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Kofi: Pure Clinical Sem 3 > Repro: Cancer > Flashcards

Repro: Cancer Flashcards

(57 cards)

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1
Q

Where can gynaecological tumours arise?

A
  • Vulva
  • Cervix
  • Endometrium
  • Myometrium
  • Ovary
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2
Q

What are the clinical features of vulval tumours?

A
  • Uncommon
  • Women over 60 makes 2/3 of patient
  • Usually Squamous cell carcinoma
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3
Q

How are vulval squamous neoplastic lesions related to HPV infection?

A
  • 30% related to HPV infection and it usually HPV 16

- 70% are unrelated to HPV. Most occur due to longstanding inflammation and hyper plastic conditions of the vulva

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4
Q

What is VIN?

A
  • Vulvar intraepithelial neoplasia
  • Atypical squamous cells in the epidermis
  • In situ precursor of vulval squamous cell carcinoma
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5
Q

How does Vulval squamous cell carcinoma spread?

A
  • Spreads initially to inguinal, pelvic, iliac and para-aortic lymph nodes
  • Also spreads to lungs and liver
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6
Q

What are the treatment options for vulval squamous cell carcinoma?

A

Less than 2cm

-Vulvectomy and lymphadenectomy

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7
Q

What is the likely causes of CIN or cervical carcinoma?

A

-Almost all cases related to High risk HPVs

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8
Q

What are the most important high risk HPV in the pathogenesis of cervical carcinoma?

A
  • HPV 16

- HPV 18

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9
Q

What is the pathogenesis of HPV in CIN or cervical carcinoma?

A
  • Infection of immature metaplastic squamous cells in transformation zone
  • Production of viral proteins E6 and E7
  • These interfere with tumour suppressor proteins (p53 and RB) to cause inability of repair damaged DNA and increased proliferation of cells
  • Most genital HPV infectious transient and eliminated by immune response in months
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10
Q

What are the risk factors of Vulval squamous cell carcinoma, CIN, and Cervical Carcinoma?

A
  • Sexual intercourse
  • Early first marriage
  • Early first pregnancy
  • Multiple births
  • Many partners
  • Promiscuous partner
  • Long term use of OCP
  • Partner with carcinoma of the penis
  • Low socio-economic class
  • Smoking
  • Immunosuppression
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11
Q

What does cervical screening involve?

A
  • Cells from the transformation zone are scraped off
  • Stained with Papanicolaou stain
  • Examined microscopically

-Can also test for HPV DNA in cervical cels through molecular method of screening

Start at age 25 and do it every 3 years till 50
Then every 5 years 50-65

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12
Q

What is done if an abnormal cervical screening is observed?

A
  • Coloscopy

- Biopsy

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13
Q

What is cervical intraepithelial neoplasia?

A

-Dysplasia of squamous cells within the cervical epithelium, induced by infection with high risk HPVs

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14
Q

What is the grading of cervical intraepithelial neoplasia?

A

CIN 1 - most regress spontaneously. Few progress
CIN 2 - proportion progresses to
CIN 3 - Carcinoma in situ. 10% Progresses to invasive carcinoma in 2-10 yrs and 30% regress

CIN 1 to CIN 3 takes 7 years

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15
Q

What is the treatment for CIN?

A
  • CIN 1: Follow up or cryotherapy

- CIN 2 and CIN 3: Superficial excision of transformation zone

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16
Q

What are the types of invasive cervical carcinoma?

A
  • Squamous cell carcinoma (80%)
  • Adenocarcinoma (15%)

Average Age - 45 years
May be exophytic or infiltrative

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17
Q

How does cervical carcinoma spread?

A
  • Locally to para-cervical soft tissues, bladder, ureters, rectum, vagina
  • Lymph nodes (para-cervical, pelvic, para-aortic)
  • Distally
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18
Q

How does cervical carcinoma present?

A
  • Screening abnormality

- Post-coital, intermenstrual or post-menopausal vaginal bleeding

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19
Q

How is invasive cervical carcinoma treated?

A

Microinvasive (5 yr survival = 100%)
-Treated with cervical cone excision

Invasive carcinoma (62% ten year survival)
-Treated with hysterectomy, lymph node dissection and if advanced, radiation and chemotherapy
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20
Q

What is endometrial hyperplasia?

A
  • Increased gland to stroma ratio
  • Frequent precursor to endometrial carcinoma
  • Endometrium line the internal cavity of uterus
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21
Q

What is associated with endometrial hyperplasia?

A
  • Annouvulation
  • Increased oestrogen from endogenous sources
  • Exogenous oestrogen
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22
Q

How is endometrial hyperplasia treated if complex and atypical?

A

Hysterectomy

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23
Q

What are the clinical features of endometrial adenocarcinoma?

Study These Flashcards
A
  • Common invasive cancer of the genital tract

- Usually 55-75

24
Q

What is the presentation of endometrial adenocarcinoma?

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A

-Irregular or post menopausal vaginal bleeding

Early detection and cure often possible.

