ONCOLOGY Flashcards
(138 cards)
1
Q
Most common gynaecological cancer in the UK?
A
Uterine cancers (5.2%)
Them ovarian -> cervical -> vulval -> vaginal
2
Q
Which gynaecological cancer has the highest mortality rate in the UK?
A
Ovarian cancer
3
Q
Most common gynaecological cancer worldwide?
A
Cervical cancer
4
Q
Which gynaecological cancer has the highest mortality rate worldwide?
A
Cervical cancer
5
Q
What are some reasons for uterine cancer being the most common gynaecological cancer in the UK?
A
Ageing population and high prevalence of obesity = both risk factors
6
Q
Typical age for cervical cancer?
A
50% of cases occur in women under 45
Incidence rates highest 25-29
7
Q
Most common types of cervical cancer?
A
Squamous cell carcinoma 80% (ectocervix)
Adenocarcinoma 20% (endocervix)
8
Q
Features of cervical cancer?
A
May be asymptomatic and detected by routine cervical screening
Abnormal PV bleeding - post coital, IMB, PMB
Unexplained persistent vaginal discharge
Pelvic pain or dyspareunia
Abnormal appearance of cervix - ulcers, inflammation, bleeding, visible tumour
9
Q
Assessing for cervical cancer?
A
Abdominal exam
Bimanual palpation
Speculum
Asses for lymphadenopathy
Arrange urgent referral for colposcopy if cervical cancer suspected
10
Q
Time interval between HPV infection and cervical cancer?
A
1-10 years between HPV infections nd pre-cancerous lesion development
>10 years for it to progress to invasive carcinomas
11
Q
How common is HPv infection in women?
A
Very prevalent - up to 80% of women will be affected at some point in their lives but the majority of these infections are cleared by the immune system within 2 years
12
Q
Risk factors for cervical cancer?
A
HPV infection - particuarly 16,18
Smoking - nicotine suppresses immune system
HIV
Early first intercourse - cervical changes in puberty increase risk
Multiple sexual partners
History of STI
Lack of use of barrier contraception method
High parity >5 full term births
Low socioeconomic status
COCP for >5 years
Not engaging with cervical screening
13
Q
What are koilocytes?
A
squamous epithelial cell that has undergone a number of structural changes, which occur as a result of infection of the cell by human papillomavirus
14
Q
Characteristics of koilocytes?
A
• enlarged nucleus
• irregular nuclear membrane contour
• the nucleus stains darker than normal (hyperchromasia)
• a perinuclear halo may be seen
15
Q
When was the NHS cervical screening programme established and how has it affected incidence rates?
A
In 1988
Cervical cancer incidence rates have nearly halved in the last 20 years
16
Q
Outline pathophysiology of HPV causing cervical cancer?
A
HPV 16 produces the E6 oncogene which inhibits p53 tumour suppressor gene
HPV 18 produces the oncogene E7 which inhibits the RB suppressor gene
17
Q
What is cervical intraepithelial neoplasia?
A
Aka cervical dysplasia
It’s the potentially precancerous transformation of cells of the cervix.
ITS NOT CANCER! But if untreated could develop into cancer
18
Q
At what point of the cervical screening is cervical intraepithelial neoplasia diagnosed?
A
At colposcopy!
19
Q
What is CIN1? Whats the prognosis?
A
Mild dysplasia
Affects 1/3rd the thickness of the epithelial layer (ectocervix or endocervix)
60% will regress without Tx and only 10% will continue to CIN2/3
20
Q
What is CIN2? Whats the prognosis?
A
Moderate dysplasia
Affects 2/3rds the thickness of the epithelial layer of the cervix
If untreated likely to progress to cancer
21
Q
What is CIN3? Whats the prognosis?
A
Severe dysplasia
Very likely to progress to cancer if untreated - 20% of cases will develop into invasive cervical carcinoma within 5 years
Aka cervical carcinoma in situ
22
Q
Explain FIGO staging of cervical cancer?
