week 3 Flashcards
what does uterine cancer develop from
the endometrium
most common type of uterine neoplasia
adenocarcinoma
risk factors for uterine neoplasia
PCOS
late menopause/early menarche
low parity/nulliparous
obesity
oestrogen only HRT
tamoxifen
genetics- lynch
presentation of uterine neoplasia
abnormal PV bleeding
post menopausal bleeding: endometrial carcinoma until proven otherwise
PV discharge
pain/weight loss
first line investigation for endometrial cancer
TVUS
- measure endometrial thickness (thickness <4mm is reassuring)
investigations for endometrial cancer
TVUS
endometrial biopsy/dilation and curettage
- performed to obtain a tissue sample for histology
hysteroscopy
- allows visualisation of endometrium
histological variation of endometrial carcinoma
purely glandular
areas of squamous differentiation
papillary
clear cell pattern
spread of endometrial carcinoma
usually spreads to myometrium and cervix
but can spread to blood and lymph too
two types of endometrial cancer
type I (endometrioid): most common
type II (serous and clear cell)
what is type I endometrial cancer
endometrioid
- usually diagnosed shortly after menopause
- oestrogen dependent
precursor lesion= atypical hyperplasia
PTEN, KRAS, PIK3CA mutations
Microsatellite instability – germline mutation of mismatch repair genes (Lynch
syndrome)
what is type II endometrial cancer
serous and clear cell
- older women usually
- poorer prognosis
- not associated with unopposed oestrogen
- TP53 mutation
precursor lesion= serous endometrial intraepithelial carcinoma
spreads fallopian tubes
endometrial sarcoma
rare
arise from endometrial stroma and locally aggressive
metastasizes early
staging used for endometrial carcinoma
figo staging
management of endometrial carcinoma
surgery is the principles treatment
- total hysterectomy and bilateral salpingo-oophorectomy + peritoneal washings
radiotherapy
chemotherapy
smooth muscle tumours of the myometrium
leiomyoma
leiomyosarcoma
leiomyoma
common
menorrhagia and infertility
(fibroid)
leiomyosarcoma
rare and poor prognosis
women > 50
peak age of ovarian cancers
75 years
genetic risks for ovarian cancers
HNPCC (lynch syndrome)- 12%
BRCA 1 and BRCA2
family member
risk factors for ovarian cancers
nulliparity
early menarche/late menopause
HRT
smoking
obesity
endometriosis
protective factors for ovarian cancer
breast feeding
COCP
multiparity
sterilisation
presentation of ovarian cancer
often non-specific symptoms
bloating, weight loss, tiredness, change in bowel habit/urinary frequency, abdo pain, poor appetite
PV bleeding
abdo mass/bimanual exam
ascites + pleural effusion
investigation for ovarian cancer
pelvis USS
CA125
RMI= USS score x menopausal score x CA125
pathology of functional ovarian cysts
enlarged follicular/corpus luteum
< 5cm
pathology of endometrioma
chocolate cyst
contains blood
associated with endometriosis
pathology of polycystic ovaries
> 12 follicles
pathology of theca lutein cyst
occur when levels of hCG are very high (molar pregnancy)
regress when hCG falls
pathology serous cystadenoma
may appear solid
1/3 bilateral
1/3 malignant
pathology of fribroma
sex cord stromal tumour
fibrous tumour
associated with meig’s syndrome (ascites and pleural effusion)
may produce oestrogen > PV bleeding
types of epithelial ovarian tumours
serous
mucinous tumours
endometrioid
clear cell
pathology of sex cord ovarian tumour
granulosa cell
low grade
coffee bean nuclei and gland-like spaces
treatment of benign ovarian tumours
LDH, AFP and hCG should be measured in women < 40 to rule out germ cell tumours
usually excised if >5cm
treatment of malignant ovarian tumours
full staging laparotomy with debulking
adjuvant chemotherapy
aetiology of infection of high risk HPV
damages the action of p53
cervicitis
often asymptomatic
follicular cervicitis- sub epithelial reactive lymphoid follicles present in cervix
chlamydia
herpes
risk factors for CIN/cervical cancer
persistence of high risk HPV (16,18)
- many sexual partners
vulnerability of SC junction
- young age of first intercourse
- long term use of oral contraceptives
- non-sue of barrier contraception
smoking
immunosuppression
if HPV is present on smear
patient referred to cytology
cytology negative: test for HPV in 12 months
cytology positive: colposcopy
CIN I
abnormal cells occupying a third of the basal epithelium
CIN II
abnormal cells have extended to the middle third
CIN III
where the abnormal cells span the full thickness of the epithelium
what happens if a patient had a negative cytology but a positive HPV smear again 12 months later
cytology again
positive: colposcopy
negative: test again in 12 months
what strain of HPV is genital warts
6 and 11
histology of CIN
infected epithelium remains flat, but may show koilocytosis
delay in maturation/differentiation
nuclear abnormalities
presentation of cervical cancer
abnormal PV bleeding- post coital, intermenstrual, post-menopausal
unusual PV discharge
menorrhagia
pelvic pain
advanced disease features
- weight loss
- back pain
- obstruction of the ureters
cervical cancer investigations
punch biopsy at colposcopy for histology
staging CT chest/abdo/pelvis
MRI
examination
cervical cancer management stage Ia
to preserve fertility: local excision with cone biopsy and close follow up or radical trachelectomy
hysterectomy with lymphadenectomy
