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Reproduction Year 3 > week 3 part 1 > Flashcards

week 3 part 1 Flashcards

1
Q

What are the sub-types of Epithelial cell tumours (ovarian cancer)

A 
	Serous tumours (the most common)
	Endometrioid carcinomas
	Clear cell tumours
	Mucinous tumours
	Undifferentiated tumours
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2
Q

Serous cystadenoma

A

Most common benign ovarian tumour, often bilateral

Cyst lined by ciliated cells (similar to Fallopian tube)

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3
Q

Serous cystadenocarcinoma

A

Malignant - Often bilateral

Psammoma bodies seen (collection of calcium)

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4
Q

Mucinous cystadenoma

A

Benign - Cyst lined by mucous-secreting epithelium (similar to endocervix)

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5
Q

Mucinous cystadenocarcinoma

A

Malignant - May be associated with pseudomyxoma peritonei (although mucinous tumour of appendix is the more common cause)

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6
Q

Brenner tumour

A

Benign ovarian growth - Contain Walthard cell rests (benign cluster of epithelial cells), similar to transitional cell epithelium. Typically have ‘coffee bean’ nuclei.

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7
Q

Dermoid Cysts / Germ Cell Tumours

A

These are benign ovarian tumours. They are teratomas, meaning they come from the germ cells. They may contain various tissue types, such as skin, teeth, hair and bone. They are particularly associated with ovarian torsion. Germ cell tumours may cause raised alpha-fetoprotein (α-FP) and human chorionic gonadotrophin (hCG).

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8
Q

Teratoma

A 
Mature teratoma (dermoid cyst) - most common: benign
Immature teratoma: malignant
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9
Q

Dysgerminoma

A

Most common malignant germ cell tumour
Histological appearance similar to that of testicular seminoma
Associated with Turner’s syndrome
Typically secrete hCG and LDH

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10
Q

Yolk sac tumour

A

Malignant
Typically secrete AFP
Schiller-Duval bodies on histology are pathognomonic

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11
Q

Granulosa cell tumour

A

Malignant
Produces oestrogen leading to precocious puberty if in children or endometrial hyperplasia in adults.
Contains Call-Exner bodies (small eosinophilic fluid-filled spaces between granulosa cells)

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12
Q

Sertoli-Leydig cell tumour

A

Benign
Produces androgens → masculinizing effects
Associated with Peutz-Jegher syndrome

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13
Q

Fibroma

A

Benign
Associated with Meigs’ syndrome (ascites, pleural effusion)
Solid tumour consisting of bundles of spindle-shaped fibroblasts
Typically occur around the menopause, classically causing a pulling sensation in the pelvis

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14
Q

Kruckenberg tumour

A

A Kruckenberg tumour refers to a metastasis in the ovary, usually from a gastrointestinal tract cancer, particularly the stomach. Kruckenberg tumours have characteristic “signet-ring” cells on histology, which look like signet rings on under a microscopy.

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15
Q

Risk factors for ovarian cancer

A 
	Age (peaks age 60)
	BRCA1 and BRCA2 genes 
	Increased number of ovulations
	Obesity
	Smoking
	Recurrent use of clomiphene
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16
Q

Protective factors for ovarian cancer

A

Having a higher number of lifetime ovulations increases the risk of ovarian cancer. Factors that stop ovulation or reduce the number of lifetime ovulations, reduce the risk:

  1. Combined contraceptive pill
  2. Breastfeeding
  3. Pregnancy
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17
Q

Presenting features of ovarian cancer

A 
	Abdominal bloating
	Early satiety (feeling full after eating)
	Loss of appetite
	Pelvic pain
	Urinary symptoms (frequency / urgency)
	Weight loss
	Abdominal or pelvic mass
	Ascites
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18
Q

Why is there hip or groin pain in some ovarian cancers?

A

An ovarian mass may press on the obturator nerve and cause referred hip or groin pain.

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19
Q

The two-week referral criteria for ovarian cancer

A
  1. Ascites
  2. Pelvic mass (unless clearly due to fibroids)
  3. Abdominal mass
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20
Q

Investigations for ovarian cancer

A
  1. CA125 blood test (>35 IU/mL is significant)

2. Pelvic ultrasound

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21
Q

The risk of malignancy index (RMI)

A

Estimates the risk of an ovarian mass being malignant, taking account of three things:

  1. Menopausal status
  2. Ultrasound findings
  3. CA125 level
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22
Q

Women under 40 years with a complex ovarian mass require tumour markers for a possible germ cell tumour: what are those markers?