A
IA - confined to cervix, only visible by microscopy and <7mm
(A1 if <3mm and A2 if 3-5)
IB - confined to cervix, clinically visible or >7mm (B1 if <4cm and B2 if >4cm)
II - extension of tumour beyond cervix (A if upper 2/3rd vagina and B if parametrial involvement)
III - extension of tumour beyond cervix and into pelvic wall (A if lower 1/3rd vagina and B if pelvic side wall) - not any tumour causing hydronephrosis or a non-functioning kidney is stage III
IV - involvement of bladder or rectum (A) or extension of tumour beyond the pelvis (B)
23
Q
Referral criteria for cervical cancer?
A
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for women if, on examination, the appearance of their cervix is consistent with cervical cancer.
24
Q
Management of stage IA cervical cancer
A
Hysterectomy +/- lymph node clearance (likely if A2)
Cone biopsy or LLETZ may be possible for preservation of fertility
Radical trachelectomy is also an option for A2
25
What is a trachelectomy?
Removal of the cervix
26
Management of stage IB cervical cancer
Radiochemotherapy for B1
Radical hysterectomy with pelvic lymph node dissection if B2
27
Management of stage II and II cervical cancer
Radiation and chemotherapy (surgery is unlikely to be curative!)
28
Management of stage IV cervical cancer
Radiation and chemotherapy (surgery is unlikely to be curative!)
Palliative chemotherapy for IVB
29
Treatment options for recurrent or metastatic cervical cancer?
Pelvic exenteration - reprodyctive organs + lower urinary tract + portion of rectosigmoid bowel
Chemo or radiotherapy after previous surgery may be used if initial surgery did not control disease
30
Possible complications of cone biopsies?
Bleeding 85%
Pain
Changes to vaginal discharge
Increased risk of preterm birth in future pregnancies
Late miscarriage risk
31
possible complications of lletz procedure?
Bleeding
Pain
Changes to cervical discharge
Premature birth or late miscarriage risk in future pregnancies
Cervical stenosis due to scarring
32
Prognosis of cervical cancer alongside FIGO stage
I - 99% 1 year, 96% 5 year
II - 85% 1 year, 54% 5 year
III - 74% 1 year, 38% 5 year
IV - 35% 1 year, 5% 5 year
33
What cancers are associated with HPV infection?
99.7% of cervical cancers
85% of anal cancers
50% of vulval and vaginal cancers
20-30% of mouth and throat cancers
Penile cancer 50%
34
Immunisation programme for HPV
All 12-13 year old girls and boys - given in school. Only 1 dose is given now (changed sep 2023)
GBMSM under 25 recieve 1 dose at sexual health clinics
GBMSM aged 25-45 recieve 2 doses at sexual health clinics
Immunosuppressed or HIV-positive people recieve 3 doses
35
What happens if you missed the HPV vaccine as a child when youb were 12-13?
You can get it for free on the NHS for all girls under 25 and all boys under 25 born after 1 September 2006
36
What vaccine is given for HPV? Which types of HPV does it protect against?
Gardasil 9
6, 11, 16, 18, 31, 33, 45, 52 and 58
37
Which cervical cancers are frequently undetected by cervical cancer screening?
Cervical adenocarcinomas - and this is significant as they account for 15% of cases!
38
Who is screened for and how often in the cervical screening?
A smear test is offered to all women between the ages of 25-64 years
25-49 years: 3-yearly screening
50-64 years: 5-yearly screening
cervical screening cannot be offered to women over 64 (unlike breast screening, where patients can self-refer once past screening age)
39
Special situations for when women get cervical screening?
(Pregnancy and low sexual activity)
cervical screening in pregnancy is usually delayed until 3 months post-partum unless missed screening or previous abnormal smears.
women who have never been sexually active have a very low risk of developing cervical cancer therefore they may wish to opt out of screening
40
Best time to take a cervical smear in the cycle?
