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Repro1 > Tumours Of The Repro Tract > Flashcards

Tumours Of The Repro Tract Flashcards

1
Q

Descrb ethe epidemiology of Vivaldi cancer

A

Uncommon
• 3% of all female cancers
• 1,339 new cases in 2015
Ss

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2
Q

What types of cancers usually arise in he vulva and wha are the clinical features

A

• Usually squamous cell carcinoma (90%)
– Others
• Melanoma
• Basal Cell Carcinoma

• SCC clinical features
– Lumps/ulcers/skin changes

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3
Q

Describe the hisptoly of vulval cancer

A

Sheets of atypical cells. No basement membrane. We know its acc bc of areas of ketatinasiauon - keratin pearls

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4
Q

What is VIN and describ ethe histology

A 
Vulval Intraepithelial Neoplasia (VIN)
• In situ precursor of vulval squamous cell
carcinoma
– May or may not develop into SCC 
• Atypical squamous cells 
• Confined to epidermis
– No invasion bast basement memo (SS)
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5
Q

Are vin and vulval acc related to Hpv

A

Ss

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6
Q

How does vulval cancer spread?

A 
• Direct extension
– Anus
– Vagina
– Bladder 
• Lymph nodes that supply the vulva 
– Inguinal
– Iliac
– Para-aortic 
• Distant Metastases
– Lungs
– Liver
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7
Q

What is the cervix transformation zone

A

Before menstruation Ectocervix is exposed acidic environment of vagina. Stratid squmaous to Thea with it. Ectocervix - simple Columbia
After menstruatio - estroge - cervix everts outside - columnar - exposed to Lowe pH. Area or inflammation - ectropian
Simple columnar epithelium undergoes metaplasia into stratified squamous to adapt to low pH - metaplasia

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8
Q

What is hpv

A 
• DNA virus - can be sexually transmitted 
• Many subtypes
– HPV 6 & 11 = anogenital warts 
– HPV 16 & 18 = high risk subtypes
• Infects transformation zone
• Produce viral proteins E6 & E7
• These inactivate tumour suppressor
    genes (p53 and Retinoblastoma ) 
• Results in uncontrolled cell growth     and proliferation
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9
Q

What is CIN

A 
• Cervical Intraepithelial Neoplasia
– Dysplasia
– Confined to cervical epithelium (in situ - doesnt break through bm )
– Caused by HPV infection
– Divided into CIN 1, 2, 3
• Increasing thickness of dysplasia 
• Increasing risk of progression to invasive squamous cell
carcinoma
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10
Q

What ae teh risk factors for cin

A 
• Increased risk of exposure to HPV:
– Sexual partner with HPV – Multiple partners 
– Early age of first intercourse
• Early first pregnancy
• Multiple births
• Smoking
• Low socio-economic class
• Immunosuppression
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11
Q

What are the treatments from cin

A 
• CIN1
– Often regresses spontaneously
– Follow up cervical smear in 1 year
• CIN2 & 3
– Needs treatment:
– Large Loop Excision of Transformation Zone
(LLETZ)
- Excised - sent to lab - check if vin is there and if it had ben completely excised
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12
Q

What is the cervical cancer screening programme

A

Brush used to scrape cells from transformation zone – sent for cytological assessment
Significant reduction in rates of cervical cancer
• Aged 25 – 49 = every 3 years
• Aged 50 – 64 = every 5 years
• Over 65 – only if recent
abnormality

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13
Q

Describe the hpv vaccine

A 
• Gardasil
– Vaccination against high risk HPV subtypes
(6,11,16,18) 
– Given aged 12-13 
– Protection from
• Cervical, vulval, oral, anal cancer 
– Not given to men…
• HPV -> penile cancer
• Men are carriers for HPV
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14
Q

Describe teh presentation of invasive cervical cancer

A

• Presentation
– Post-coital, inter menstrual, post-menopausal bleeding
– Mass
• exophytic and infiltrative – Screening

