Repro 12 Flashcards Preview

Semester 4 > Repro 12 > Flashcards

Flashcards in Repro 12 Deck (66):
1

What type of cancer are most carcinomas of the cervix?

Squamous
Adenocarcinoma 25-30%

2

What is required for cervical changes to be malignant?

HPV

3

What is CIN?

Cervical intraepithelial neoplasia.
Grade given based on mitotic activity, nuclear pleomorphism/hyperchromasia and nuclear/cytoplasmic ratio

4

What are the aetiology factors associated with carcinoma of the cervix?

Lifestyle - Number of sexual partners, promiscuity, low social class, smoking
Immunocompromised
OCP
Number of pregnancies
Familial

5

What is the aim of cervical screening?

Detect the pre-invasive lesion and to excise the involved area completely before a tumour can develop

6

Why is exfoliative cytology adequate for cervical screening?

Cells at surface level always affected no matter what CIN stage

7

What does cervical screening detect?

Cells with abnormally enlarged nuclei possessing abnormal chromatin

8

When are women referred for colposcopy?

Abnormal cells and HPV positive

9

What chemical is used in colposcopy?

Diluted acetic acid

10

How are abnormal cells commonly existed for biopsy?

Diathermy

11

How often and at what age are women screened for cervical cancer?

3 years age 25-50
5years age 50-65

12

What features determine the prognosis of carcinoma of the cervix?

Spread - depth of invasion, size (much more important that differentiation)

13

Where do cervical carcinomas tend to spread?

Iliac and aortic lymph nodes initially before wider systemic dissemination
Local - ureters, bladder, rectum (extemely distressing with pain and fistula formation)

14

Who receives the vaccination for HPV?

12-13 year old girls (not effective if already exposed)

15

What is the most common type of vulval tumour?

Squamous carcinoma
Rarer - adenocarcinoma, basal cell and malignant melanoma

16

What is the cause of vulval tumour?

HPV in pre-menopausal women
In older women, the causative agent is unknown but are probably related to chronic irritation and longstanding dermatoses such as lichen sclerosis and squamous hyperplasia

17

How might vulval squamous cell carcinoma present?

Scaly red patch
Sore
Itchy
White
Incidental finding in 30%

18

Where do vulval carcinomas commonly spread to?

locally and metastasise to the inguinal lymph nodes

19

Can vuval sqaumous cell carcinoma be cured?

Yes if caught early - vulvectomy

20

Describe extramammary Paget's disease?

Commonly found in the vulva
Grows downwards
24-30% associated with invasive neoplasm
0.2% vulval carcinoma
Average age 63

21

How does vulval basal cell carcinoma present?

Pearly white/pigmented nodule
Ulcerated

22

Does vulval basal cell carcinoma have a positive prognosis?

Deeply infiltrative if neglected
Does not metastasise
Vulvectomy does not work

23

What is the common treatment of vulval squamous carcinomas?

Vulvectomy

24

Who commonly develops endometrial adenocarcinoma?

Perimenopausal and older women

25

What causes endometrial adenocarcinoma?

Unopposed oestrogen:
- obesity
- exogenous oestrogen administration
- hormone-secreting tumour
- late menopause/early menarche (long reproductive lifespan)
- Tamoxifen

26

What types of cancer may occur in the endometrium?

Adenocarcinoma
Adenosquamous
Malignant stroma

27

What does the prognosis of endometrial adenocarcinoma depend on?

Grade
Spread in the myometrium

28

Where does endometrial adenocarcinoma commonly spread to?

Invades myometrium and cervix
Bladder
Rectum
Through peritoneal cavity
Regional lymph nodes
Adnex

29

When might adjuvant therapy be required to treat endothelial adenocarcinoma?

With involvement of more than half the myometrium depth

30

Who is endometrial carcinoma easier to treat in?

Younger women with type I (hormone related) as hormone dependent tumours are generally simpler to treat

31

Describe type II endometrial carcinoma.

Occurs in older women
Not hormone related
High grade
Spontaneous
Clear cell
Uterine serous papillary

32

Describe the histology of endometrial adenocarcinoma.

Glands
Malignant epithelium
Squamous areas sometimes

33

What are fibroids?

Benign tumours of uterine smooth muscle
Leiomyomas. Can be single but more commonly multiple leiomyomas

34

What are the symptoms of fibroids?

