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Flashcards in 12.1 Gynae tumours Deck (39):
1

Most common caner of the vulva?

Squamous carcinoma

2

Causative factor of vulva tumour in pre-menopausal women?

HPV 16 with invasion:
Vulvan intraepithelial neoplasia?

3

How does vulval intraepithelial neoplasia present

Brown patches around anus,
white patches around clitoris

4

Why is used to detect Vulval intraepithelial neoplasia?

Toludine blue dye
Acetic acid stains white

5

What is the causative factor in older women?

Chronic irritation
Longstanding skin disease - lichen sclerosis

6

Where does vulval carcinoma spread to?

Inguinal, pelvic, iliac and para-aortic lymph nodes
Lungs and liver

7

What is the cause of cervical carcinoma?

HPV 16/18 causing cervical intraepithelial neoplasia

8

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.

9

Give risk factors of cervical carcinoma?

Sexual intercourse
Early first marriage
Multiple births
Many partners

10

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)

11

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

12

Describe the screening programme.

25 -49 every 3 years
50-64 5 yearly
65+ not screened since 50/abnormality

13

Classify cervical cell carcinoma.

Squamous carcinoma

Also adenocarcinoma

14

Where do cervical carcinomas spread?

Local
Soft tissue, bladder ureter, rectum, vagina

Lymph
Iliac
Para-aortic

Then wider dissemination

15

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

Micro-invasice excision
Invasive
Hysterectomy,, raiation, chemo

16

What is endometrial hyperplasia? What is it associated with?

Precursor to endometrial carcinoma.
Increased gland:stroma
Associated with oestrogen:
Anovulation
Increased endogenous oestrogen (adipose)
Exogensous oestrogen

17

Give the types of endometrial adenocarcinoma.

Endometrioid

Mimics proliferative glands
Unopposed oestrogen/obesity
Myometrial invasion and adjacent structures.

Serous

Poorly differentiated, worse prognosis
Travels through fallopian tubes - peritoneum

18

Risk factors for endometrial adenocarcinoma?

Obestiy, Early menarche
Late menopause
Few pregnancy.

19

Why are ovaries and fallopian tubes removed with hysterectomy?

Exclude the possibility of hormone producing tumour in ovaries and subsequent risk of neoplasia

20

Give 2 tumours of the myometrium

Fibroids
Leimyosarcoma

21

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

22

Describe lyomeiosarcoma.

Malignant fibroid
Uncommon
Increased mitotic activity
Cellular atypia - pleomorphism
Infiltrative growth
Blood stream metastasis to lungs

23

Describe ovarian tumours. When do they produce symptoms? What are these?

Non-functional, produce symptoms when they become large and invade adjacent strucutres/metastasise:
Abdo pain
Distension
Urinary/GI
Menstrual disturbance
Sex hormone

24

Where can ovarian tumours arise from?

Mullerian epithelium
Germ cells
SEx cord stroma
Metastases

25

3 main types of ovarian tumours?

Serous
Mucous
Endometrioid

26

Risk factors for ovarian tumours?

Few children (increased ovarian rupture)
No OCP use
BRCA1/BRCA2 inheritance
Smoking
Endometriuosis

27

How can ovarian cancer be detected?

Ca125 tumour marker
Ultrasound

28

What is pseudomyxoma peritonea? What occurs?

Mucinous ovarian tumour
Cancer begins as polyp in appendix
filled with thick fluid
Extensive mucinous ascites

29

Describe endometrioid ovarian tumours.

Tubular glands resembling endometrial glands.

30

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

31

Give some tumour markers for germ cell tumours.

Yolk sac tumour - alph fetoprotein
Non-gestational choriocarcionma hCG

32

What can teratomas contain?

o Hair, sebaceous, teeth, cartilage, bone, thyroid, neural
More than one germ later

Monodermal (specialised)
Thyroid tissue

33

What are sex cord tumours derived from? Types?

SEx cords - theca cells/granulosa cells
Thecoma - becnign from ovarian stroma
Fibroma - pressure symptoms

34

What do sex cord tumours produce and what are they responsible for?

Oestrogens
Endometrial adnocarcinoma
Precocious puberty.

35

Describe what happens in ovarian sertoli-leydig cell tumours?

Androgens produced:
Definisation
MAsculinisation
Amenorrhoea
Infertility
Breast atrophy
Hirsuitism

36

What are gestational tumours? Give 4 gestational tumours. Hormone significance?

Tumours of placental - villous or trophoblastic tissue

Hydatidiform mole
Ivasive mole
Choriocarcinoma.

hCG levels raised.

37

Describe hydatidiform mole. Where does it occur? Diagnosis?
Presenation?
Hormone?
TReatement?

Chromosomal defect in conceptus causing oedema of chorionic villi.
Friable mass of translucent swollen oedema villi.
TRophoblastic hyperplasia
Diagnosed by ultrasound
Risk of choriocarcinoma.
Present with miscarriage
hCG levels high
Treated wit curettage followed by fall in hCG

38

What is an invasive mole? Hormone? Presentation?
TReatment?

Penetrates uterine wall.
Persistently elevated hCG
Can cause uterine rupture
Vaginal bleeding, uterine enlargement
Chemotherapy

39

Describe gestational chriocarcinoma. Hormone? Presentation? TReatment?

Malignant tumour of syncytiotrophyblast and cytotrophoblast without villi.
hCG high
Vaginal spotting
Uterine evacuation and chemotherapy