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Phase 3 > Week 4 - female GU and breast > Flashcards

Week 4 - female GU and breast Flashcards

1
Q

What is the name of the gene on the Y chromosome which causes development of the testis in the male embryo?

A

SRY gene

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2
Q

What is the name of the hormone produced by sertoli cells in the male embryo which causes regression of the paramesonephric ducts?

A

Anti-mullerian hormone

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3
Q

What structures do the paramesonephric ducts give rise to in the female embryo?

A

Fallopian tubes, uterus, cervix, upper 1/3 of vagina.

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4
Q

What structures does the urogenital sinus give rise to?

A

lower 2/3 of vagina, bulbourethral glands, vestibule, bladder, urethra.

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5
Q

What is the name of the embryological structures that give rise to the external genitalia in both males and females?

A

Genital tubercle, genital folds, genital swellings.

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6
Q

What type of epithelium lines the fallopian tube?

A

Ciliated columnar epithelium

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7
Q

What is salpingitis?

A

Inflammation of the fallopian tubes, on the spectrum of pelvic inflammatory disease.

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8
Q

What 2 types of bacteria can cause salpingitis?

A

Chlamydia trachomatis, Neisseria gonorrhoeae

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9
Q

What can be some of the clinical signs and symptoms of salpingitis?

A

Fever, lower abdominal pain, pelvic masses.

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10
Q

What are three potential complications of salpingitis?

A

Tubo-ovarian abscess
Tubal ectopic pregnancy
Infertility

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11
Q

What inherited gene mutation increases the risk of fallopian tube carcinoma?

A

BRCA1

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12
Q

Primary adenocarcinomas arising from the Fallopian tubes alone are rare. What is the most common?

A

Papillary serous carcinoma.

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13
Q

Polycystic ovarian syndrome is caused by overproduction of androgens by multiple cystic follicles in the ovaries. What are the symptoms of POS?

A

Weight gain, hirsutism, irregular periods, difficulty conceiving,

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14
Q

What are two risk factors for epithelial ovarian cancers? What can reduce your risk of ovarian cancer?

A

Nulliparity and family history.

Prolonged use of oral contraceptive is protective.

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15
Q

What gene mutations can increase risk of ovarian cancer?

A

BRCA1 and BRCA2
HER2 (sporadic)
KRAS
P53

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16
Q

Which gene mutation are more common in HGSC and which in borderline and LGSC?

A

HGSC: BRCA1, P53

Borderline and LGSC: BRAF, KRAS

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17
Q

Ovarian endometrioid carcinoma are often associated with loss of which tumour supressor gene?

A

PTEN

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18
Q

What other conditions is ovarian endometrioid carcinoma often associated with?

A

Endometriosis and endometrial cancer.

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19
Q

What are Brenner tumours?

A

Mixed surface epithelial stromal tumours.

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20
Q

What is Meig’s syndrome? What does it indicate?

A

Combination of an ovarian fibroma with ascites and pleural effusion.
Ovarian carcinoma.

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21
Q

What are the three types of cells in the ovary that tumours can arise from?

A
  1. Surface epithelial
  2. Germ cell
  3. Sex-cord/stromal
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22
Q

Which part of the cervix is most the most likely place for abnormal cells to develop?

A

Transformation zone of squamocolumnar junction.

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23
Q

Persisting infection with an oncogenic strain of HPV is a cause of cervical cancer. Which strains are particularly prevalent in Glasgow?

A

HPV 16 and HPV 18

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24
Q

If dyskaryosis (nuclear abnormalities) are detected on a cervical cancer screening smear test, what are the next steps?

A

Referral to colposcopy clinic.

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25
Q

Which part of the cervix are cyological screening samples taken from?

A

Transformation zone.

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26
Q

Who is screened as part of the UK cervical screening programme? How often are they screened?

A

Women aged 25-65
Age 25-50 three yearly
Age 50-65 five yearly

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27
Q

Genes carried by HPV are throught to cause cervical cancer. What are the names of these genes?

