Gynecology 2

Question 1

What’s the most common cause of death in cervical cancer?

Answer 1

Renal failure = due to hydronephrosis. blockage of bladder as cancer invades.

Question 2

What do the early genes in HPV code for?

Answer 2

INteract with molecules to disrupt normal cell cycle:

E6= p53

E7 = Rb

Question 3

What do the late genes in HPV code for?

Answer 3

Capsid proteins for the virus

Question 4

What is HPV 18 more associated with?

Answer 4

Adenocarcinoma

Question 5

What are the risk factors for cervical cancer?

Answer 5

Multiple sexual partners

smoking

early sexual intercourse

multiple pregnancies

Question 6

If there is invasion of cervical cancer within 3mm - microinvasion, what is the treatment?

Answer 6

Hysterectomy with sparing of lymph nodes

Question 7

What’s the biggest cause of endometrial adenocarcinoma?

Answer 7

Unopposed oestrogen

Question 8

There are two main types of endometrial adenocarcinomas, what are they and how do they differ?

Answer 8

Endometrial Intraepithelial Neoplasia - dereives from hyperplasia - Oestrogen

Sporadic form/ serous carcinoma: P53 mutation. occurs in more elderly

Question 9

Is simple endometrial hyperplasia associated with increase in cancer risk? what is?

Answer 9

No

Atypical type is associated with endometrial cancer - endometrial intraepithelial carcinoma

Question 10

How is endometrial adenocarcinomas managed?

Answer 10

Oestrogen antagonists - mirena

Hysterectomy

Radiation therapy

Question 11

What is the other type of endometrial cancer which can develop?

Answer 11

Endometrial stroma carcinoma

Question 12

What are the investigations for endometriosis and management?

Answer 12

Ultrasound

• transvaginal
• transrectal

NSAIDs
progesterone
Oral contraceptive

Question 13

What is it called when there is endometrial tissue within the muscle of the uterus?

Answer 13

Adenomyosis

Question 14

How are endometrial polyps treated?

Answer 14

Hysteroscope

Question 15

Where do leiomyosarcomas tend to metastasis to?

Answer 15

Liver, brain, lungs

Question 16

What are the symptoms of a hydatidiform molar pregnancy?

Answer 16

Odematous villie

Trophoblast proliferation

Large for due date

Increase Beta- hCG

Question 17

What the most common genetic link to serous cystoadenocarcinomas of the ovaries?

Answer 17

BRCA1

Question 18

What substances can be seen in granuloma/ theca cell tumours?

Answer 18

Cal Exner bodies

- little fluid filled sacs

Question 19

What are the two main types of tumour that develop on the vulva?

Answer 19

HPV related - young person. VIN

Non - HPV. usually lichen sclerosis related - old person.

Question 20

What can extra mamillary paget disease of the vulva be hard to differentiate between? and how is it done?

Answer 20

Melanoma

evidence of keratin = squamous

S100 = melanoma

Question 21

Whats the symptoms of salpingitis:

Answer 21

Pain in pelvis

Fever

Feeling of fullness

Question 22

What are complication of salpingitis?

Answer 22

Tubo-ovarian abscesses

Ectopic pregnancy

Infertility

endometriosis
- increases the chance of this occurring in the tubes

Question 23

Whats the most common cancer of the fallopian tubes? and what is it associated with?

Answer 23

Papillary serious carcinoma

BRCA1

often involve omentum

Question 24

What are some risk factors of ovarian tumours?

Answer 24

Never having children

Family history

Oral contraceptive

Question 25

What are the most common cause of sporadic ovarian cancers?

Answer 25

p53 - causes high grade KRAS - 30% - most common for mucinous HER2 - 35%

Question 26

if there is a lack of cystic formation, i.e. they are solid, what are ovarian then called?

Answer 26

Adenofibromas - usually always benign AS opposed to (cystadenocarcinoma)

Question 27

What are the two types of serous carcinomas of the ovary? and what are they associated with?

Answer 27

Low grade - KRAS mutations - young women High grade - p53 - older women

Question 28

If you have bilateral mucinous tumours - what has most likely happened?

Answer 28

Metastasis from the G.I

Question 29

What is associated with malignant teratomas of the ovary?

Answer 29

Immature cells

Question 30

How do thecoma/ granulosa tumours often present and why?

Answer 30

Postmenopausal bleeding | - to the increase in oestrogen again

Question 31

What are the two common types of endometrial cancer | and how are they diagnosed?

Answer 31

Adenocarcinoma = hyperplasia related. >50 years old Serous carcinoma = sporadic related to p53 defect - >70 years old

Question 32

List some common symptoms of ovarian cancer and list the investigations you would do:

Answer 32

Pelvis Mass often presents as G.I symptoms - bloating - discomfort abdominally - early satiety - sister mary umbilical nodules Ultrasound CT scan Ca125 Cytology - biopsy

Question 33

Some ovarian tumours can present with hirsutism, why is this and what tumour are the most likely to be? and what class of tumours do they belong to?

Answer 33

Sertoli- leydig ovarian tumours. Secrete androgens leading to the hirtuism. Belong to the: - sex chord stromal

Question 34

Outline some strategies that can be implemented to improve breast cancer detection to prevent early deaths:

Answer 34

Education around breast cancer IMportance of self checking - with education in how to do so regular physical examination Mammograms 50- 70 year olds every 3 years

Question 35

List some risk factors for cervical cancer:

Answer 35

Multiple sexual partners Early Sexual activity HPV infection Multiple Pregnancies Smoking

Question 36

How many breast cancers are picked up by examination?

Answer 36

50%

Question 37

Where does the breast expand from vertically?

Answer 37

2nd - 7th rib

Question 38

Not having children is a risk factor for breast cancer, what age and over is considered a risk?

Answer 38

30 years old