25
What are the macroscopic features of endometrial adenocarcinoma?
-Can be polyploid or infiltrative
26
What types of endometrial adenocarcinoma are there?
- Endometrioid (more common) | - Serous carcinoma
27
What are the features of endometrioid adenocarcinoma?
- Mimics proliferative glands - Arises from endometrial hyperplasia - Associated with unopposed oestrogen ad obesity - Spread by myometrial invasion and direct extension to adjacent structures, to local lymph nodes and distant sites
28
What are features of Serous Carcinoma?
- Poorly differentiated, aggressive, worse prognosis | - Exfoliates, travels through Fallopian tubes and implants on peritoneal surfaces
29
What is the commonest tumour of the myometrium?
- Leiomyoid = fibroid - Benign tumour of myometrium - Often multiple - Tiny to massive, filling the pelvis
30
What is the presentation of leiomyoma?
- Asymptomatic - Can cause heavy/painful periods - Urinary frequency - Infertility
31
What is a malignant tumour of myometrium?
Uterine leimyosarcoma - Uncommmon (40-60 yrs) - Highly malignant - Doesn't arise from leiomyomas - Metastasise to lungs
32
What are clinical features of ovarian tumours?
- Approximately 80% are benign and generally occur at 20-45 yrs - Malignant tumours generally occur at 45-65 yrs - Malignant tumours generally occur at 45-65 yrs - Many are bilateral
33
How do ovarian tumours present?
- Most are non-functional. Only produce symptoms when they become large and invade adjacent structures or metastasise - Hormonal problems
34
What are the symptoms of large non-functional tumours?
- Abdominal pain - Abdominal distension - Urinary and Gastrointestinal symptoms - Ascites
35
What are the hormonal problems of ovarian tumours?
- Menstrual disturbances | - Inappropriate sex hormones
36
What are the clinical features of malignant ovarian tumours?
- 50% spread to other ovary - Spread to regional nodes and elsewhere - Some associated with BRCA mutations (carriers treated with prophylactic sapling-oophrectomy)
37
What is used in diagnosis of malignant ovarian tumours?
CA-125 | -Monitor disease recurrence and progression
38
How are ovarian tumour classified?
- Mullerian (ovarian) epithelium (endometriosis) - Germ cell - Sex cord-stromal cells - Metastases
39
What are the 3 main histological types of ovarian epithelial tumours?
- Serous - Mucinous - Endometrioid Many are cystic
40
What are risk factors for ovarian epithelial tumours?
- Nulliparity or low parity - OCP protective - Heritable mutations eg BRCA1 and BRCA2 - Smoking - Endometriosis
41
What are serous ovarian tumours?
-Often spread to peritoneal surfaces and omentum and commonly associated with ascites
42
What are mucinous ovarian tumours?
- Often large, cystic masses which can be more than 25 kg - Filled with sticky, thick fluid - Usually benign or borderline
43
What is pseudomyxoma peritonei? (thought to be from micnous but not)
- Extensive mucinous ascites - Epithelial implants on peritoneal surfaces - Frequent involvement f ovaries - Can cause intestinal obstruction - Most likely is extra-ovarian usually appendix
44
What is endometrioid ovarian tumour?
- Tumour has tubular gland resembling endometrial glands - Can arise in endometriosis - 15-30% have associated endometrial endometrial endometriod adenocarcinoma probably arising separately
45
What are Germ cell ovarian tumours?
- 15-20% of all ovarian neoplasms - Most are teratomas which are usually benign - Other types are malignant and include dysgerminoma, Yolk sac tumour, Choriocarcinoma, Embryonal carcinoma
46
What are the types of ovarian teratoma?
- Mature (benign) is most common - Mono-dermal (highly specialised) - Immature (malignant) is rare and composed to tissues that resemble immature foetal tssue
47
What are the clinical features of ovarian mature teratomas?
- Most are cystic - Most contain skin lie structures - Usually occur in young women - Bilateral in 10-15% of cases
48
What is usually contain in ovarian mature teratomas?
- Contain hair and sebaceous material and can contain tooth structures - Often also tissue from other germ laters such as cartilage, bone, thyroid and neural tissue
49
What is the most common mono-dermal ovarian teratoma?
Struma ovarii - Benign - Composed entirely of mature thyroid tissue - May be functional and cause hyperthyroidism
50
What are ovarian sex cord-strumal tumours?
- Derived from ovarian stroma - Produces Sertoli and Leydig cells leading cell in testes and Granulosa and Theca cells in the ovaries - Tumours reselling all of these four cell types can be found in the ovary - These tumours can be feminising or masculinising
51
What are the clinical features of granulosa cell tumours?
- Most occur in post-menopausal women | - May produce large amounts of oestrogen
52
What may be produced in pre-pubertal girls and adult women due to granulosa cell tumours?
- Precocious puberty in pre-pubertal girls | - Endometrial hyperplasia, endometrial carcinoma and breast disease in adult women
53
What are the clinical features of ovarian-sertoli leading cell tumours?
Often functional. Peak incidence in teens or twenties - In children, may block normal female sexual development - In women can cause defeminisation and masculinisation
54
What tumours occur in the testes?
- Germ cell tumours - Sex cord-stromal tumors (Sertoli cell tumours, Leydig cell tumours) - Lymphomas
55
What are types of germ cell tumours occurring in men?
- Seminomas | - Non-seminomatous germ cell tumours (Yolk sac tumours, Embryonal carcinomas, Choriocarcinomas, Teratomas)
56
Which tumours commonly metastasise to the ovaries?
Mullerian tumours from - Uterus - Fallopian tubes - Contralateral ovary - Pelvic peritoneum
57
What other tumours metastasise to the ovaries?
- Gastrointestinal tumour and breast - Krukenberg tumour : metastatic gastrointestinal tumour within the ovaries which is often bilateral and from the stomach

Kofi: Pure Clinical Sem 3 (44 decks)

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