A

Early genes E1-E7 and late genes L1 and L2

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28
Q

Name 2 treatments can be used to remove abnormal cells in the cervix.

A

LLETZ (large loop excision of the transformation zone.)

Cold coagulation

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29
Q

The cervical screening programme was designed to pick up squamous lesions. What other type of malignancy undergoes pre-malignant change?

A

Cervical Glandular Epithelial neoplasia (cGIN).

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30
Q

What are the symptoms of cervical cancer?

A

Post coital bleeding, intermenstrual bleeding, irregular vaginal bleeding, pain, possibly no symptoms.

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31
Q

Low oestrogen after menopause may lead to what condition of the vagina? What may this lead to?

A

Atrophic vaginitis. Discomfort, dysparenia (painful sexual intercourse), bleeding.

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32
Q

What are some infections of the vagina that can be detected on a smear?

A

Bacterial vaginosis, thrush, trichomonas vaginalis.

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33
Q

The detection of what protein in the blood may be a sign of ovarian cancer?

A

CA 125 (cancer antigen 125)

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34
Q

What radiological test would be performed as a first line investigation for ovarian pathology?

A

Ultrasound

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35
Q

What is ovarian torsion? What is the potential serious complication?

A

The twisting, or torsion, of the ovary around its ligamentous supports.
Blood supply to the ovary and fallopian can be cut off and resulting in loss of these parts.

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36
Q

What are the clinical signs and symptoms of a tubo-ovarian abscess?

A

Pelvic pain, raised WBC count and CRP, high temperature, vaginal discharge.

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37
Q

What are the clinical signs and symptoms of an ectopic pregnancy?

A

Pain, missed period, raised bHCG, circulatory collapse.

38
Q

What are some non-specific symptoms indicative of conditions affecting the uterus?

A

Irregular bleeding, post-menopausal bleeding, pain.

39
Q

What are some symptoms of endometriosis? How is endometriosis diagnosed? How is it treated?

A

Progressively painful periods, dyspareunia, pain with bowel movements, abdominal pain.
Laparoscopy.
Hormonal therapy and analgesia.

40
Q

How is cervical cancer diagnosed and staged?

A

Diagnosis: colposcopy
Staging: MRI

41
Q

What is a bartholin cyst?

A

A benign lesion on the vagina.

42
Q

What are some of the general toxic effects of chemotherapy?

A

Bone marrow suppression, hair loss, damage to GI epithelium, growth depression in children, sterility, teratogenicity, damage to liver, heart, kidney.

43
Q

What do you call anti-cancer drugs that are only active on dividing cells?

A

Cell-cycle specific drugs.

44
Q

What do you call anti-cancer drugs that active on dividing cells and resting cells?

A

Cell cycle-non specific drugs.

45
Q

How do Alkylating agents work as a cancer treatment?

A

They form covalent bonds with DNA, interfering with transcription and replication.

46
Q

Name an alkylating agent used to treat cancer.

A

Cyclophosphamide

47
Q

How do anti-metabolites work as a cancer treatment? Give two examples.

A

Interfere with nucleotide synthesis or DNA synthesis. Methotrexate, 5-flourouracil

48
Q

How to cytotoxic antibiotics work as a cancer treatment? Give an example of one of these drugs.

A

Act mainly by a direct action on DNA as intercalators (i.e. inserts molecules in between base pairs of DNA, inhibiting replication.)
Doxorubicin.

49
Q

How do microtubule inhibitors work as a cancer treatment? Give an example of such a drug.

A

Block normal spindle formation, therefore blocking cell division.
Vincristine.

50
Q

Give an example of a steroid hormone which can be used to treat cancer? How does it work?

A

Prednisone.

Converted in prednisolone in body. Suppresses lymphocye growth.

51
Q

How does tamoxifen work in the treatment of breast cancer?

A

Antagonises the oestrogen receptor, suppressing tumour growth.