A

 Alpha-fetoprotein (α-FP)

 Human chorionic gonadotropin (HCG)

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23
Q

CA125

A

CA125 is a tumour marker for epithelial cell ovarian cancer. It is not very specific, and there are many non-malignant causes of a raised CA125

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24
Q

Causes of raised CA125 tumour markers

A
  1. Endometriosis
  2. Fibroids
  3. Adenomyosis
  4. Pelvic infection
  5. Liver disease
  6. Pregnancy
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25
Q

The International Federation of Gynaecology and Obstetrics (FIGO) staging system

A

Staging system for ovarian cancers

Stage 1: Confined to the ovary
Stage 2: Spread past the ovary but inside the pelvis
Stage 3: Spread past the pelvis but inside the abdomen
Stage 4: Spread outside the abdomen (distant metastasis)

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26
Q

Benign ovarian cysts

A

Benign ovarian cysts are extremely common. They may be divided into physiological cysts, benign germ cell tumours, benign epithelial tumours and benign sex cord stromal tumours. Complex (i.e. multi-loculated) ovarian cysts should be biopsied to exclude malignancy.

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27
Q

Physiological cysts (functional cysts)

A
  1. Follicular cysts

2. Corpus luteum cyst

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28
Q

Follicular cysts

A

o commonest type of ovarian cyst
o due to non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle
o commonly regress after several menstrual cycles

29
Q

Corpus luteum cyst

A

o during the menstrual cycle if pregnancy doesn’t occur the corpus luteum usually breaks down and disappears. If this doesn’t occur the corpus luteum may fill with blood or fluid and form a corpus luteal cyst
o more likely to present with intraperitoneal bleeding than follicular cysts

30
Q

Dermoid cyst

A
  1. also called mature cystic teratomas. Usually lined with epithelial tissue and hence may contain skin appendages, hair and teeth
  2. most common benign ovarian tumour in woman under the age of 30 years
  3. median age of diagnosis is 30 years old
  4. bilateral in 10-20%
  5. usually asymptomatic. Torsion is more likely than with other ovarian tumours
31
Q

Serous cystadenoma

A

i. the most common benign epithelial tumour which bears a resemblance to the most common type of ovarian cancer (serous carcinoma)
ii. bilateral in around 20%

32
Q

Mucinous cystadenoma

A

i. second most common benign epithelial tumour
ii. they are typically large and may become massive
iii. if ruptures may cause pseudomyxoma peritonei

33
Q

Benign epithelial tumours

A

Arise from the ovarian surface epithelium

  1. Serous cystadenoma
  2. Mucinous cystadenoma
34
Q

Risk of Malignancy Index (RMI)

A

The RMI I is the most effective for women with suspected ovarian cancer. This is also recommended by the National Institute for Health and Care Excellence (NICE) guideline on ovarian cancer[8]. It should not be used for premenopausal women though.

RMI I combines three pre-surgical features: serum CA 125 (CA 125); menopausal status (M); and ultrasound score (U).

35
Q

Simple ovarian cysts management

A

do not require treatment

36
Q

Women with small (less than 50 mm in diameter) simple ovarian cysts management

A

No treatment

37
Q

Women with simple ovarian cysts of 50-70 mm management

A

should have yearly ultrasound follow-up and those with larger simple cysts should be considered for either further imaging (MRI) or surgical intervention

38
Q

Complications of ovarian cancer and cysts

A
  1. Torsion of an ovarian cyst can occur.
  2. Haemorrhage is more common for tumours of the right ovary.
  3. Rupture of an ovarian cyst can occur.
  4. Infertility can occur as a result of ovarian tumours or their treatment
39
Q

Uterine fibroid

A

Fibroids are benign smooth muscle tumours of the uterus. They are thought to occur in around 20% of white and around 50% of black women in the later reproductive years

40
Q

Uterine fibroid associations

A

more common in Afro-Caribbean women

rare before puberty, develop in response to oestrogen

41
Q

Uterine fibroid presentation

A 
>   may be asymptomatic
>   menorrhagia
>   lower abdominal pain: cramping pains, 
>   bloating
>   urinary symptoms, e.g. frequency
>   subfertility
42
Q

Uterine fibroid diagnosis

A

Transvaginal ultrasound

43
Q

Asymptomatic fibroids treatment

A

No treatment is needed other than periodic review to monitor size and growth

44
Q

Medical Treatment to shrink/remove fibroids

A

GnRH agonists may reduce the size of the fibroid but are typically useful for short-term treatment

45
Q

Surgical treatment to shrink/remove fibroids

A
  1. myomectomy
  2. hysteroscopic endometrial ablation
  3. hysterectomy
  4. uterine artery embolization
46
Q

Endometrial cancer

A

Endometrial cancer is a common oestrogen-dependent gynaecological cancer which tends to affect older women. Unlike cervical cancer, it is not currently screened for in the UK.

47
Q

Myometrium

A

the thick layer of smooth muscle and connective tissue lying beneath the endometrium. It contracts during a period to reduce blood loss (causing cramps) and during labour to expel the foetus. It often gives rise to benign growths called fibroids (leiomyomas) but rarely undergoes malignant change.

48
Q

Parametrium

A

the parametrium is a fibrous fascial layer which lines the outer surface of the upper part of the cervix and separates it from the bladder. It contains the uterine artery and the ovarian ligament. The parametrium is important, as cervical cancers often spread out to invade it as they grow.