Mid-cycle
Although there is limited evidence to support this so in real practice it is done whenever
41
Flow diagram of cervical screening uk
Testing for high-risk strains of HPV and only if positive…
Cytology and only if positive…
Colposcopy
42
How long does protection from HPV immunisation last?
At least 10 years
43
How has the NHS cervical screening programme affected cervical cancer prevalence?
Number of women dying from cervical cancer has halved
44
What’s there aim of the NHS cervical cancer screening programme?
To detect pre-malignant changes (not to detect the cancer!!)
45
What to do if negative hrHPV in NHS cervical cancer screening programme?
Return to normal recall
46
What to do if positive hrHPV in NHS cervical cancer screening programme?
Examine sample cytologically
47
What counts as abnormal cytology in the cervical screening programme?
borderline changes in squamous or endocervical cells.
low-grade dyskaryosis.
high-grade dyskaryosis (moderate).
high-grade dyskaryosis (severe).
invasive squamous cell carcinoma.
glandular neoplasia
48
What to do if cytology is abnormal in NHS cervical cancer screening programme?
Refer for colposcopy
49
What to do if hrHPV positive but cytology is normal in NHS cervical cancer screening programme?
Repeat test in 12 months
If the repeat test is now hrHPV negative return to recall
If still positive and cytology still normal repeat again in 12 months
If hrHPV negative at 24 months then return to recall
If its now positive then refer to colposcopy without doing cell cytology
50
What to do if sample is inadequate for cytology in NHS cervical cancer screening programme?
repeat the sample in 3 months
if two consecutive inadequate samples then → colposcopy
51
What can be used in colposcopy to help see abnormal cervical cells?
Acetic acid - abnormal cells will appear bright white
Iodine solution - will stain normal cells dark brown and cancerous cells wont take up the stain
52
What is the LLETZ procedure?
Performed under local anaesthetic during colposcopy
Uses a diathermy loop to remove abnormal epithelial tissue on the cervix
Often used to treat CIN
53
What is a cone biopsy?
Involves a general anesthetic
Surgeon removes a cone-shaped piece of cervix using a scalpel
Can be used to treat CIN and stage IA1 cervical cancer
54
What is cervical ectropion?
When the columnar epithelium extends out of the ectocervix and replaces the squamous cell epithelium
Causes the cervix to have a red velvety halo around it where the epithelium has changed
It’s benign and will only be managed if it’s symptomatic!
55
What can increase chance of cervical ectropion?
Elevated oestrogen levels - ovulating phase, pregnancy, COCP use
56
What symptoms may cervical ectropion cause?
Why?
vaginal discharge
post-coital bleeding
This is because the columnar epithelial cells are more fragile and prone to trauma so are more likely to bleed
57
What Tx can be offered for cervical ectropion if it’s causing troublesome symptoms?
Ablative treatment e.g. cold coagulation, silver nitrate
58
What are Nabothian cysts?
Fluid-filled cysts often seen on the surface of the cervix
Usually up to 1cm in size
Harmless and unrelated to cervical cancer!
59
Cause of Nabothian cysts?
Columnar epithelium of the endocervix produces cervical mucus and when the squamous epithelium of the ectocervix slightly covers these cells, the mucus becomes trapped and forms a cyst
Common after childbirth, minor trauma to cervix or cervicitis secondary to infection
60
Presentation of Nabothian cysts?
Found incidentally of speculum exam
Very rarely if really large they may cause a feeling of fullness in the pelvis
Smooth, rounded bumps on the cervix usually near the os
Usually 2mm-30mm
Whitish or yellowish appearance
61
Management of Nabothian cysts?
Where the diagnosis is clear, women can be reassured, and no treatment is required. They do not cause any harm and often resolve spontaneously.
If the diagnosis is uncertain, women can be referred for colposcopy to examine in detail. Occasionally they may be excised or biopsied to exclude other pathology. Rarely they may be treated during colposcopy to relieve symptoms.
