Week 12.0 - Gynae Tumours

Question 1

What is CIN?

Answer 1

-Cervical Intraepithelial Neoplasia -> premalignant changes of the cervix (dysplasia)

Question 2

How long does CIN I take to progess to CINIII?

Answer 2

-7 years

Question 3

What risk factor gives you the highest risk of developing CIN?

Answer 3

-HPV 16 and 18

Question 4

Which part of the cervix is most commonly affected by CIN?

Answer 4

-Transformation zone

Question 5

Besides HPV, give 3 risk factors for CIN

Answer 5

• Sexual intercourse
• Multiple births
• Longterm use of OCP
• Partner with carcinoma of the penis

Question 6

Describe 3 disease factors which make cervical screening a good programme

Answer 6

• 3rd most common female cancer -> relevant
• Natural history and progression of disease well understood
• Has an early detectable stage

Question 7

What is the most common type of cervical cancer?

Answer 7

-SCC

Question 8

At what age does cervical cancer typically occur?

Answer 8

-Average age is 45

Question 9

How does cervical cancer characteristically spread?

Answer 9

• Locally to para-cervical soft tissues eg bladder, rectum

- Lymphatics to surrounding lymph nodes

Question 10

How does cervical cancer usually present?

Answer 10

• Screening abnormality

- Post-coital, intermenstrual or post-menopausal bleeding

Question 11

What is endometrial hyperplasia a precursor to?

Answer 11

-Endometrial carcinoma

Question 12

What is the main risk factor for endometrial carcinoma?

Answer 12

-Prolonged oestrogen exposure

eg exogenous oestrogen, increased oestrogen from endogenous sources eg adipose, annovulation

Question 13

When does endometrial adenocarcinoma commonly occur?

Answer 13

-between ages 55-75 (rare before 40)

Question 14

What are the two main types of endometrial adenocarcinoma and state the differences between them

Answer 14

• Endometrioid -> Common, glandular proliferation, arising after endometrial hyperplasia,
• Serous -> poorly differentiated, aggressive, worse prognosis, exfoliates

Question 15

What is a leiomyoma?

Answer 15

-Fibroid -> beinign tumour of smooth muscle of myometrium

Question 16

Where does leiomyosacroma metastasise?

Answer 16

-Lungs

Question 17

When do malignant ovarian tumours commonly occur?

Answer 17

-45-65

Question 18

Why does ovarian cancer have a poor survival rate?

Answer 18

-Often spread to other sites by the time it presents

Question 19

Which tumour marker can be used to monitor ovarian cancer?

Answer 19

-CA125

Question 20

Which genetic mutation is linked to ovarian cancer?

Answer 20

-BRCA

Question 21

Give some risk factors for ovarian epithelial tumours

Answer 21

• Null or low parity
• Smoking
• BRCA

Question 22

What are the 4 groups of ovarian tumours?

Answer 22

• Mullarian epithelial
• Germ cell
• Sex cord
• Mets

Question 23

Why are serous ovarian tumours associated with acites?

Answer 23

-Exfoliative and thus seed to the peritoneum

Question 24

What is pseudomyxoma perinotei

Answer 24

-An extensive mucinous ascites caused by mets to the peritoneum, often involves the ovaries but the primary is the appendix

Question 25

What is the most common germ cell tumour?

Answer 25

-Teratoma

Question 26

Besides teratoma, give another germ-cell tumour

Answer 26

-Yolk sac tumour

Question 27

What is a-fetoprotein?

Answer 27

-A tumour marker which is used in yolk sac tumours and liver tumours

Question 28

In who do mature teratomas most commonly occur?

Answer 28

-Young women

Question 29

What is struma ovarii?

Answer 29

-Monodermal teratoma consisting solely of thyroid tissue

Question 30

What is meant by a sex-chord tumour being feminising or masculinising?

Answer 30

-Can contain any of the 4 sex cells eg granulosa, theca, sertoli or leydig, thus can produce testosterone or oestrogen

Question 31

Typically at what age does vulva cancer occur?

Answer 31

-Over 60

Question 32

What types of vulva cancer are there?

Answer 32

- BCC - SCC - Malignant melanoma - Extramammary pagets disease

Question 33

With which infection is vulva cancer associated with? What age group does this affect?

Answer 33

- HPV (16) | - 6th decade

Question 34

What age group does vulva cancer not associated with HPV affect?

Answer 34

-8th decade

Question 35

What is VIN?

Answer 35

- Vulva intraepithelial Neoplasia - An in situ precursor with no mucosal invasion. - Often white patches on mucosa or brown patches on anus

Question 36

What are the 3 major types of gestational tumours?

Answer 36

- Hydatidiform mole - Invasive mole - Choriocarcinoma

Question 37

What is a hydatidiform mole?

Answer 37

-Molar pregnancy when all the cells are dedicated to the outercell mass (trophoblast)

Question 38

What is an invasive mole?

Answer 38

-Hydatidiform mole which penetrates and invades the endometrium/myometrium

Question 39

Why is an invasive mole so dangerous?

Answer 39

-Invasion can be extensive leading to haemorrhage and local destruction of tissue. (needs to be treated with chemo)

Question 40

What is a gestational choriocarcinoma?

Answer 40

-Malignant neoplasm of trophoblast cells which is rapidly invasive and metastasises