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Flashcards in 12.1 Deck (43):
1

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

Squamous carcinoma

Adenocarcinoma
Basal cell carcinoma
Malignant melanoma

2

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

3

How does vulva carcinoma present?

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

4

How is vulval carcinoma treated?

Definitive surgery, removing the primary tumour and nodes.

5

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

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

6

Where does vulval carcinoma spread to?

Inguinal, pelvic, iliac and para-aortic lymph nodes
Then lungs and liver

7

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

8

What does cervical screening look for?

Cells with abnormally enlarged nuclei possessing abnormal chromatin
Cervical Intraepithelial Neoplasia

9

What is CIN

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

10

Describe how to treat CIN I, II, III.
How long from I to III

Follow up/colposcopy
Excision with diathermy
Excision

7 years

11

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

12

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

13

What is the most common cervical cancer?

Squamous carcioma

14

Describe the spread of cervical carcinoma

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

15

What does prognosis of cervical carcinoma depend on?

Depth of invasion and size of tumour.

16

How does cervical carcinoma present?

Postcoital, intermenstrual or postmenopausal vaginal bleeding

17

How is cervical cancer treated?

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

18

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

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

19

What is the most common cancer of the female genital tract

Endometrial adenocarcinoma

20

How does endometrial adenocarcinoma present? When?

Irregular or postmenopausal bleeding
55-75 - perimeopausal and older

21

What are the types of endometrial adenocarcinoma?

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

What causes endometrial adenocarcinoma in perimenopausal women?

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

23

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

24

What is fibroid?

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