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Flashcards in Repro Session 12 Deck (60):
1

vulval tumours are most commonly what type of cancer?

squamous carcinomas, carcinoma= malignant neoplasm of epithelial cells, so squamous= malignant neoplasm of squamous epithelial cells, with malignant= ability to metastasise

2

most common cause of vulval tumours in pre-menopausal women?

HPV

3

where does a vulval tumour caused by HPV metastasise to? to

inguinal LNs

4

what is vulval carcinoma in older women related to?

chronic irritation and longstanding dermatoses e.g. lichen sclerosus and squamous hyperplasia

5

most carcinomas of cervix are what type?

squamous

6

common aetiology of cervical carcinomas?

HPV

7

aim of cervical screening programme?

detect pre-invasive lesion and excise involved area completely before a tumour can develop

8

cells of pre-invasive lesion detected in cervical screening?

dyskaryotic cells= cells with abnormally enlarged nuclei possessing abnormal chromatin

9

what is prognosis of cervical carcinoma affected by?

size of tumour
depth of invasion

10

where does cervical carcinoma spread?

iliac and then aortic LNs, before wider systemic dissemination
local spread involves ureters, bladder and rectum, and is very distressing with pain and fistula formation

11

most probable aetiology in perimenopausal women of endometrial adenocarcinoma?

unopposed oestrogen from obesity, exogenous oestrogen administration, or a hormone-secreting tumour

12

symptoms of fibroids?

menorrhagia and intermenstrual bleeding, pain, discharge and infertility

13

malignant counterpart of fibroids?

leimyosarcoma

14

where might a leiomyosarcoma metastasise?

blood to lungs and then systemically

15

what do ovarian tumours cause by spreading through the abdomen?

ascites
intestinal obstruction
perforation
death

16

useful tumour markers in malignant germ cell tumours?

beta hCG
alpha fetoprotein

17

examples of malignant germ cell tumours?

dysgerminoma
yolk sac tumour
choriocarcinoma
embryonal carcinoma

18

what is a thecoma?

benign tumour derived from ovarian stroma

19

examples of a sex cord tumour?

granulosa cell tumour

20

consequences of rare sex cord stromal tumours secreting androgens?

defeminisation
masculinisation
amenorrhoea
infertility

21

what is a hydatidiform mole?

results from a chromosomal defect in the conceptus causing oedema of the placetal chorionic villi. Assoc. atypical trophoblastic hyperplasia and tumours have the propensity for myometrial penetration. May persisit, invade, metastasise and kill. sig. risk of development of choriocarcinoma

22

what is a choriocarcinoma?

malignant tumour of placenta composed of syncytio and cytotrophoblast without villi.

23

RFs for cervical cancer?

smoking
multiple sexual partners
multiple births
low SE class

24

macroscopic cervical carcinoma appearance?

ulcer
cervical expansion
nodule

25

symptoms of squamous cell cervical carcinoma?

post-coital, intermenstrual bleeding or post menopausal bleeding

26

what is cervical intraepithelial neoplasia graded on?

mitotic activity
nuclear pleomorphism/hyperchromasia
nuclear to cytoplasmic ratio

27

when does cervical screening start?

age 25, then every 3 years till 50
5 years 50-65
Abnormal – referred for colposcopy- magnifying instrument to look at surface of cervix

28

malignant features of leiomyosarcoma?

mitoses
atypia
necrosis- as outgrows its blood supply
infiltration

29

what do granulosa cell tumours usually secrete?

oestrogen

30

granulosa cell tumour histological appearance?

coffee bean nuclei
call-exner bodies

31

histology of leygig/steroid cell tumour?

abundant cytoplasm in cells arranged in pink sheets
crystals of Reinke

32

which cells are affected in cervical intraepithelial neoplasia, and how does this progress?

all cells at all levels abnormal= important as screening only looks at the surface layer, exfoliative cytology wouldn't work otherwise
CIN I, II and III= carcinoma in-situ= most likely to invade and so progress to cancer

33

risk factors for type I endometrial adenocarcinoma?

