week 3 Flashcards by Connie Baume-kennedy

what does uterine cancer develop from

the endometrium

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most common type of uterine neoplasia

adenocarcinoma

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risk factors for uterine neoplasia

PCOS
late menopause/early menarche
low parity/nulliparous
obesity
oestrogen only HRT
tamoxifen
genetics- lynch

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presentation of uterine neoplasia

abnormal PV bleeding
post menopausal bleeding: endometrial carcinoma until proven otherwise
PV discharge
pain/weight loss

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first line investigation for endometrial cancer

TVUS
- measure endometrial thickness (thickness <4mm is reassuring)

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investigations for endometrial cancer

TVUS
endometrial biopsy/dilation and curettage
- performed to obtain a tissue sample for histology
hysteroscopy
- allows visualisation of endometrium

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histological variation of endometrial carcinoma

purely glandular
areas of squamous differentiation
papillary
clear cell pattern

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spread of endometrial carcinoma

usually spreads to myometrium and cervix
but can spread to blood and lymph too

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two types of endometrial cancer

type I (endometrioid): most common
type II (serous and clear cell)

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what is type I endometrial cancer

endometrioid
- usually diagnosed shortly after menopause
- oestrogen dependent
precursor lesion= atypical hyperplasia
PTEN, KRAS, PIK3CA mutations
Microsatellite instability – germline mutation of mismatch repair genes (Lynch
syndrome)

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what is type II endometrial cancer

serous and clear cell
- older women usually
- poorer prognosis
- not associated with unopposed oestrogen
- TP53 mutation
precursor lesion= serous endometrial intraepithelial carcinoma
spreads fallopian tubes

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endometrial sarcoma

rare
arise from endometrial stroma and locally aggressive
metastasizes early

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staging used for endometrial carcinoma

figo staging

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management of endometrial carcinoma

surgery is the principles treatment
- total hysterectomy and bilateral salpingo-oophorectomy + peritoneal washings
radiotherapy
chemotherapy

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smooth muscle tumours of the myometrium

leiomyoma
leiomyosarcoma

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leiomyoma

common
menorrhagia and infertility
(fibroid)

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leiomyosarcoma

rare and poor prognosis
women > 50

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peak age of ovarian cancers

75 years

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genetic risks for ovarian cancers

HNPCC (lynch syndrome)- 12%
BRCA 1 and BRCA2
family member

risk factors for ovarian cancers

nulliparity
early menarche/late menopause
HRT
smoking
obesity
endometriosis

protective factors for ovarian cancer

breast feeding
COCP
multiparity
sterilisation

presentation of ovarian cancer

often non-specific symptoms
bloating, weight loss, tiredness, change in bowel habit/urinary frequency, abdo pain, poor appetite
PV bleeding
abdo mass/bimanual exam
ascites + pleural effusion

investigation for ovarian cancer

pelvis USS
CA125
RMI= USS score x menopausal score x CA125

pathology of functional ovarian cysts

enlarged follicular/corpus luteum
< 5cm

pathology of endometrioma

chocolate cyst contains blood associated with endometriosis

pathology of polycystic ovaries

>12 follicles

pathology of theca lutein cyst

occur when levels of hCG are very high (molar pregnancy) regress when hCG falls

pathology serous cystadenoma

may appear solid 1/3 bilateral 1/3 malignant

pathology of fribroma

sex cord stromal tumour fibrous tumour associated with meig's syndrome (ascites and pleural effusion) may produce oestrogen > PV bleeding

types of epithelial ovarian tumours

serous mucinous tumours endometrioid clear cell

pathology of sex cord ovarian tumour

granulosa cell low grade coffee bean nuclei and gland-like spaces

treatment of benign ovarian tumours

LDH, AFP and hCG should be measured in women < 40 to rule out germ cell tumours usually excised if >5cm

treatment of malignant ovarian tumours

full staging laparotomy with debulking adjuvant chemotherapy

aetiology of infection of high risk HPV

damages the action of p53

cervicitis

often asymptomatic follicular cervicitis- sub epithelial reactive lymphoid follicles present in cervix chlamydia herpes

risk factors for CIN/cervical cancer

persistence of high risk HPV (16,18) - many sexual partners vulnerability of SC junction - young age of first intercourse - long term use of oral contraceptives - non-sue of barrier contraception smoking immunosuppression

if HPV is present on smear

patient referred to cytology cytology negative: test for HPV in 12 months cytology positive: colposcopy

CIN I

abnormal cells occupying a third of the basal epithelium

CIN II

abnormal cells have extended to the middle third

CIN III

where the abnormal cells span the full thickness of the epithelium

what happens if a patient had a negative cytology but a positive HPV smear again 12 months later

cytology again positive: colposcopy negative: test again in 12 months

what strain of HPV is genital warts

6 and 11

histology of CIN

infected epithelium remains flat, but may show koilocytosis delay in maturation/differentiation nuclear abnormalities

presentation of cervical cancer

abnormal PV bleeding- post coital, intermenstrual, post-menopausal unusual PV discharge menorrhagia pelvic pain advanced disease features - weight loss - back pain - obstruction of the ureters

cervical cancer investigations

punch biopsy at colposcopy for histology staging CT chest/abdo/pelvis MRI examination

cervical cancer management stage Ia

to preserve fertility: local excision with cone biopsy and close follow up or radical trachelectomy hysterectomy with lymphadenectomy