Flashcards in 12.1 Deck (43)
What is the most common cancer of the vulva? Rarer?
Basal cell carcinoma
What is the casusative factor of vulval carcinoma in pre-menopausal women?
HPV with invasion developing in field of intraepithelial neoplasia (Vulval intraepithelial neoplasia - VIN).
Detected by patient or in gynae exam
How does vulva carcinoma present?
Brown patches around anus and white areas around the clitoris.
Toludine blue dye used to detect VIN
How is vulval carcinoma treated?
Definitive surgery, removing the primary tumour and nodes.
What is the causative factor of vulval cancer in older women?
Chronic irritation, Lichen sclerosus (itching and white patches on skin) squamous hyperplasia
Where does vulval carcinoma spread to?
Inguinal, pelvic, iliac and para-aortic lymph nodes
Then lungs and liver
What causes cervical carcinoma?
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
What does cervical screening look for?
Cells with abnormally enlarged nuclei possessing abnormal chromatin
Cervical Intraepithelial Neoplasia
What is CIN
Cervical Intraepithelial neoplasia
Dysplasia of squamous cells within the cervical epithelium induced by infection with high risk HPVs
Describe how to treat CIN I, II, III.
How long from I to III
Excision with diathermy
Describe how the biopsy is tested
Cells from the transformation zone are scapred off,s gained with papanicolaou and examined for precursor lesions and low stage cancer
Describe the age of screening.
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
What is the most common cervical cancer?
Describe the spread of cervical carcinoma
Locally to para-cervical soft tissue, bladder, ureters, rectum vagina
Lymph nodes - Initially to iliac then aortic
What does prognosis of cervical carcinoma depend on?
Depth of invasion and size of tumour.
How does cervical carcinoma present?
Postcoital, intermenstrual or postmenopausal vaginal bleeding
How is cervical cancer treated?
Microinvasive = cervical cone excision
Invasive = hysterectomy, lymph node dissection, radiation and chemotherapy
What is a precursor to endometrial carcinoma? What is it associated with?
Increased gland to stroma ratio
Associated with prolonged oestrogen stimulation:
What is the most common cancer of the female genital tract
How does endometrial adenocarcinoma present? When?
Irregular or postmenopausal bleeding
55-75 - perimeopausal and older
What are the types of endometrial adenocarcinoma?
Mimics proliferative glands
Typically arises in setting of endometrial hyperplasia
Spreads by myometrial invasion and direct extension
Poorly differentiated, aggressive, worse prognosis
Exfoliates, travels through Fallopian tubes, implants on peritoneum
What causes endometrial adenocarcinoma in perimenopausal women?
Unopposed oestrogen from obesity
Hormone secreting tumour
Tamoxifen (used to treat breast cancer)
What are some risk factors of endometrial adenocarcinoma?
Early menarche, late menopause and few pregnancies - high oestrogen exposure
Obesity may produce oestrogen from androgens through adipose
What is fibroid?
Benign tumour of uterine smooth muscle
Symptoms of fibroids
Heavy menstrual loss and intermenstrual bleeding, pain, discharge and infertility.
Are fibroids malignant? What does growth depend on?
Regress after menopause
What is leimyosarcoma?
Malignant tumour of myometrium
Infiltrate locally with metastasis by the blood stream to lungs and then systemically
What are the symptoms of ovarian tumours? When do they occur?
When they become large, invade adjacent structures or metastasise
What can ovarian tumours arise from?
Sex cord stroma
What are the risk factors for ovaria cancer?
OCP is protective
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
What are teratoma?
Germ cell tumours that contain tissue from more than one germ layer:
skin hair teeth bone neural
What does the presence of immature tissue indicate?
Risk for intra-abdominal spread
What tumour markers are for non-gestational choriocarcinoma?
What tumour marker is for yolk sac tumour
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?
What are the comas?
Benign tumours derived from the ovarian stroma
May produce oestrogen.
What do ovarian sertoli-leydig cells cause?
What is high hCG associated with?
Give 3 gestational tumours
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.
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