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15
Q

What is figo staging

A

Ss

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16
Q

Describe teh treatment of invasive cervical cancer

A

If advanced: • Hysterectomy • Lymph node

dissection • Chemoradiotherapy

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17
Q

Describe the histology of the endometrium

A

The fact that there are glands an stroke doesn’t hinge. In endometrium, gland lining tends to be columnar. Intervening stroma cells support and architecture

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18
Q

Describe endometrial hyperplasia

A

Thickened endometrium
>11mm
Can be a precursor to endometrial cancer
Inter- menstrual/post- menopausal bleeding

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19
Q

What is endometrial hyperplasia caused by

A

• Caused by excessive oestrogen
– Endogenous
• Obesity (androgens -> oestrogens — More peripheral fat, more of this conversion within it, more oestrogen)
• Early menarche/late menopause (More mentruamtion, more oestrogen exposure)
• Oestrogen secreting tumours (e.g. Granulosa cell tumour)
– Exogenous
• Unopposed oestrogen HRT (Estrogen not given if they have a uterus - need progesterone too)
• Tamoxifen (Er receptor positive breast cancer. It blocks receptors in breast but activates oestrogen receptors in the endometrium - agonist)
– Irregular cycles
• PCOS (Polycystic Ovary Syndrome)

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20
Q

Describe the epidemiology f endometrial cancer

A

Most common gynaecological tract cancer

21
Q

Describe the presentation of endometrial cenacle

A 
Presentation
• Intermenstrual
bleeding 
• Postmenopausal
bleeding
 •if it progresses, palpable  Mass
22
Q

What are the types of endometrial cancer

A

Endometrioid Adenocarcinoma
- Most common
• Resembles normal endometrial glands
• Commonly arises from endometrial hyperplasia
Subtypes into endometrioid and serous .
Endometrioid - still glands , but glands ar fusing together, cels piling up, and no stroma.

23
Q

Decsribe the sprea of endometrioid cancer

A

Ss

24
Q

Describe serous carcinoma

A 
Serous 
• Less common • More
aggressive
 • Poorly differentiated cells 
Massive nuclei that look different from ach other. Irregular chromatin. Mitotic bodies.
25
Q

Describe the spread of serous carcinoma

A

Exfoliates
Travels through Fallopian tubes
Deposits on peritoneal surface
Associated with collections of calcium (Psammoma bodies)

26
Q

How is endometrial cancer manages

A
  • Hysterectomy
  • Bilateral salpingo-oophrectomy
  • +/- lymph node node dissection
  • +/-chemo radiotherapy
27
Q

What is a leiomyoma

A 
Tumour of the myometrium 
Leiomyoma (fibroid)
• Most common
tumour of myometrium
• Benign
• Pale, homogenous, well circumscribed mass
28
Q

Scribe the presentation of leiomyoma

A 
Vast range of sizes
Presentation 
• Asymptomatic 
• Pelvic pain 
• Heavy periods 
• Urinary frequency (bladder compression)
29
Q

Describe teh histology of leiomyoma

A

Whorled, intersecting fascicles of benign smooth muscle cells
Not much variation. Slightly unusually arrangement. - streaming. These are called fascia=cels. They ae intersecting. Some have spindle nuclei and some are rounder - but this is due to the blame of the section. Benign.

30
Q

Describe teh histology. Of meiomyosarcoma

A 
Malignant tumour of smooth muscle
Cells are bizarre and atypical
Doesn’t arise from a leiomyoma
Metastases to lung common
Mitotic figures. No fascicles.
31
Q

Desribe the presentation of ovarian cancer

A

• Presentation
– Early symptoms – vague and non specific
- Delayed diagnosis

– Later symptoms
• Abdominal pain
• Abdominal distension
• Urinary symptoms
• Gastrointestinal symptoms
• Hormonal disturbances
32
Q

What are Ca-125 and brca1/2

A

• Ca-125
– Serum marker
– used in diagnosis and monitoring for recurrence
• Some cancers associated with BRCA1/2 mutations
– High grade serous cancers
– Prophylactic salpingo-oophrectomy

