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Phase 3 > Week 4 - female GU and breast > Flashcards

Week 4 - female GU and breast Flashcards

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1
Q

What is the name of the gene on the Y chromosome which causes development of the testis in the male embryo?

A

SRY gene

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2
Q

What is the name of the hormone produced by sertoli cells in the male embryo which causes regression of the paramesonephric ducts?

A

Anti-mullerian hormone

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3
Q

What structures do the paramesonephric ducts give rise to in the female embryo?

A

Fallopian tubes, uterus, cervix, upper 1/3 of vagina.

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4
Q

What structures does the urogenital sinus give rise to?

A

lower 2/3 of vagina, bulbourethral glands, vestibule, bladder, urethra.

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5
Q

What is the name of the embryological structures that give rise to the external genitalia in both males and females?

A

Genital tubercle, genital folds, genital swellings.

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6
Q

What type of epithelium lines the fallopian tube?

A

Ciliated columnar epithelium

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7
Q

What is salpingitis?

A

Inflammation of the fallopian tubes, on the spectrum of pelvic inflammatory disease.

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8
Q

What 2 types of bacteria can cause salpingitis?

A

Chlamydia trachomatis, Neisseria gonorrhoeae

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9
Q

What can be some of the clinical signs and symptoms of salpingitis?

A

Fever, lower abdominal pain, pelvic masses.

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10
Q

What are three potential complications of salpingitis?

A

Tubo-ovarian abscess
Tubal ectopic pregnancy
Infertility

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11
Q

What inherited gene mutation increases the risk of fallopian tube carcinoma?

A

BRCA1

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12
Q

Primary adenocarcinomas arising from the Fallopian tubes alone are rare. What is the most common?

A

Papillary serous carcinoma.

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13
Q

Polycystic ovarian syndrome is caused by overproduction of androgens by multiple cystic follicles in the ovaries. What are the symptoms of POS?

A

Weight gain, hirsutism, irregular periods, difficulty conceiving,

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14
Q

What are two risk factors for epithelial ovarian cancers? What can reduce your risk of ovarian cancer?

A

Nulliparity and family history.

Prolonged use of oral contraceptive is protective.

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15
Q

What gene mutations can increase risk of ovarian cancer?

A

BRCA1 and BRCA2
HER2 (sporadic)
KRAS
P53

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16
Q

Which gene mutation are more common in HGSC and which in borderline and LGSC?

A

HGSC: BRCA1, P53

Borderline and LGSC: BRAF, KRAS

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17
Q

Ovarian endometrioid carcinoma are often associated with loss of which tumour supressor gene?

A

PTEN

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18
Q

What other conditions is ovarian endometrioid carcinoma often associated with?

A

Endometriosis and endometrial cancer.

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19
Q

What are Brenner tumours?

A

Mixed surface epithelial stromal tumours.

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20
Q

What is Meig’s syndrome? What does it indicate?

A

Combination of an ovarian fibroma with ascites and pleural effusion.
Ovarian carcinoma.

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21
Q

What are the three types of cells in the ovary that tumours can arise from?

A
  1. Surface epithelial
  2. Germ cell
  3. Sex-cord/stromal
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22
Q

Which part of the cervix is most the most likely place for abnormal cells to develop?

A

Transformation zone of squamocolumnar junction.

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23
Q

Persisting infection with an oncogenic strain of HPV is a cause of cervical cancer. Which strains are particularly prevalent in Glasgow?

A

HPV 16 and HPV 18

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24
Q

If dyskaryosis (nuclear abnormalities) are detected on a cervical cancer screening smear test, what are the next steps?

A

Referral to colposcopy clinic.

