Repro - tumours (including breast) Flashcards by Eilidh Edmiston

metastatic ovarian tumours commonly originate from what organs?

breast
pancreas
stomach
GI

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what are functional cysts

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

rarely >5cm

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what are the symptoms of a functional cysts

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

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what is the treatment of a functional cyst

resolve spontaneously

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what is a Endometriotic Cyst? describe them

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

they have a “chocolate” appearance

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what are the symptoms of Endometriotic Cysts

severe dysmenorrhoea
premenstrual pain/painful sex
sub-fertility

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

aka cystic tertoma

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

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

rim calcification with fat located inside

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what are the types of ovarian cancer

epithelial cell tumours (90%)

germ/granulosa cell tumours

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what are the risk factors for ovarian cancer

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

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what are the symptoms of ovarian cancer

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

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what are the investigations of ovarian cancer

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

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what are the stages of ovarian cancer

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

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what is the treatment of ovarian cancer

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

fertility conserving treatment if stage I or II

chemo = carboplatin +/- paclitaxel

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

oophorectomy + removal of fallopian tubes

hormone replacement required after

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what is Cervical Intraepithelial Neoplasia

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

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what causes Cervical Intraepithelial Neoplasia

dysplasia of cervical squamous cells

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what are the risk factors for Cervical Intraepithelial Neoplasia

HPV
smoking
immunosuppression

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what are the 3 stages of Cervical Intraepithelial Neoplasia

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

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what are the symptoms of Cervical Intraepithelial Neoplasia

asymptomatic

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what is the treatment of Cervical Intraepithelial Neoplasia

stage 1 = monitor

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

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what are the two types of cervical cancer

cervical adenocarcinoma

cervical squamous carcinoma

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what is the most common type of cervical cancer

cervical squamous carcinoma

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what is the pre-malignant stage of cervical squamous carcinoma

Cervical Intraepithelial Neoplasia

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what are the stages of cervical squamous carcinoma

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.

what are the symptoms of cervical squamous carcinoma

early stages = none bleeding after sex/ after menopause pelvic pain haematuria/UTIs ureteric obstruction

what is the treatment of cervical squamous carcinoma

surgery (fertility sparing) radiotherapy chemotherapy

what is Cervical Glandular intraepithelial Neoplasia (CGIN)

pre-invasive stage of cervical adenocarcinoma

where does Cervical Glandular intraepithelial Neoplasia originate

cervical epithelium

what are the risk factors for | Cervical Adenocarcinoma

smoking | HPV (18)

what is the treatment of | Cervical Adenocarcinoma

surgery (fertility sparing) radiotherapy chemotherapy

what is the pre-invasive stage of Cervical Adenocarcinoma

Cervical Glandular intraepithelial Neoplasia

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

50-60yrs old if young consider PCOS or lynch syndrome

what are the risk factors for endometrial carcinoma

obesity | oestrogen = HRT, tamoxifen

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

hereditary non-polyposis colorectal cancer autosomal dominant

what are the symptoms of endometrial carcinoma

abnormal bleeding

what are the two types of endometrial cancer

endometrioid | serous

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

related to unopposed oestrogen precursors: hyperplasia, lynch syndrome

what is the precursor to serous endometrial cancer

serous endometrial intraepithelial carcinoma TP53 is often mutated

what are the grades of endometrial cancer

1 = 5% or less solid growth 2 = 6-50% solid growth 3 >50% solid growth serous carcinoma is not formally graded

what is adenomyosis

endometrial glands and stroma within the myometrium

what is cacrinosarcoma, what does it look like?

Mixed tumour with malignant epithelial and stroma elements large, bulky tumour which fills the cavity and commonly protrudes through the cervical canal

what is an Endometrial stromal sarcoma

tumour arising from endometrial stroke

what is Vulvar Intraepithelial Neoplasia (VaIN)

precancerous lesion to Vulvar Invasive Squamous Carcinoma

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

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

what is the cause of Vulvar Invasive Squamous Carcinoma

arises from normal epithelium or VaIN

what are the symptoms of vaginal Pagets disease

crusting rash | tumours containing mucin arises from sweat glands

what is a Phyllodes tumour? who does it affect

biphasic tumour which rarely metastasises affects 40-50s

what causes a Phyllodes tumour

stromal overgrowth

what are the symptoms of a Phyllodes tumour

slow growing, unilateral breast mass

what is an intraduct papilloma

tumour located in the sub-areolar ducts

what are the symptoms of intraduct papilloma

nipple discharge +/- blood nodules calcification asymptomatic

what is the most common female cancer

breast

what type of tumour are most breast cancers

adenocarcinomas

where do breast adenocarcinomas arise from

glandular epithelium of the terminal duct lobular unit

what is the treatment of a ER positive tumour

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

what are the symptoms of breast cancer

``` asymptomatic lump nipple change or discharge colour/texture change dimpled/depressed skin ```

what are the investigations of breast cancer

triple assessment: Breast exam ultrasound/mammogram biopsy

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

breast exam ultrasound biopsy

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

breast exam bilateral mammogram ultrasound of lump biopsy

what are the symptoms of lobular breast cancer

thickened/dimpled skin | inverted nipple

what is the precursor to lobular breast cancer

Lobular in situ carcinoma

where is Lobular in situ carcinoma located

basement membrane of acini and ducts

what are the 2 types of Lobular in situ carcinoma

atypical lobular hyperplasia = <50% of lobule affected Lobular in situ carcinoma = >50% of lobule affected

treatment of Lobular in situ carcinoma

excision | vacuum

what is intraductal proliferation

precursors to breast cancer

what are the types of intraductal proliferation

Ductal carcinoma in situ ductal or epithelial hyperplasia cell changes

where is Ductal carcinoma in situ found

within basement membrane of duct

when is radiotherapy given

adjuvant treatment usually after a wide local excision

what are the side effects of radiotherapy

lymphedema of the arm

when can chemotherapy be given

neo-adjvant (shrink tumour) or adjuvant

what are the side effects of chemotherapy

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

when should you worry about neutropenia

if patient has a fever or sepsis

when can hormonal therapy be given

neo-adjuvant (too weak for surgery) or adjuvant

what are the side effects of hormonal therapy

hot flushes | vaginal dryness

give examples of hormonal therapy

tamoxifen | aromatase inhibitor

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

for 5 yrs vaginal bleeding

give examples of aromatase inhibitors

letrozole, anastrozole

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

trastuzumab S/C injection

what is the side effects to antibody treatment

allergic reaction | reversible cardiac failure