62
What are cervical polyps?
Who are they most common in?
What do they look like?
How does it affect cervical smears?
Small benign growths on the cervix
Most common in women aged 40-50 who have had children
Usually cherry red in colour and normally look bulb-shaped with a stem
Smear will have to be delayed by 3 months as polyps can block o cervical cells leading to false negatives
63
Referral criteria for endometrial cancer?
2 week wait for:
>55 with PMB
Consider for the following:
<55 with PMB
>55 with unexplained symptms of vaginal discharge and: are presenting for the first time for the first time, or have thrombocytosis or haematuria
>55 and have visible haematuria and: low Hb, or thrombocytosis or high blood glucose level
64
Types of uterine cancer?
Endometrial cancer - most common
Uterine sarcoma - rare
65
What is endometrial cancer?
What is the most common type?
Cancer of the endometrium, the lining of the uterus
80% are adenocarcinomas
66
What is endometrial hyperplasia?
an abnormal proliferation of the endometrium in excess of the normal proliferation that occurs during the menstrual cycle.
<5% of patients with endometrial hyperplasia may develop endometrial cancer
67
Types of endometrial hyperplasia and their risk of progression to cancer?
Simple - 1%
Complex - 3.5%
Simple atypical - 8%
Complex atypical - 30%
68
Management of endometrial hyperplasia?
simple endometrial hyperplasia without atypia: high dose progestogens with repeat sampling in 3-4 months. The levonorgestrel intra-uterine system may be used
atypia: hysterectomy is usually advised
69
Who does endometrial cancer affect?
Mostly post menopausal women
25% of cases occur before menopause
70
Risk factors for endometrial cancer
Excess oestrogen causes:
- nulliparity
- early menarche or late menopause
- unopposed oestrogen e.g. oestrogen-only HRT
Metabolic syndrome:
- obesity
- T2DM
- PCOS
Tamoxifen
HNPCC
71
Why is PCOS a risk factor for endometrial cancer?
As it causes anovulation which leads to the endometrium being exposed to unopposed oestrogen
This is because no corpus luteum is formed from the rupture follicle so no progesterone production
Also… PCOS is associated with insulin resistance and increased insulin production which can stimulate endometrial cells and increase risk of hyperplasia and cancer
72
Endometrial protection in women with PCOS?
If women’s cycles are >90 days then they need protection
COCP, intrauterine system or cyclical progestogens to induce a withdrawal bleed work
73
Why is obesity a risk factor for endometrial cancer?
Adipose tissue contains aromatase which converts androgens into oestrogen in post menopausal women
In women with more adipose tissue, more oestrogen is produced
This is unopposed oestrogen because women are not ovulating so no corpus luteum to produce progesterone
74
Why is tamoxifen a risk factor for endometrial cancer?
Tamoxifen acts as an estrogen receptor antagonist in breast tissue, meaning it blocks the effects of estrogen and inhibits the growth of estrogen-sensitive breast cancer cells. However, in the endometrium (the lining of the uterus), tamoxifen has estrogen-like effects, leading to increased cell proliferation.
75
Why is type 2 diabetes a risk factor for endometrial cancer?
Increased production of insulin which can stimulate endometrial cells and increase the risk of hyperplasia and cancer
76
Protective factors for endometrial cancer?
Multiparity - less ovulation and more progesterone production during pregnancy
COCP
Smoking - not clear but may be anti-oestrogen in many ways
77
Features of endometrial cancer?
The classic symptoms - Post menopausal bleeding - usually slight and intermittent initially before becoming heavier
Pre-menopausal women may develop menorrhagia or IMB
(Pain and discharge are uncommon)
78
Investigations for ?endometrial cancer?
First line - transvaginal USS to measure endometrial thickness
Hysteroscopy with endometrial biopsy
79
Normal endometrial thickness?
<4mm
80
FIGO staging for endometrial cancer?