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25
Which part of the cervix are cyological screening samples taken from?
Transformation zone.
26
Who is screened as part of the UK cervical screening programme? How often are they screened?
Women aged 25-65 Age 25-50 three yearly Age 50-65 five yearly
27
Genes carried by HPV are throught to cause cervical cancer. What are the names of these genes?
Early genes E1-E7 and late genes L1 and L2
28
Name 2 treatments can be used to remove abnormal cells in the cervix.
LLETZ (large loop excision of the transformation zone.) | Cold coagulation
29
The cervical screening programme was designed to pick up squamous lesions. What other type of malignancy undergoes pre-malignant change?
Cervical Glandular Epithelial neoplasia (cGIN).
30
What are the symptoms of cervical cancer?
Post coital bleeding, intermenstrual bleeding, irregular vaginal bleeding, pain, possibly no symptoms.
31
Low oestrogen after menopause may lead to what condition of the vagina? What may this lead to?
Atrophic vaginitis. Discomfort, dysparenia (painful sexual intercourse), bleeding.
32
What are some infections of the vagina that can be detected on a smear?
Bacterial vaginosis, thrush, trichomonas vaginalis.
33
The detection of what protein in the blood may be a sign of ovarian cancer?
CA 125 (cancer antigen 125)
34
What radiological test would be performed as a first line investigation for ovarian pathology?
Ultrasound
35
What is ovarian torsion? What is the potential serious complication?
The twisting, or torsion, of the ovary around its ligamentous supports. Blood supply to the ovary and fallopian can be cut off and resulting in loss of these parts.
36
What are the clinical signs and symptoms of a tubo-ovarian abscess?
Pelvic pain, raised WBC count and CRP, high temperature, vaginal discharge.
37
What are the clinical signs and symptoms of an ectopic pregnancy?
Pain, missed period, raised bHCG, circulatory collapse.
38
What are some non-specific symptoms indicative of conditions affecting the uterus?
Irregular bleeding, post-menopausal bleeding, pain.
39
What are some symptoms of endometriosis? How is endometriosis diagnosed? How is it treated?
Progressively painful periods, dyspareunia, pain with bowel movements, abdominal pain. Laparoscopy. Hormonal therapy and analgesia.
40
How is cervical cancer diagnosed and staged?
Diagnosis: colposcopy Staging: MRI
41
What is a bartholin cyst?
A benign lesion on the vagina.
42
What are some of the general toxic effects of chemotherapy?
Bone marrow suppression, hair loss, damage to GI epithelium, growth depression in children, sterility, teratogenicity, damage to liver, heart, kidney.
43
What do you call anti-cancer drugs that are only active on dividing cells?
Cell-cycle specific drugs.
44
What do you call anti-cancer drugs that active on dividing cells and resting cells?
Cell cycle-non specific drugs.
45
How do Alkylating agents work as a cancer treatment?
They form covalent bonds with DNA, interfering with transcription and replication.
46
Name an alkylating agent used to treat cancer.
Cyclophosphamide
47
How do anti-metabolites work as a cancer treatment? Give two examples.
Interfere with nucleotide synthesis or DNA synthesis. Methotrexate, 5-flourouracil
48
How to cytotoxic antibiotics work as a cancer treatment? Give an example of one of these drugs.
Act mainly by a direct action on DNA as intercalators (i.e. inserts molecules in between base pairs of DNA, inhibiting replication.) Doxorubicin.
49
How do microtubule inhibitors work as a cancer treatment? Give an example of such a drug.
Block normal spindle formation, therefore blocking cell division. Vincristine.
50
Give an example of a steroid hormone which can be used to treat cancer? How does it work?
Prednisone. | Converted in prednisolone in body. Suppresses lymphocye growth.
51
How does tamoxifen work in the treatment of breast cancer?
Antagonises the oestrogen receptor, suppressing tumour growth.
52
Name 2 drugs that can be used to treat prostate cancer.
Bicalutamide | Prostap
53
Define endometriosis and adenomyosis.
Endometiosis: the presence of endometrial tissue outwith the uterus. Adenomyosis: the presence of endometrial tissue within the myometrium.
54
Where are the possible sites of endometriosis?
Ovary, fallopian tubes, cervical mucosa, vagina, peritoneal surfaces, small and large bowl, appendix, laparotomy scars
55
What are the clinical symptoms of endometriosis?
Dysmenorrhoea (painful periods), pelvic pain, infertility.
56
Explain the two theories surrounding the pathogenesis of endometriosis and adenomyosis.
Metastatic theory: retrograde menstruation or surgical procedures induces endometrium to sites outwith the uterine cavity. Metaplastic theory: endometrium arises directly from the coelomic epithelium (peritoneum) of the pelvis as this is where endometrium arises from during embryological development.
57
What are endometrial polyps? What drug is associated with endometrial polyps? What can sometimes be found in them?
Masses of varying size which project into the endometrial cavity. Tamoxifen. Cytological atypia or adenocarcinoma.
58
Endometrial hyperplasia and adenocarcinoma are associated prolonged simulation of what hormone to the endometrium? What could be the causes of this?
Oestrogen. | Obesity, PCOS, anovulatory cycles, HRT.
59
What is endometrial hyperplasia histologically characterised by? What is this condition a precursor of?
Increase in gland to stroma ratio. | Endometrial adenocarcinoma.
60
What is a leimyoma?
A common benign smooth muscle tumour of the myometrium.
61
What is a leiomyosarcoma?
