Session 12 - Gynecological tumours

Question 1

What is CIN? What is the most common cause of CIN and cervical carcinomas and how does it do so?

Answer 1

Cervical intraepithelial neoplasia

HPVs - 16 and 18

HPV infects metaplastic squamous cells in transformation zone and produces proteins that interfere with tumour suppressor proteins.

Question 2

What stain is used to examine cells from the transformation zone of the cervix?

Answer 2

papanicolaou stain

Question 3

Answer 3

Question 4

What ages is cervical screening for? If an abnormality is detected what is the patient referred for?

Answer 4

25-50 every 3 years

60-65 every 5 years

If abnormality, referred for colposcopy and biopsy

Question 5

How long does it take for CIN to go from 1 to 3?

Answer 5

7 years

Question 6

Describe CIN

Answer 6

dysplasia of squamous cells within the cervial epithelium, induced by infection with HPV

Question 7

How is CIN 1, 2 and 3 treated?

Answer 7

1 - follow up or cryotherapy

2 and 3 - superficial excision

Question 8

where can a cervical carcinoma spread to?

Answer 8

bladder, ureters, rectum, vagina

lymph nodes - para cervical, pelvic, para aortic

Question 9

How does a cervical carcinoma present?

Answer 9

postcoital, intermenstrual, or post menopausal vaginal bleeding

Question 10

How is a microinvasive and invasive carcinoma treated?

Answer 10

Microinvasive - cervical cone excision

Invasive - hysterectomy, lymph node dissection, radiation and chemo

Question 11

What can be a precursor to endometrial carcinoma? What features does it contain? WHy does it occur?

Answer 11

endometrial hyperplasia

increased gland to stroma ratio

Occurs due to prolonged oestrogenic stimulation

Question 12

What are the 2 main types of endometrial adenocarcinoma? How do they differ?

Answer 12

1. Endometrioid - mimics proliferative glands
2. Serous - poorly differentiated, aggressive, exfoilates and travels through fallopian tubes

Question 13

What is a leiomyoma and how can it cause problems?

Answer 13

• Tumour of myometrium
• Benign
• Can be massive and cause heavy periods, bladder compression, infertility

Question 14

How do ovarian tumours present?

Answer 14

• Abdo pain, abdo distension
• Urinary and GI symptoms
• Ascites
• Menstrual disturbances

Question 15

Why is lower parity a riskfactor for ovarian epithelial tumours?

Answer 15

Repeated breach and repair of epithelium during ovum release predisposes to cancer

Question 16

What is pseudomyxoma peritonei?

Answer 16

Cancer that begins as polyp in the appendix and spreads through the wall.

Spreads to ovaries, peritoneum and can cause intestinal obstruction

Question 17

What is a teratoma?

Answer 17

tumour with tissue contianing derivatives of more than 1 germ layer

Question 18

What are the effects of a granulosa cell tumour?

Answer 18

produces large amount of oestrogen

May produce precocious puberty in pre-pubertal girls

In adults - endometrial hyperplasia, carcinoma, and breast disease

Question 19

What are the effects of ovarian sertoli-leydig cell tumours?

Answer 19

• Definiminsation and masculinisation
• Breast atrophy
• Amenorrhoea
• hair loss
• hirsuitism
• clitoral hypertrophy

Question 20

Where does a vulval squamous cell carcinoma spread to?

Answer 20

Initially to inguinal, pelvic, iliac, and para-aortic lymph nodes

Then lungs and liver

Question 21

What hormone indicates the possibility of an invasive mole during pregnancy?

Answer 21

HCG levels dont fall during pregnancy