Gynaecological malignancies Flashcards by Bridie Peters

What are the two types of endometrial cancer?

Type I - endometrial adenocarcinomas

Type II - tumours of non-endometrioid histology

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What causes endometrial cancer?

Long-term high oestrogen exposure

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Which mutation is most strongly associated with type II endometrial cancers?

p53

Present in 90% of type II cancers

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Why is pregnancy protective for endometrial cancer?

Progesterone is the main hormone in pregnancy and it is protective

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What proportion of postmenopausal bleeding is due to endometrial cancer?

20-30%

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What is menometrorrhagia?

Prolonged or excessive uterine bleeding that occurs irregularly

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Which strains of HPV are most strongly associated with cervical cancer?

16 + 18

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What are the two subtypes of cervical cancer?

Squamous cell carcinoma (80%)

Adenocarcinoma (20%)

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What is the most common gynaecological malignancy?

Endometrial cancer

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Which gynaecological cancer confers the highest mortality?

Ovarian

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Which HPV strains are associated with genital warts?

6 + 11

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What is the most common cause of postmenopausal bleeding?

Atrophic vaginitis

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What are the features of a CIN 1 lesion?

Low grade

Mildly atypical cellular changes

Limited to the lower third of the epithelium

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What are the features of a CIN 2 lesion?

High grade

Moderately atypical cellular changes

Confined to the basal two thirds of the epithelium

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What are the features of a CIN 3 lesion?

High grade lesion

Severely atypical cellular changes

Encompasses greater than 2/3 of the epithelial thickness

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What cell type is pathognomonic of HPV infection?

Koilocytes

Dysplastic squamous cells characterised by well-defined, clear, balloon-like, perinuclear halo and hyperchromasia

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What strains of HPV are covered with Gardasil?

6, 11, 16, 18

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What is a typical endometrial thickness for a postmenopausal woman?

<5mm

Risk of carcinoma increases with endometrial thickness*
Risk is very low if endometrial thickness is < 5mm*

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When is liquid based cytology performed?

On all CST samples in which oncogenic HPV is detected

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What is the follow up for patients with oncogenic HPV 16/18 detected on CST?

Colposcopy

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What is the follow up for patients with oncogenic HPV (non-16/18) detected on CST?

Depends on liquid based cytology (ThinPrep)

Negative/pLSIL/LSIL: repeat in 1 year

pHSIL/HSIL: colposcopy

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What CIN corresponds with a high grade squamous intraepithelial lesion (HSIL)?

2/3

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What CIN corresponds with a low grade squamous intraepithelial lesion (LSIL)?

CIN 1

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What is the most important risk factor for ovarian cancer?

Family history

BRAC1/2

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What serum marker would you following in a patient with ovarian cancer?

CA-125

Name 3 genetic risk factors for developing ovarian cancer

1. BRAC-1 2. BRAC-2 3. HNPCC (hereditary nonpolyposis colorectal cancer)

What is a hydatidiform mole?

Molar pregnancy Benign trophoblastic disease (a benign presence of abnormal tissue derived from foetal cells)

What are the two types of molar pregnancy?

Complete (90%) Partial (10%)

What is the pathophysiology of a complete molar pregnancy?

1. Fertilisation of an egg which does not contain chromosomes → male (X) genetic material duplicates → XX OR 2. Two sperm fertilise an empty egg → XX/XY

What is the pathophysiology of a partial molar pregnancy?

Dispermic fertilisation of an egg → XXX/XXY/XYY

How is a molar pregnancy treated?

D&C Monitor hCG levels

What are the US features of a complete molar pregnancy?

Theca lutein cysts ## Footnote *hCG mimics LH and FSH*

What are the ultrasound features of a partial molar pregnancy?

Foetal parts and abnormalities e.g., IUGR, hydrocephaly Oligohydramnios Enlarged placenta with "swiss cheese" appearance

What is CA-125 used to assess?

Ovarian cancer

What is the association between endometrial cancer and the COCP?

COCP decreases risk ## Footnote *Likely due to progesterone component which restricts endometrial hyperplasia*

What is the definition of endometrial hyperplasia in a postmenopausal woman?

\>4mm

Which type of physiological ovarian cyst is most likely to rupture?