52
Q

Name 2 drugs that can be used to treat prostate cancer.

A

Bicalutamide

Prostap

53
Q

Define endometriosis and adenomyosis.

A

Endometiosis: the presence of endometrial tissue outwith the uterus.
Adenomyosis: the presence of endometrial tissue within the myometrium.

54
Q

Where are the possible sites of endometriosis?

A

Ovary, fallopian tubes, cervical mucosa, vagina, peritoneal surfaces, small and large bowl, appendix, laparotomy scars

55
Q

What are the clinical symptoms of endometriosis?

A

Dysmenorrhoea (painful periods), pelvic pain, infertility.

56
Q

Explain the two theories surrounding the pathogenesis of endometriosis and adenomyosis.

A

Metastatic theory: retrograde menstruation or surgical procedures induces endometrium to sites outwith the uterine cavity.
Metaplastic theory: endometrium arises directly from the coelomic epithelium (peritoneum) of the pelvis as this is where endometrium arises from during embryological development.

57
Q

What are endometrial polyps? What drug is associated with endometrial polyps? What can sometimes be found in them?

A

Masses of varying size which project into the endometrial cavity.
Tamoxifen.
Cytological atypia or adenocarcinoma.

58
Q

Endometrial hyperplasia and adenocarcinoma are associated prolonged simulation of what hormone to the endometrium? What could be the causes of this?

A

Oestrogen.

Obesity, PCOS, anovulatory cycles, HRT.

59
Q

What is endometrial hyperplasia histologically characterised by? What is this condition a precursor of?

A

Increase in gland to stroma ratio.

Endometrial adenocarcinoma.

60
Q

What is a leimyoma?

A

A common benign smooth muscle tumour of the myometrium.

61
Q

What is a leiomyosarcoma?

A

An uncommon malignant smooth muscle tumour of the myometrium.

62
Q

What must a a cyst have for it to be called a cyst?

A

An epithelial lining.

63
Q

Name 2 antigen markers that would be positive and one that would be negative in a kruckenburg’s tumour (secondary tumour of the ovary from the GI tract.)

A

Carcinoembryonic antigen, transcription factor CDX2.

Oestrogen receptor would be negative.

64
Q

Describe inn brief the structure of the breast?

A

Lactiferous ducts lined with inner luminal and outer myoepithelial epithelium. Interlobular stroma which is fibrous/fatty.

65
Q

Name two conditions associated with breast hypoplasia?

A

Turner’s syndrome, congenital adrenal hyperplasia.

66
Q

What is acute mastitis?

A

Cellulitis associated with breast feeding.

67
Q

What changes can the spectrum of fibrocystic change include?

A

Cysts, adenosis (increased amount of glandular tissue), increased fibrous stroma, epithelial hyperplasia with or without atypia, papillomas, apocrine metaplasia.

68
Q

Does fibrocystic change increase risk of breast cancer?

A

Either classified as ‘non-proliferative’ - no further risk
Proliferative without atypia - 2 x risk
Proliferative with atypia - 5 x risk

69
Q

What are radial scars?

A

Benign lesion characterised by a fibrotic and elastotic core, trapped glands and pseudo-infiltrative appearance.

70
Q

What are intraductal papilloma and papillomatosis? Do they have any associated risk of cancer?

A

Intraductal papilloma is a benign tumour of the epithelial lining of mammary ducts. Innocuous unless epithelial atypia.

Papillomatosis are multiple papillomas. Slight association with malignancy.

71
Q

What is Diabetic fibrous mastopathy?

A

Benign stromal fibrosis with infiltrating lymphocytes associated with type 1 diabetes.

72
Q

What is a fibroadenoma?

A

Common overgrowth of epithelium and stroma resembling a giant lobule.

73
Q

What are phyllodes tumours?

A

A spectrum of tumours similar to fibroadenomas but with a more cellular stroma. Can be malignant and require excision.