33
Q

Where can tumours arise from in the ovaries

A

Lined by
epithelium
• Epithelial tumours

Contains germ cells
• Germ cell tumours

Contains stromal
cells
• Sex cord stromal. tumours Is also a site for metastatic spread

34
Q

Descrbe ovarian epithelial tumours

A 
• Often present as cystic masses 
• Histological subtypes:
– Serous – Mucinous – Endometrioid
• Can all be:
– Benign 
– Borderline (Increased atypia, no stromal invasion) 
– Malignant
35
Q

Describe ovarian serous tumours

A

Highly atypical, pleomorphic cells
Bizarre atypical cells - clumps and sheets
Often show Psammoma Bodies
Often spreads to peritoneal surface
Transcoelomic spread - into serous cavities - biopsies from onetime, peritoneum, - impact on staging and prognosis

36
Q

What are ovarian mutinous tumours

A

Atypical epithelial cells
Secreting mucin
Nuclei are piled up - some mitotic bodies. - may b e malignant

37
Q

Descrbe varian endometrioid tumours

A

Glands resembling endometrium
May arise in endometriosis
May have synchronous endometrial endometrioid adenocarcinoma
Cells piling up, mitotic bodies. May arise in endometriosis.

38
Q

What is a teratoma

A 
Most common germ cell tumour
Three subtypes: 
• Mature (benign) - hair and teeth can be in them  
• Immature (malignant) 
• Monodermal (highly specialised)
39
Q

What is a mature teratoma

A 
Aka dermis cyst
Contain fully mature, Skin
differentiated tissue from all germ cell layers
Can haeve g, resp, neural, skin tissue, etc 
Can be bilateral
Cartilage
Often contains skin + hair GI epithelium
structures
40
Q

What are immature teratomas

A

• Contains immature, embryonal tissue
• Malignant
- Tissue thats not able to differentiate - indicated malignancy

41
Q

What is a monodetmal teratoma

A

Teratoma comprised almost entirely of one fully differentiated tissue type
Most common = thyroid tissue (Struma Ovarii)
Benign
Can cause hypo/hyperthyroid -ism

42
Q

Whar are some other germ cell tumours

A
  • Dysgerminoma (equivalent of Seminoma in testes)
  • Choriocarcinoma
  • Embryonal Carcinoma
  • Yolk Sac Tumour
  • All are malignant
43
Q

Whar are sex cord stromal tumours

A

• From ovarian stroma
– Stroma derived from sex cord of embryonic gonad
– Sex cord produces
• Sertoli and Leydig cells in the testes
• Granulosa and Theca cells in the ovaries
– Tumours resembling all these cell types can arise in the ovary

44
Q

What are theca and granulosa cell tumours

A 
• Produce oestrogen
– Patient pre-puberty?
• Precocious puberty 
– Adult patient?
• Breast cancer
• Endometrial hyperplasia
• Endometrial carcinoma
45
Q

Describe sertoli and leydig cell umours

A 
• Produce testosterone 
– Patient pre-puberty?
• Prevents normal female pubertal changes 
– Adult patient?
• Sterility
• Amenorrhoea
• Hirsuitism
• Male pattern baldness
• Breast atrophy
46
Q

Describe metastases to ovary

A

Ss

47
Q

Give an overview of testicular cancer

A 
• Risk factor:
– Cryptorchidism (undescended testicle) 
• Presentation:
– Mass +/- pain
• Investigations:
– Scans (Ultrasound)
– Tumour markers
48
Q

What are subtypes of testicular cancer

A

Ss

49
Q

Describe testicular cancer tumour markers

A

• Used in germ cell tumour diagnosis/assessing response to treatment
• β hCG
– Choriocarcinoma
• Alpha fetoprotein (AFP)
– Yolk Sac tumours
• Tumours may be benign/malignant depending on age of patient
Tumours that arise in adults tend to be mixed. - more than one subtype - more than 1 marker elevated

Repro1 (20 decks)

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