Stage 1: Confined to the uterus
Stage 2: Invades the cervix
Stage 3: Invades the ovaries, fallopian tubes, vagina or lymph nodes
Stage 4: Invades bladder, rectum or beyond the pelvis
81
Management of endometrial cancer?
Usual Tx… Total abdominal hysterectomy with bilateral salpingo-oophorectomy (known as a TAH and BSO)
Pt with high risk disease may have postoperative radiotherapy
In frail elderly women not considered suitable for surgery, progestogen therapy may be used instead - should slow progeression of cancer
82
What proportion of women with post menopausal bleeding will have endometrial cancer or endometrial hyperplasia?
1 in 10
83
Genetic predisposition for endometrial cancer?
Lynch syndrome - HNPCC
84
If you have a woman with postmenopausal bleeding and you send her for transvaginal USS and it comes back as her endometrial thickness <4mm, what should you do?
Look for another cause
No need for endometrial sampling as the negative predictive value of this measurement is 96%
85
Why does endometrial cancer most commonly present after menopause?
It’s an oestrogen dependant cancer..
After menopause lack of ovulation means lack of progesterone production
But there is still peripheral production of oestrogen e.g. from adipose tissue
Also some of these women are on oestrogen-only HRT
Also risk increases with age as there has been exposure to oestrogen for longer
86
Why does ovarian cancer have the worst prognosis of all gynaecological cancers?
Due to late diagnosis - this is because of non-specific symptoms that present late
70% of pt will present after it has spread beyond the pelvis
87
Average age of diagnosis for ovarian cancer?
60
88
Types of ovarian cancer
Epithelial cell tumours - 90%
Dermoid cycle/germ cell tumours 1.5%
Sex cord-stromal tumours 1%
Metastasis from cancer elsewhere 7%
Note that epithelial cell tumours tend to affect >50s and other tumour types generally affect younger women and progress faster and more aggressively
89
Subtypes of epithelial cell ovarian tumours? Which is most common?
Serous cystadenoma - most common benign ovarian tumour
Serous cystadenocarcinoma
Mucinous cystadenoma
Mucinous cystadenocarcinoma
Brenner tumour
90
Germ cell ovarian tumours:
Age most common in?
Types?
Most common benign ovarian tumours in women under 30
Types: teratoma (90%), dysgerminoma, yolk sac tumour, choriocarcinoma
91
What is a serous cystadenoma? (Ovarian cancer)
the most common benign epithelial tumour
Benign
bilateral in around 20%
Cysts lined by ciliated cells
92
What is mucinous cystadenoma? (Ovarian cancer)
second most common benign epithelial tumour
Benign
Cysts lined by mucous-secreting epithelium
they are typically large and may become massive
if ruptures may cause pseudomyxoma peritonei
93
What is the commonest type of ovarian cyst?
Follicular cyst
94
What is a follicular cyst?
A functional cyst
due to non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle
commonly regress after several menstrual cycles
95
What is a corpus luteum cyst?
during the menstrual cycle if pregnancy doesn't occur the corpus luteum usually breaks down and disappears. If this doesn't occur the corpus luteum may fill with blood or fluid and form a corpus luteal cyst
more likely to present with intraperitoneal bleeding than follicular cysts
96
What should you do if you find complex ovarian cysts?
Biopsy them to exclude malignancy
May measure tumour markers for possible germ cell tumour - AFP and hCG
97
Risk factors for ovarian cancer
FHx - Mutations in BRCA1 or BRCA 2 gene
Many ovulations e.g. early menache, late menopause or nulliparity
Older age
Obesity
Smoking
98
What are sex cord-stromal tumours? (ovarian cancer)
Types?
These are rare tumours, that can be benign or malignant.
They arise from the stroma (connective tissue) or sex cords (embryonic structures associated with the follicles).
There are several types, including Sertoli–Leydig cell tumours and granulosa cell tumours.
99
What is a Krukenberg tumour?
