Flashcards in 12.1 Gynae tumours Deck (39):
Most common caner of the vulva?
Causative factor of vulva tumour in pre-menopausal women?
HPV 16 with invasion:
Vulvan intraepithelial neoplasia?
How does vulval intraepithelial neoplasia present
Brown patches around anus,
white patches around clitoris
Why is used to detect Vulval intraepithelial neoplasia?
Toludine blue dye
Acetic acid stains white
What is the causative factor in older women?
Longstanding skin disease - lichen sclerosis
Where does vulval carcinoma spread to?
Inguinal, pelvic, iliac and para-aortic lymph nodes
Lungs and liver
What is the cause of cervical carcinoma?
HPV 16/18 causing cervical intraepithelial neoplasia
Where does HPV infect?
Metaplastic squamous cell in transition zone. just above external os of cervix where mucus-secreting simple columnar become vagina stratified squamous, non K.
Interferes with TSG - inability to repair damaged protein and increased proliferation.
Give risk factors of cervical carcinoma?
Early first marriage
What is the aim of cervical screening? What is detected?
Detect pre-invasive lesion and excise area before tumour can develop.
Dyskaryotic cells (abnormal chromatin, enlarged nuclei)
What do cytological smears detect? What are the levels?
Cells scraped, stained and examined. (Dilute acetic acid white)
Cervical Intraepithelial Neoplasia (CIN)
dysplasia of squamous cells within cervical epithelium.
CIN I - regress spont.
CIN 2 - superficial excision
CIN III - superifical excision
Treatment before invasion is curative
Describe the screening programme.
25 -49 every 3 years
50-64 5 yearly
65+ not screened since 50/abnormality
Classify cervical cell carcinoma.
Where do cervical carcinomas spread?
Soft tissue, bladder ureter, rectum, vagina
Then wider dissemination
What is the prognosis of cervical carcinoma dependent on?
How does it present?
How is it treated?
Depth of invasion and size of tumour
Stage and burden
Post-coital, intermenstrual, post-menopausal bleeding
Hysterectomy,, raiation, chemo
What is endometrial hyperplasia? What is it associated with?
Precursor to endometrial carcinoma.
Associated with oestrogen:
Increased endogenous oestrogen (adipose)
Give the types of endometrial adenocarcinoma.
Mimics proliferative glands
Myometrial invasion and adjacent structures.
Poorly differentiated, worse prognosis
Travels through fallopian tubes - peritoneum
Risk factors for endometrial adenocarcinoma?
Obestiy, Early menarche
Why are ovaries and fallopian tubes removed with hysterectomy?
Exclude the possibility of hormone producing tumour in ovaries and subsequent risk of neoplasia
Give 2 tumours of the myometrium
Descrie fibroids. Symptoms? Why do they regress after menopause?
Benign tumours of smooth muscles
Intermenstrual bleeding, pain, discharge.
Growth is oestrogen dependent so regress after menopause
Wel circumscribed firm and white
Increased mitotic activity
Cellular atypia - pleomorphism
Blood stream metastasis to lungs
Describe ovarian tumours. When do they produce symptoms? What are these?
Non-functional, produce symptoms when they become large and invade adjacent strucutres/metastasise:
Where can ovarian tumours arise from?
SEx cord stroma
3 main types of ovarian tumours?
Risk factors for ovarian tumours?
Few children (increased ovarian rupture)
No OCP use
How can ovarian cancer be detected?
Ca125 tumour marker
What is pseudomyxoma peritonea? What occurs?
Mucinous ovarian tumour
Cancer begins as polyp in appendix
filled with thick fluid
Extensive mucinous ascites
Describe endometrioid ovarian tumours.
Tubular glands resembling endometrial glands.
What are the most common germ cell tumours. Give malignant germ cellt umours.
MAture benign cystic teratoma containing skin, hair, teeth, bon
Malignant gem cell tumours include dugerminoma, yolk sac tumour, choriocarcinoma
Give some tumour markers for germ cell tumours.
Yolk sac tumour - alph fetoprotein
Non-gestational choriocarcionma hCG
What can teratomas contain?
o Hair, sebaceous, teeth, cartilage, bone, thyroid, neural
More than one germ later
What are sex cord tumours derived from? Types?
SEx cords - theca cells/granulosa cells
Thecoma - becnign from ovarian stroma
Fibroma - pressure symptoms
What do sex cord tumours produce and what are they responsible for?
Describe what happens in ovarian sertoli-leydig cell tumours?
What are gestational tumours? Give 4 gestational tumours. Hormone significance?
Tumours of placental - villous or trophoblastic tissue
hCG levels raised.
Describe hydatidiform mole. Where does it occur? Diagnosis?
Chromosomal defect in conceptus causing oedema of chorionic villi.
Friable mass of translucent swollen oedema villi.
Diagnosed by ultrasound
Risk of choriocarcinoma.
Present with miscarriage
hCG levels high
Treated wit curettage followed by fall in hCG
What is an invasive mole? Hormone? Presentation?
Penetrates uterine wall.
Persistently elevated hCG
Can cause uterine rupture
Vaginal bleeding, uterine enlargement