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24 Cards in this Set

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How does endometrial hyperplasia present?
Abnormal bleeding (w/ some anovulatory cycles)

Occurs in perimenopausal women

NONINVASIVE, NONPATHOLOGICAL endometrial proliferation
What causes endometrial hyperplasia?
1) UNOPPOSED ESTROGEN

2) Tamoxifen (estrogen agonist)

Risk factors include obesity, hypertension, diabetes, PCOD

Protective factor: Progesterone, increased # of birhts.
What are the 4 types of endometrial hyperplasia?
1-2) Simple and Complex hyperplasia w/o atypia

3-4) Simple and complex hyperplasia w/ atypia.

RARE to see SIMPLE W/ ATYPIA.
What is the difference between simple and complex hyperplasia?
Complex hyperplasia has much less stroma in between glands.

MANY MORE GLANDS TOO!
What is the importance of atypia?
More important prognostic factor for cancer risk (more important than simple/complex classification)
What defines atypia?
Loss of nuclear polarity. Borders lost. Enlarged nuclei with coarse chromatin.
How much does a hysterectomy reduce the risk of cancer AFTER a diagnosis of complex hyperplasia with atypia?
NO REDUCTION!

Patients already likely have carcinoma before hysterectomy.
What are the three criteria for endometrial carcinoma diagnosis
1) Irregular infiltration of glands associated with altered fibroblastic stroma (stroma becoming spindly)

2) NO Stroma between "cribiform" glands

3) Glands turn inside out with extensive papillary growth pattern.
TRUE/FALSE

All endometrial carcinomas are estrogen-dependent?
FALSE!

Only Type I's, which account for ~80%.

Type II's are only 15-20% and are not
What are the differences between Type I and Type II endometrial carcinoma?
Type I: Low-grade tumor. UNOPPOSED ESTROGEN. Pre-and-peri-menopausal women. MINIMAL MYOMETRIAL INVASION. Indolent

Type II: clear cell, serous. Aggressive. NOT ESTROGEN DEPENDENT. Postmenopausal.
What has a malignant cancer invaded that a hyperplasia has not?
MYOMETRIUM.
What does Type 1 look like?
Glands and tumor cells are similar to those of atypical hyperplasia of endometrium (precursos lesion)...still looks somewhat glandular
What does Type 2 look like.
Complex papillae and IRREGULAR GAPING GLANDS. Glands turned inside out. Marked nuclear atypia.
What is the precursor to a TYPE II endometrial carcinoma?
Intraepithelial carcinoma.
What are the 4 stages of endometrial carcinoma?
Stage 1: Confined to uterus

Stage 2: Spread to cervix

Stage 3: Spread to uterine serosa, adnexa, LN metastases

Stage 4: Distant spread. Bowel/bladder involvement.
What are prognosis for treatment?
75-80% total.

90% if lesion is localized.
What is the MAIN cancer type in cervical cancer?
Squamous cell (>90%). HPV is the strongest risk factor.
What are the two HPV types MOST ASSOCIATED w cancer.
Oncogenic types: 16 (squamous) & 18 (adenocarcinoma)
TRUE/FALSE

The HPV strains that cause genital works have a high oncogenic capacity?
FALSE!

HPV strains that cause gential warts are likely strain 6 or 11. THESE ARE NOT ONCOGENIC.
How do you screen for HPV?
Pap smear
What is the mechanism of action of HPV?
Integrates into host DNA. Peristence is necessary but not sufficient to survival.
Is flow from normal to low grade to high grade lesion only UNIDIRECTIONAL?
No!

Low-grade lesions can resolve to normal. High-grade lesions can resolve to low-grade lesions, though the rate of transformation from low to high grade is HIGHER than regression of high to low grade
Where is the first site of neoplastic lesions in cervical cancer?

HINT: also the first place to do PAP smear
SQUAMOCOLUMNAR JUNCTION!
What is the 2nd leading cause of death in women 20-39?
CERVICAL CANCER.

Affects underserved countries more. WORLDWIDE is 2nd most lethal cancer.