A malignant tumours
metastasis in the ovary, usually from GIT (mainly stomach)
They have the characteristic “signet ring” cells on histology
100
Protective factors for ovarian cancer?
COCP
Breast feeding
Pregnancy
These all reduce the number of ovulations, therefore lowering the risk of
101
Clinical features of ovarian cancer?
abdominal distension and bloating
abdominal and pelvic pain
urinary symptoms e.g. Urgency
early satiety
diarrhoea
Weight loss
Ascites
Pelvic mass
An ovarian mass may press on the obturator nerve and cause referred hip or groin pain!
102
Referral criteria for ovarian cancer
Refer urgently if physical examination identified ascites or a pelvic/absominal mass which is not obviously uterine fibroids
103
Which women should you test for ovarian cancer in?
Women (esp if >50) has any symptoms on a persistent or frequent basis (esp if >12 times a month):
- persistent bloating
- early satiety or loss of appetite
- pelvic or abdominal pain
- increased urinary urgency and/or frequency
Any woman >50 who has experience IBS-like symptoms within the last 12 months (IBS unlikely to present for the first time in women of this age)
Consider if a woman reported unexplained weight loss, fatigue or changes in bowel habit
104
Investigating for ovarian cancer?
CA125
If this is raised (35 or greater) then an urgent USS of abdomen and pelvis should be ordered
If USS suggests ovarian cancer then refer urgently for further investigation - diagnosis is tricky and will usually involve a diagnostic laparotomy
105
What is a “risk of malignancy index” and what does it take into account?
Estimates the risk of an ovarian mass being malignanct
Takes into account:
Menopausal status
USS findings
CA125 level
106
Causes of raised CA125?
Endometriosis
Fibroids
Benign ovarian cysts
Menstruation
Adenomyosis
Pelvic infection
Liver disease
Pregnancy
107
FIGO staging for ovarian cancer
Stage 1: Confined to the ovary
Stage 2: Spread past the ovary but inside the pelvis
Stage 3: Spread past the pelvis but inside the abdomen
Stage 4: Spread outside the abdomen (distant metastasis)
108
Management of ovarian cancer
Usually a combination of surgery and platinum-based chemotherapy
109
Prognosis of ovarian cancer
80% of women have advanced disease at presentation
the all stage 5-year survival is 46%
110
Screening opportunities for ovarian cancer?
UKCTOCS is a large study that looked at whether screening could be useful in ovarian cancer. They found that USS tests can’t find ovarian cancers any earlier and neither USS or blood test could save lives.
111
What is vulval intraepithelial neoplasia?
A pre-cancerous skin lesion of the vulva, and may result in squamous skin cancer if untreated
112
What age does vulval intraepithelail neoplasia typically affect?
What are the risk factors of it?
50
HPV 16&18
Smoking
HSV 2
Lichen planus
113
What type are most vulval cancers?
What age do they affect?
80% are squamous cell carcinomas
Usually affect women over 65
114
Risk factors for vulval carcinoma
age
HPV - associated with persistent infection in 90% of cases!!
Vulval intraepithelial neoplasia
Immunosuppression
Lichen sclerosis
115
Presentation of vulval cancer?
lump or ulcer on the labia majora
inguinal lymphadenopathy
may be associated with itching, irritation
116
Referral criteria for vulval cancer?
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for vulval cancer in women with an unexplained vulval lump, ulceration, or bleeding.
117
Management of vulval cancer?
Wide local excision to remove the cancer
Groin lymph node dissection
Chemotherapy
Radiotherapy
118
Referral criteria for suspected vaginal cancer?
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for vaginal cancer in women with an unexplained palpable mass in or at the entrance to the vagina.
119
Cause of vaginal cancer?
What type is most common?
What are they mist commonly related to?
Primary vaginal cancers are so rare!! Most vaginal cancers are metastatic from uterus or vulva
Predominantly squamous cell carcinoma
commonly HPV-related
120
Sources of patient support for gynaecological cancers?
