulvar Intraepithelial Neoplasia (VaIN)

A

young women - can be recurrent or persistent
old women - risk of progressing to invasive squamous carcinoma
HPV

46
Q

what is the cause of Vulvar Invasive Squamous Carcinoma

A

arises from normal epithelium or VaIN

47
Q

what are the symptoms of vaginal Pagets disease

A

crusting rash

tumours containing mucin arises from sweat glands

48
Q

what is a Phyllodes tumour? who does it affect

A

biphasic tumour which rarely metastasises

affects 40-50s

49
Q

what causes a Phyllodes tumour

A

stromal overgrowth

50
Q

what are the symptoms of a Phyllodes tumour

A

slow growing, unilateral breast mass

51
Q

what is an intraduct papilloma

A

tumour located in the sub-areolar ducts

52
Q

what are the symptoms of intraduct papilloma

A

nipple discharge +/- blood
nodules
calcification
asymptomatic

53
Q

what is the most common female cancer

A

breast

54
Q

what type of tumour are most breast cancers

A

adenocarcinomas

55
Q

where do breast adenocarcinomas arise from

A

glandular epithelium of the terminal duct lobular unit

56
Q

what is the treatment of a ER positive tumour

A

Oophorectomy
Tamoxifen
Aromatase inhibitors (Letrozole)
GnRH antagonists (Goserilin [Zoladex])

57
Q

what are the symptoms of breast cancer

A 
asymptomatic 
lump
nipple change or discharge 
colour/texture change 
dimpled/depressed skin
58
Q

what are the investigations of breast cancer

A

triple assessment:

Breast exam
ultrasound/mammogram
biopsy

59
Q

what investigations would you do if you suspected breast cancer in <40

A

breast exam
ultrasound
biopsy

60
Q

what investigations would you do if you suspected breast cancer in >40

A

breast exam
bilateral mammogram
ultrasound of lump
biopsy

61
Q

what are the symptoms of lobular breast cancer

A

thickened/dimpled skin

inverted nipple

62
Q

what is the precursor to lobular breast cancer

A

Lobular in situ carcinoma

63
Q

where is Lobular in situ carcinoma located

A

basement membrane of acini and ducts

64
Q

what are the 2 types of Lobular in situ carcinoma

A

atypical lobular hyperplasia = <50% of lobule affected

Lobular in situ carcinoma = >50% of lobule affected

65
Q

treatment of Lobular in situ carcinoma

A

excision

vacuum

66
Q

what is intraductal proliferation

A

precursors to breast cancer

67
Q

what are the types of intraductal proliferation

A

Ductal carcinoma in situ
ductal or epithelial hyperplasia
cell changes

68
Q

where is Ductal carcinoma in situ found

A

within basement membrane of duct

69
Q

when is radiotherapy given

A

adjuvant treatment

usually after a wide local excision

70
Q

what are the side effects of radiotherapy

A

lymphedema of the arm

71
Q

when can chemotherapy be given

A

neo-adjvant (shrink tumour) or adjuvant

72
Q

what are the side effects of chemotherapy

A

neutropenia
alopecia
severe skeletal pain = gCSF injection
myalgia + peripheral neuropathy = taxanes

73
Q

when should you worry about neutropenia

A

if patient has a fever or sepsis

74
Q

when can hormonal therapy be given

A

neo-adjuvant (too weak for surgery) or adjuvant

75
Q

what are the side effects of hormonal therapy

A

hot flushes

vaginal dryness

76
Q

give examples of hormonal therapy

A

tamoxifen

aromatase inhibitor

77
Q

how long should tamoxifen be given? what are the side effects

A

for 5 yrs

vaginal bleeding

78
Q

give examples of aromatase inhibitors

A

letrozole, anastrozole

79
Q

what antibodies are used to treat breast cancer? how are they given

A

trastuzumab

S/C injection

80
Q

what is the side effects to antibody treatment

A

allergic reaction

reversible cardiac failure

3rd year (12 decks)

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