Corpus luteal cyst

What is Meig's syndrome?

Triad of ascites, pleural effusion and benign ovarian tumour

What conditions must be met for medical (rather than surgical) treatment of ectopic pregnancy to be considered?

No significant pain An unruptured ectopic pregnancy with an adnexal mass smaller than 35 mm No visible heartbeat Serum hCG level less than 1500 IU/litre No intrauterine pregnancy (as confirmed on an ultrasound scan)

What are the clinical features of complete hydatidiform molar pregnancy?

Bleeding in first or early second trimester Exaggerated symptoms of pregnancy e.g. hyperemesis Uterus large for weeks of gestation Very high serum levels of human chorionic gonadotropin (hCG) Hypertension Features of hyperthyroidism

Why are features of hyperthyroidism seen in complete hydatidiform molar pregnancy?

hCG can mimic thyroid-stimulating hormone (TSH) at the very high levels seen in complete hydatidiform molar pregnancy.

What would be seen on ultrasound of someone with complete hydatidiform molar pregnancy?

Molar pregnancy has a characteristic 'bunches of grapes' appearance on ultrasound.

What conditions must be met for medical (rather than surgical) treatment of ectopic pregnancy to be considered?

No significant pain An unruptured ectopic pregnancy Adnexal mass smaller than 35 mm No visible heartbeat Serum hCG level less than 1500 IU/litre No intrauterine pregnancy (as confirmed on an ultrasound scan).

Hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome) is an autosomal dominant cancer syndrome involving defects in DNA mismatch repair. Which cancers are seen in this syndrome?

Colon Endometrial Ovarian

How many times is the swab twirled and dabbed in the CST?

Twirl: 3-5 times in the cervix Dap: 5-10 times in the Thin Prep. Do not leave the head of the sampler in the vial

What is the risk of malignancy index?

Risk assessment tool for ovarian malignancy

Which ovarian cancer is frequently bilateral?

Serous cystadenoma/cystadenocarcinoma

Psammoma bodies are characteristic of which type of ovarian tumour?

Serous cystadeoma/cystadenocarcinoma

What is the most aggressive ovarian cancer?

Serous cystadenoma/adenocarcinoma

What is the prognosis for a mucinous ovarian tumour? (type of epithelial tumour)

75% benign

What is the most common malignant ovarian tumour in young women?

Dysgerminoma

What is the prognosis of most HPV infections?

Transient and clear within 1-2 years Persists in up to 10% of women

What HPV strain is the 3rd most oncogenic for cervical cancer?

45 ## Footnote * 10% of cervical cancer* * More likely to regress than 16 and 18*

What are 3 risk factors for vulvar cancer?

1. HPV (16, 18, 33) 2. Immunosuppression 3. Smoking 4. Precancerous lesions 5. Vulvar dystrophy and vulvar/cervical intraepithelial neoplasia

What is the most common type of vulvar cancer?

Squamous cell carcinoma (\>80%)

What are some of the clinical features of vulvar cancer?

Pruritis Discolouration Wart-like lesions Vulvar bleeding or discolouration Dysuria, dyspareunia Lymphadenopathy

What is the most common site of vaginal cancer?

Upper 1/3 of the posterior vaginal wall

Which HPV strains are most strongly linked to vaginal and vulval cancer?

16, 18 and 33

What are some of the symptoms of vaginal cancer?

Vaginal bleeding Vaginal ulceration Contact bleeding Malodourous discharge Leukoplakia

What is the association between hormone replacement therapy and breast cancer?

Increased risk with oestrogen-progestin therapy Reduced risk with oestrogen-only therapy

What are the types of ovarian cancer?

*GEMS* G - Germ cell E - Epithelial M - Metastatic S - Sex-cord stromal

What are some protective factors for ovarian cancer?

OCP Pregnancy Breastfeeding Salpingectomy

Which women are eligible for a self-collected CST?

Overdue for \> 2 years Have never screened (must be \> 30 years)

What is the most common type of ovarian cystadenoma?

Serous | (as opposed to mucinous)

Are BRCA1/2 oncogenes or tumour suppressor genes?

Tumour suppressor genes

Gynaecological malignancies Flashcards

(65 cards)