Macmillan
Cancer research UK
The Eve Appeal - all gynae cancers
target Ovarian cancer
Jo’s trust - for cervical cancer
Womb cancer support UK
OVACOME - ovarian cancer
NHS website
121
What is the Eve Appeal?
The leading UK national charity funding research and raising awareness into womb, ovarian, cervical, vulval and vaginal cancer
122
What are Target Ovarian Cancer?
A charity specifically for ovarian cancer in the UK
They help with early diagnosis, reach and support
123
What is Jo’s Trust?
The UK’s leading cervical cancer charity
They provide information and support, and campaign for the best cervical cancer prevention/diagnosis/treatment and care
124
What is Ovacome?
A national UK ovarian cancer charity focused on providing support and information to anyone affected by ovarian cancer
125
Are most ovarian cysts cancerous?
No
126
Does COCP increase risk for ovarian cancer?
No it reduces it as there are fewer ovulations
127
Is CA125 a reliable ovarian cancer marker in all stages of disease?
It’s elevated in 90% of late stage disease but only 50% of early stage
Also more likely to be raised in women >50
128
Ovarian germ cell tumour: Teratoma
- benign or malignant?
- what % of germ cell tumours does it account for?
- what do they contain?
Mature teratomas (aka dermoid cyst) = benign - most common
Immature teratoma = malignant
Accounts for 90% of germ cell tumours
Contains a combination of ectodermal (e.g. hair), mesodermal (e.g. bone) and endodermal tissue
129
Ovarian germ cell tumour: Dysgerminoma
- benign or malignant?
- how common?
- what do they secrete?
- what syndrome are they associated with?
Malignant
Most common maligannt germ cel tumour
Secret hCG and LDH
Turner’s syndrome
130
Ovarian germ cell tumour: yolk sac tumour
- benign or malignant?
- what do they secrete?
- histology
Malignant
Secrete AFP
Schiller-Duval bodies on histology are pathognomonic
131
Ovarian germ cell tumour: choriocarcinoma
- benign or malignant?
- what spectrum of disease are they part of?
- what do they secrete?
- where do they spread to early on?
Maligannt
Rare tumour part of spectrum of gestational trophoblastic disease
Increased hCG levels
Often have early haematogenous spread to the lungs
132
What are serous cystadenocarcinomas?
What are seen histolgoically?
Malignant ovarian tumours
Often bilateral
Psammoma bodies seen (collections of calcium)
133
What are Mucinous cystadenocarcinomas?
What is a complication?
Malignant ovarian tumours
May be associated with pseudomyxoma peritonei (although Mucinous tumour of appendix is a more common cause)
134
What is a Brenner tumour?
Histology findings?
A benign ovarian tumour
Contains walthard cell rests which are benign clusters of epithelial cells
“Coffee bean” nuclei
135
Granulosa cell tumours:
Malignant or benign?
What do they produce? Effect?
Histology?
Maligannt sex cord stromal ovarian tumour
Produce oestrogen = precocious puberty if in children or endometrial hyperplasia in adults
Call-exner bodies (small eosinophilic fluid-filled spaces between granulosa cells)
136
Sertoli-leydig cell tumours:
Malignant or benign?
What do they produce? Effect?
What sundrome are they associated with?
Benign sex cord stromal ovarian tumour
Androgens -> masculinising effects
Associated with Peutz-Jegher syndrome
137
Characteristics of the sex-cord stromal ovarian tumour: fibroma?
Malignant or benign?
What is it associated with?
What does thr tumour consist of?
What age?
Benign
Associated with Meigs’ syndrome - ascites and pleural effusion
Solid tumours consisting of bundles of spindle-shaped fibroblasts
Typically occur around menopause
138
What is meigs’ sundrome?
- presence of a benign ovarian tumour e.g. ovarian fibroma, brenner tumour etc
- ascites
- pleural effusion