Heavy menstrual loss
Intermenstrual bleeding
Pain
Discharge
Infertility

35

How do fibroids resolve?

Oestrogen dependent and usually regress after the menopause

36

How do fibroids appear histologically?

Interlacing bundles of smooth muscle
Rounded ends to nuclei
Fibrotic or myloid stroma
Atypical types

37

Compare leiomyoma and leiomyosarcoma.

Present with similar symptoms but leiomyosarcoma usually single

38

What is the aetiology of leiomyosarcoma?

Unknown

39

How do leiomyosarcoma appear histologically?

Massively increased mitotic activity
Cellular atypia
Infiltrative growth pattern

40

Where do leiomyosarcomas metastasise to?

Lung by blood stream and systemically

41

What is the aetiology of ovarian carcinoma?

Super ovulation (IVF)
HRT
Smoking
Obesity
Endometriosis
Prior cysts
Talcum powder used to carry risk (asbestos)

42

Where might tumours of the ovary arise from?

Epithelium (most common)
Stroma
Germ cells
Sex cord elements

43

Why is there currently no screening for ovarian cancer?

No accepted pre-cursor lesion
Although, CA125 and ultrasonography is currently being investigated

44

How does ovarian cancer tend to present?

Does not present until late
IBS symptoms initially
Spread within the abdomen where they can cause ascites, intestinal obstruction, perforation and death

45

How are ovarian cancers typed?

Epithelium (serous, mucinous, endometrioid, transitional)
Benign, Low malignant potential or malignant

46

What genes have been associated with ovarian cancer?

BRCA1 and 2 associated with familial ovarian epithelial carcinoma but this accounts for less than 1% of cases

47

What is the most common type of germ cell tumour?

Mature (benign) cystic teratoma that contains skin, hair, teeth, bone and other tissue

48

What is and immature germ cell tumour?

Malignant such as primitive neuroepithelium
Risk of intra abdominal spread and potential cause of death

49

How should immature germ cell tumours be treated?

Chemo

50

What other malignant germ cell tumours are there?

Dysgerminoma
Yolk sac tumour
Choriocarcinoma
Embryonal carcinomas

51

How should dysgerminoma be treated?

Radiotherapy

52

What is alpha-fetoprotein?

Plasma protein produced by the yolk sac - can be used to determine yolk sac tumours

53

What is beta human chorionic gonadotrophin hormone?

Hormone secreted in pregnancy but also in certain cancers e.g. ovarian

54

What are granulosa cell tumours?

Resemble the cells lining the ovarian follicle and are thus sex cord tumours

55

What other diseases are associated with granulosa cell tumours and why?

Endometrial adenocarcinoma
Iso-sexual precocious puberty
Commonly produce oestrogens

56

Where might granulosa cell tumours spread to and when might they recur?

Intra-abdominally
Can recur within 5 years or up to 20 years later

57

What are thecomas?

Benign tumours derived from ovarian stroma. May also produce oestrogen and give rise to similar conditions as granulosa cell tumours

58

What are fibromas?

Stromal tumours that cause pressure symptoms and sometimes ascites

59

What is Meig's syndrome and when is it commonly seen?

Ovarian tumour with ascites and pleural effusion that resolves after resection of the tumour. Most commonly produced by benign ovarian tumours

60

Why can some tumours cause defeminisation?

Secrete androgens eg rare sex cord stromal tumours, Leydig cell tumours
Amenhorroea, masculinisation and infertility

61

What are hydatidiform moles?

Gestational tumours from a chromosomal defect in the conceptus. Associated atypical trophoblastic hyperplasia and these tumours have the propensity for myometrial penetration

62

What results from hydatidiform moles?

Oedema of the placental chorionic villi.
May persist, invade, metastasise and kill
Significant risk of development of choriocarcinoma and placental site trophoblastic tumour

63

What is choriocarcinoma and where might it metastasise to?

A malignant tumour of placenta composed of syncytio and cytotrophoblast without villi
Genital tract, lungs and brain

64

What is placental site trophoblastic tumour?

A rare variant of trophoblastic malignancy resembling intermediate trophoblast

65

What is a complete hydatidiform mole?

Diploid chromosomal defect.
Most villi involved, with or without vessels
Atypical trophoblastic proliferation
p57 negative

66

What is partial hydatidiform mole?

Partial triploid (1 egg, 2 sperm)
Some normal villi
Geographical profile
Epithelial inclusion
Circumferential proliferation
p57 positive