unopposed oestrogen:
early menarche
late menopause
obesity
iatrogenic
nulliparous- continuous cycling of endometrium with SF breakdown every month

34

what is type II endometrial adenocarcinoma?

clear cell and uterine serous papillary, high grade and arises spontaneously, post-menopause, cancer doens't have to grow very far to invade other structures as endometrium small and atrophied

35

endometrial adenocarcinoma macroscopic appearance?

soft, white, mushy
invades myometrium and cervix
spread to adnexa
glands

36

what determines endometrial adenocarcinoma prognosis?

depth- myometrial thickness
grade/type- hormone related tend to be better grade and prognosis
assoc hyperplasia
involvement of cervical stroma/adnexa

37

types of endometrial hyperplasia?

simple: cystic glands, abundant stroma
complex: crowded, branched or budded glands
complex with atypia: cytological features of malignancy of varying degrees

38

what are polyps in the uterus?

benign growths of endometrium

39

why can excessive bleeding and cramping occur with endometrial hyperplasia?

inflammatory response of uterus

40

why do fibroids cause menorrhagia?

increase area of endometrium that can bleed

41

what may ovarian neoplasms arise from?

metastases e.g. krukenberg tumour- from gastric cancer- virchow's node
germ cells
sex cord components e.g. granulosa cell tumour
stroma
surface epithelium- simple cuboidal

42

clinical presentation of ovarian neoplasms?

presents late
no symptoms of precursor
symptoms later confused with IBS: abdominal pain, bloating after meals
hormonal: menstrual disturbances, inappropriate sex hormones
late: ascites, obstruction, perforation and DEATH- transcoelomic spread through peritoneum

43

types of epithelial ovarian carcinoma?

serous
mucinous
endometrioid
clear cell
Brenner (transitional)
All can be benign, malignant or borderline- don't invade/spread but epithelial characteristics of malignant cells

44

where do mucinous ovarian tumours usually arise from?

usually metastasise from bowel and appendix
intestinal mucin secreting epithelium

45

why is combined OCP protective against ovarian cancer?

progesterone and oestrogen acting together inhibit ovulation and hence the destruction of the overlying epithelium of the ovaries and their subsequent regeneration process

46

what cancer might endometriosis increase the risk of?

endometrioid ovarian tumour- may occur in patient who has had a hysterectomy but is on HRT- oestrogen will allow growth of ectopic endometrial tissue

47

RFs for ovarian cancer?

BRCA1 and 2 genes in familial cases
smoking
obesity
endometriosis
prior cyst e.g. as a result of PID?

48

where do leydig cell tumours- a type of sex cord stromal tumour of the ovary arise?

hilum of ovary

49

symtpoms of a patient with an androgen secreting sex cord stomal tumour?

male pattern baldness
clitoromegaly
acne

50

what is meig's syndrome?

occurs with a thecoma: stromal cell tumour, ascitic fluid accumulation, unilateral fluid in thorax

51

why is there increasing incidence of vulval tumours?

ageing population
increased HPV transmission

52

examples of vulval tumours?

squamous carcinoma
adenocarcinoma
basal cell carcinoma
malignant melanoma

53

why might a patient with a vulval carcinoma die from bleeding?

cancer involvement of femoral artery

54

characteristics of squamous vulval carcinomas?

keratotic
warty
ulcerated

55

characteristics of vulval intraepithelial neoplasia?

scaly red patch
sore
itchy
white
labia, perineum, perianal, incidental

56

histology of VIN?

abnormal maturation
mitotic activity above basal layer

57

characteristics of vulva basal cell carcinoma?

ulcerated
pearly white or pigmented nodule
mainly labia major- from LS folds
deeply infiltrating if neglected
doesn't metastasise

58

describe a hydatidiform mole

villous growth abnormality: villi swollen- oedema, as blood not being pumped by fetus through villi as fetus absent or abnormality

59

at risk groups of hydatidiform mole?

50 yr old women

60

where does a choriocarcinoma metastasise to?

genital tract, lungs and brain