74
Q

What are risk factors for breast cancer?

A

Earlier menarche, late menopause, older at first pregnancy, OC use, HRT, obesity, tallness, alcohol, positive family history.

75
Q

What are the symptoms for possible breast cancer?

A

A new lump or thickening in breast or axilla.
Altered shape, size or feel of the breast, pain (not often).
Skin changes: puckering dimpling, peau d’orange, rash, redness, feels different.
Nipple changes: tethering/inversion, discharge, eczema-like changes in paget’s disease.
Rarely: widespread inflammation in inflammatory cancer.

76
Q

How are breast abnormalities investigated?

A

Clinical examination: inspection and palpation.
Imaging: ultrasound, XR mammography, MRI.
Fine needle aspiration cytology or core biopsy.
Excisional biopsy: diagnostic, therapeutic or both.

77
Q

Describe the treatment of breast cancer.

A

Small cancer - wide local excision with radiotherapy.

Larger cancer - may require mastectomy or neoadjuvant treatment (chemotherapy or endocrine therapy) may cause enough regression for breast-conserving surgery.

78
Q

Name three types of drugs which can treat breast cancer.

A

Endocrine therapy - targets steroid hormone receptors i.e. Tamoxifen.
Aromatase inhibitors prevents conversion of androgens to oestrogens i.e. Letrazole
Her2 targeted therapy i.e. herceptin

79
Q

What would be the treatment for ‘triple negative’ i.e. negative ER, PR and Her2?

A

Neoadjuvant chemotherapy

80
Q

What three histological properties is breast cancer grading based on?

A

1 - nuclear pleomorphism
2 - number of mitoses/mm^2
3 - degree of gland formation

81
Q

What are the features of a carcinoma in situ in the breast?

A

Malignant looking proliferation of epithelial cells within the basement membrane.
No extension into breast stroma.
No communication with blood vessels or lymphatics.
No possibility of metastases.

82
Q

What is an ovarian cystadenoma? What is an ovarian cystadenofibroma?

A

Benign epithelial tumour of the ovary.

Benign epithelial tumour of the ovary with a solid stromal component.

83
Q

List some of the different types of ovarian carcinoma?

A

High grade serous (HGSC), endometrioid, clear-cell, Low grade serous (LGSC) or mucinous.

84
Q

What is the prognosis of serous tumours like?

A

Benign and borderline have an excellent prognosis.

Invasive serous carcinoma has a poor prognosis, depends on stage at diagnosis.

85
Q

Give 2 examples of ovarian sex cord/stromal tumours. What is the problem associated with these?

A

Granulosa and theca cell tumours.

They often secrete oestrogen which can lead to endometrial hyperplasia/endometriosis.

86
Q

What are some of the ways that ovarian malignancy can present?

A

Local pressure symptoms: pain, GI complaints, urinary frequency.
Acute abdomen due to torsion.
Functioning ovarian tumours may present because of the hormones they produce.
Ascites.

87
Q

Which strains of HPV does the vaccination in Scotland target?

A

6, 11, 16, 18

88
Q

What are some of the immediate and delayed complications of treatment for cervical cancer?

A

Immediate - pain, haemorrhage

Delayed - secondary haemorrhage, infection, cervical stenosis

89
Q

What is cervical intraepithelial neoplasia?

A

Dyskaryotic cells of the cervix which can progress to squamous carcinoma.

90
Q

What is the name of the non-infective inflammation of the vulva which has a link with vulval squamous carcinoma?

A

Lichen sclerosus.

91
Q

What is the management of endometrial hyperplasia and endometrial adenocarcinoma?

A

Hyperplasia - Progesterone therapy i.e. mirena coil or hysterectomy

Endometrial adenocarcinoma - hysterectomy, subsequent management depends on tumour stage and grade.

92
Q

Name 2 gestational trophoblastic diseases.

A

Hydatiform moles

Choriocarcinoma

Phase 3 (14 decks)

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