An uncommon malignant smooth muscle tumour of the myometrium.
62
What must a a cyst have for it to be called a cyst?
An epithelial lining.
63
Name 2 antigen markers that would be positive and one that would be negative in a kruckenburg's tumour (secondary tumour of the ovary from the GI tract.)
Carcinoembryonic antigen, transcription factor CDX2. | Oestrogen receptor would be negative.
64
Describe inn brief the structure of the breast?
Lactiferous ducts lined with inner luminal and outer myoepithelial epithelium. Interlobular stroma which is fibrous/fatty.
65
Name two conditions associated with breast hypoplasia?
Turner's syndrome, congenital adrenal hyperplasia.
66
What is acute mastitis?
Cellulitis associated with breast feeding.
67
What changes can the spectrum of fibrocystic change include?
Cysts, adenosis (increased amount of glandular tissue), increased fibrous stroma, epithelial hyperplasia with or without atypia, papillomas, apocrine metaplasia.
68
Does fibrocystic change increase risk of breast cancer?
Either classified as 'non-proliferative' - no further risk Proliferative without atypia - 2 x risk Proliferative with atypia - 5 x risk
69
What are radial scars?
Benign lesion characterised by a fibrotic and elastotic core, trapped glands and pseudo-infiltrative appearance.
70
What are intraductal papilloma and papillomatosis? Do they have any associated risk of cancer?
Intraductal papilloma is a benign tumour of the epithelial lining of mammary ducts. Innocuous unless epithelial atypia. Papillomatosis are multiple papillomas. Slight association with malignancy.
71
What is Diabetic fibrous mastopathy?
Benign stromal fibrosis with infiltrating lymphocytes associated with type 1 diabetes.
72
What is a fibroadenoma?
Common overgrowth of epithelium and stroma resembling a giant lobule.
73
What are phyllodes tumours?
A spectrum of tumours similar to fibroadenomas but with a more cellular stroma. Can be malignant and require excision.
74
What are risk factors for breast cancer?
Earlier menarche, late menopause, older at first pregnancy, OC use, HRT, obesity, tallness, alcohol, positive family history.
75
What are the symptoms for possible breast cancer?
A new lump or thickening in breast or axilla. Altered shape, size or feel of the breast, pain (not often). Skin changes: puckering dimpling, peau d'orange, rash, redness, feels different. Nipple changes: tethering/inversion, discharge, eczema-like changes in paget's disease. Rarely: widespread inflammation in inflammatory cancer.
76
How are breast abnormalities investigated?
Clinical examination: inspection and palpation. Imaging: ultrasound, XR mammography, MRI. Fine needle aspiration cytology or core biopsy. Excisional biopsy: diagnostic, therapeutic or both.
77
Describe the treatment of breast cancer.
Small cancer - wide local excision with radiotherapy. Larger cancer - may require mastectomy or neoadjuvant treatment (chemotherapy or endocrine therapy) may cause enough regression for breast-conserving surgery.
78
Name three types of drugs which can treat breast cancer.
Endocrine therapy - targets steroid hormone receptors i.e. Tamoxifen. Aromatase inhibitors prevents conversion of androgens to oestrogens i.e. Letrazole Her2 targeted therapy i.e. herceptin
79
What would be the treatment for 'triple negative' i.e. negative ER, PR and Her2?
Neoadjuvant chemotherapy
80
What three histological properties is breast cancer grading based on?
1 - nuclear pleomorphism 2 - number of mitoses/mm^2 3 - degree of gland formation
81
What are the features of a carcinoma in situ in the breast?
Malignant looking proliferation of epithelial cells within the basement membrane. No extension into breast stroma. No communication with blood vessels or lymphatics. No possibility of metastases.
82
What is an ovarian cystadenoma? What is an ovarian cystadenofibroma?
Benign epithelial tumour of the ovary. Benign epithelial tumour of the ovary with a solid stromal component.
83
List some of the different types of ovarian carcinoma?
High grade serous (HGSC), endometrioid, clear-cell, Low grade serous (LGSC) or mucinous.
84
What is the prognosis of serous tumours like?
Benign and borderline have an excellent prognosis. | Invasive serous carcinoma has a poor prognosis, depends on stage at diagnosis.
85
Give 2 examples of ovarian sex cord/stromal tumours. What is the problem associated with these?
Granulosa and theca cell tumours. | They often secrete oestrogen which can lead to endometrial hyperplasia/endometriosis.
86
What are some of the ways that ovarian malignancy can present?
Local pressure symptoms: pain, GI complaints, urinary frequency. Acute abdomen due to torsion. Functioning ovarian tumours may present because of the hormones they produce. Ascites.
87
Which strains of HPV does the vaccination in Scotland target?
6, 11, 16, 18
88
What are some of the immediate and delayed complications of treatment for cervical cancer?
Immediate - pain, haemorrhage Delayed - secondary haemorrhage, infection, cervical stenosis
89
What is cervical intraepithelial neoplasia?
Dyskaryotic cells of the cervix which can progress to squamous carcinoma.
90
What is the name of the non-infective inflammation of the vulva which has a link with vulval squamous carcinoma?
Lichen sclerosus.
91
What is the management of endometrial hyperplasia and endometrial adenocarcinoma?
Hyperplasia - Progesterone therapy i.e. mirena coil or hysterectomy Endometrial adenocarcinoma - hysterectomy, subsequent management depends on tumour stage and grade.
92
Name 2 gestational trophoblastic diseases.
Hydatiform moles | Choriocarcinoma

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