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12.1 Flashcards

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1
Q

What is the most common cancer of the vulva? Rarer?

A

Squamous carcinoma

Adenocarcinoma
Basal cell carcinoma
Malignant melanoma

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2
Q

What is the casusative factor of vulval carcinoma in pre-menopausal women?

A

HPV with invasion developing in field of intraepithelial neoplasia (Vulval intraepithelial neoplasia - VIN).
Detected by patient or in gynae exam

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3
Q

How does vulva carcinoma present?

A

Brown patches around anus and white areas around the clitoris.
Toludine blue dye used to detect VIN

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4
Q

How is vulval carcinoma treated?

A

Definitive surgery, removing the primary tumour and nodes.

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5
Q

What is the causative factor of vulval cancer in older women?

A

Chronic irritation, Lichen sclerosus (itching and white patches on skin) squamous hyperplasia

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6
Q

Where does vulval carcinoma spread to?

A

Inguinal, pelvic, iliac and para-aortic lymph nodes

Then lungs and liver

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7
Q

What causes cervical carcinoma?

A

HPV infection of metaplastic squamous cells in transformation zone.
Produces protein that interferes with tumour suppressor proteins.
Arise on the basis of Cervical Intraepithelial Neoplasia or

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8
Q

What does cervical screening look for?

A

Cells with abnormally enlarged nuclei possessing abnormal chromatin
Cervical Intraepithelial Neoplasia

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9
Q

What is CIN

A

Cervical Intraepithelial neoplasia

Dysplasia of squamous cells within the cervical epithelium induced by infection with high risk HPVs

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10
Q

Describe how to treat CIN I, II, III.

How long from I to III

A

Follow up/colposcopy
Excision with diathermy
Excision

7 years

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11
Q

Describe how the biopsy is tested

A

Cells from the transformation zone are scapred off,s gained with papanicolaou and examined for precursor lesions and low stage cancer

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12
Q

Describe the age of screening.

A

25 years = first invitation
25-49 = 3 yearly
50-64 = 5 yearly
65+ = those who have not been screened since 50 of have had abnormalities

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13
Q

What is the most common cervical cancer?

A

Squamous carcioma

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14
Q

Describe the spread of cervical carcinoma

A

Locally to para-cervical soft tissue, bladder, ureters, rectum vagina
Lymph nodes - Initially to iliac then aortic

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15
Q

What does prognosis of cervical carcinoma depend on?

A

Depth of invasion and size of tumour.

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16
Q

How does cervical carcinoma present?

A

Postcoital, intermenstrual or postmenopausal vaginal bleeding

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17
Q

How is cervical cancer treated?

A 
Microinvasive = cervical cone excision
Invasive = hysterectomy, lymph node dissection, radiation and chemotherapy
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18
Q

What is a precursor to endometrial carcinoma? What is it associated with?

Study These Flashcards
A

Endometrial hyperplasia
Increased gland to stroma ratio
Associated with prolonged oestrogen stimulation:
Annovulation

19
Q

What is the most common cancer of the female genital tract

Study These Flashcards
A

Endometrial adenocarcinoma

20
Q

How does endometrial adenocarcinoma present? When?

Study These Flashcards
A

Irregular or postmenopausal bleeding

55-75 - perimeopausal and older

21
Q

What are the types of endometrial adenocarcinoma?

Study These Flashcards
A

Endometrioid
Mimics proliferative glands
Typically arises in setting of endometrial hyperplasia
Spreads by myometrial invasion and direct extension

Serous
Poorly differentiated, aggressive, worse prognosis
Exfoliates, travels through Fallopian tubes, implants on peritoneum

22
Q

What causes endometrial adenocarcinoma in perimenopausal women?

Study These Flashcards
A

Unopposed oestrogen from obesity
Exogenous oestrogen
Hormone secreting tumour
Tamoxifen (used to treat breast cancer)

23
Q

What are some risk factors of endometrial adenocarcinoma?

Study These Flashcards
A

Early menarche, late menopause and few pregnancies - high oestrogen exposure
Obesity may produce oestrogen from androgens through adipose

24
Q

What is fibroid?

Study These Flashcards
A

Leiomyoma

Benign tumour of uterine smooth muscle

25
Symptoms of fibroids
Heavy menstrual loss and intermenstrual bleeding, pain, discharge and infertility.
26
Are fibroids malignant? What does growth depend on?
No Oestrogen Regress after menopause
27
What is leimyosarcoma?
Malignant tumour of myometrium | Infiltrate locally with metastasis by the blood stream to lungs and then systemically
28
What are the symptoms of ovarian tumours? When do they occur?
``` Abdo pain Abdo distension Urinary/GI Ascites Menstrual disturbances When they become large, invade adjacent structures or metastasise ```
29
What can ovarian tumours arise from?
Mullerian epitehlium Germ cells Sex cord stroma Metastases
30
What are the risk factors for ovaria cancer?
Low parity BRAC1/BRCA2 mutations Smoking Endometriosis OCP is protective
31
What is pseudomyoma peritonei
Cancer that begins as a polyp in the appendix and spreads through the wall. Extensive mucinous ascites Epithelial implants on peritoneal surfaces Frequent involvement of ovaries Intestinal obstruction
32
What are teratoma?
Germ cell tumours that contain tissue from more than one germ layer: skin hair teeth bone neural
33
What does the presence of immature tissue indicate?
Risk for intra-abdominal spread
34
What tumour markers are for non-gestational choriocarcinoma?
hCG
35
What tumour marker is for yolk sac tumour
alpha fetoprotein
36
What is the significance of sex cord tumours?
Commonly produce oestrogen's and may be responsible for endometrial adenocarcinoma and isosexual precocious pubertyWHAT ARE THECOMAS?
37
What are the comas?
Benign tumours derived from the ovarian stroma | May produce oestrogen.
38
What do ovarian sertoli-leydig cells cause?
``` Defeminisation, amenorrhoea Infertility Breast atrophy Hair loss Hirsuitism Clitoral hypertrophy ```
39
What is high hCG associated with?
Gestational tumours.
40
Give 3 gestational tumours
Hydatidiform mole Invasive mole Choriocarcinoma
41
What do hydatidiform moles result from? What are they associated with? Presentation? Treatment?
Result from chromosomal defect in conceptus causing oedema of placental chorionic villi. Associated with atypical trophoblastic hyperplasia - have potential for myometrial penetration. Can present with miscarriage Treated with curettage.
42
How does invasive mole present? How is it differed from hydatidiform mole? Treatment
Penetrates uterine wall Vaginal bleeding and uterine enlargement Persistent elevated hCG Treated with chemotherapy
43
What is choriocarcinoma? Presentation Treatment
Malignant tumour of placenta composed of syncytiotrophoblast and cytotrophoblast without villi. hCG levels high Presents with vaginal spotting Treated with uterine evacuation and chemo

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