49
Q

Perimetrium

A

The perimetrium is the membranous layer of visceral peritoneum which lines the outer surface of the whole uterus, apart from a small area anteriorly where it deflects forwards to cover the bladder.

50
Q

Endometrium

A

The endometrium is the thin inner mucous membrane which lines the cavity of the uterus and is shed during the monthly menstrual period. Its high cell turnover makes it the most common site for cancers of the uterus to develop.

51
Q

The wall of the uterus has four distinct layers: what are they?

A

the endometrium, myometrium, parametrium and perimetrium (peritoneum)

52
Q

Postmenopausal bleeding (PMB)

A

is vaginal bleeding occurring after 12 months of amenorrhoea in a woman of menopausal age or who has experienced the menopause – this affects 4-11% of postmenopausal women and accounts for 5% of all gynaecology outpatient referrals

53
Q

Uterine sarcomas

A

 these are tumours arising from the myometrium and connective tissues of the uterus
 this is a rare diagnosis with an aggressive clinical course and a poor prognosis
 2% leiomyosarcoma
 1% carcinosarcoma (aka mixed mesodermal Mullerian tumour)
 <1% endometrial stromal carcinoma

54
Q

Symptoms of endometrial cancer

A
  1. postmenopausal bleeding
  2. in pre- or perimenopausal women (20-25% of cases), symptoms can include intermenstrual bleeding or menorrhagia
  3. increased vaginal discharge
  4. pyometra (a collection of pus in the uterine cavity)
  5. symptoms of advanced disease include pelvic pain, pelvic mass, leg swelling, haematuria, PR bleeding, weight loss and fatigue
  6. symptoms of metastatic disease
55
Q

Cervical cancer

A

Cancer of the cervix tends to affect younger women, peaking in the reproductive years. 80% of cervical cancers are squamous cell carcinoma. Adenocarcinoma is the next most common type. Very rarely there are other types, such as small cell cancer.

56
Q

Cervical cancer associations

A

Cervical cancer is strongly associated with human papillomavirus. Children aged 12 – 13 years are vaccinated against certain strains of HPV to reduce the risk of cervical cancer.

57
Q

What strains of HPV are associated with cervical cancer?

A

type 16 and 18, as they are responsible for around 70% of cervical cancers and also the strains targeted with the HPV vaccine. There is no treatment for infection with HPV. Most cases resolve spontaneously within two years, while some will persist.

58
Q

Risk factors for cervical cancer

A

> 

Increased risk of catching HPV
Later detection of precancerous and cancerous changes (non-engagement with screening) •	Early sexual activity •	Increased number of sexual partners •	Sexual partners who have had more partners •	Not using condoms •	Smoking •	HIV  •	Combined contraceptive pill use for more than five years •	Family history
59
Q

Appearances that may suggest cervical cancer need urgent referral; what are they?

A 
Appearances that may suggest cervical cancer are:
•	Ulceration
•	Inflammation
•	Bleeding
•	Visible tumour
60
Q

Cervical Intraepithelial Neoplasia

A

A grading system for the level of dysplasia (premalignant change) in the cells of the cervix. CIN is diagnosed at colposcopy (not with cervical screening)

61
Q

Cervical Intraepithelial Neoplasia grading criteria

A
  1. CIN I: mild dysplasia, affecting 1/3 the thickness of the epithelial layer, likely to return to normal without treatment
  2. CIN II: moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, likely to progress to cancer if untreated
  3. CIN III: severe dysplasia, very likely to progress to cancer if untreated CIN III is sometimes called cervical carcinoma in situ.
62
Q

dyskaryosis

A

Dyskaryosis refers to the change of appearance in cells that cover the surface of the cervix. A smear test or cervical screening test is used to detect abnormal cells in your cervix (the entrance to your womb). Regular screening monitors changes in the cells.

63
Q

The cervical screening program involves performing a smear for women (and transgender men that still have a cervix): how often is a smear test carried out?

A
  • Every three years aged 25 – 49

* Every five years aged 50 – 64

64
Q

Vulval cancer

A

Vulval cancer is rare compared with other gynaecological cancers. Around 90% are squamous cell carcinomas. Less commonly, they can be malignant melanomas.

65
Q

Risk factors for vulval cancer

A

 Advanced age (particularly over 75 years)
 Immunosuppression
 Human papillomavirus (HPV) infection
 Lichen sclerosis

66
Q

Vulval intraepithelial neoplasia (VIN)

A

Vulval intraepithelial neoplasia (VIN) is a premalignant condition affecting the squamous epithelium of the skin that can precede vulval cancer. VIN is similar to the premalignant condition that comes before cervical cancer (cervical intraepithelial neoplasia).

67
Q

High grade squamous intraepithelial lesion

A

High grade squamous intraepithelial lesion is a type of VIN associated with HPV infection that typically occurs in younger women aged 35 – 50 years.

68
Q

Symptoms of vulval cancer

A 
	Vulval lump
	Ulceration
	Bleeding
	Pain
	Itching
	Lymphadenopathy in the groin

Reproduction Year 3 (17 decks)

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