11 Flashcards
Describe tumours of the vulva
- relatively uncommon
- most are squamous cell carcinomas and affect older women
- cause is usually unknown but probably related to chronic irritation and longstanding dermatoses such as lichen sclerosis and squamous hyperplasia
- in pre-menopausal women main cause is HPV with invasion developing from the precursor; vulval intraepithelial neoplasia (VIN
- tumour spreads locally and metastasizes predominantly in inguinal lymph nodes
- definitive surgery would include removing the primary tumour and nodes with a higher survival rate in smaller lesions
- clinical features: lump, skin changes, ulceration
See gynae tumours slide 7-16
Describe tumours of the cervix
- endocervix made of glandular epithelium while ectocervix is made of squamous epithelium
- transformation zone: where Metaplasia occurs between the 2 epithelial types
- most are SCC while few are adenocarcinoma
- aetiology: HPV which infect the transformation zone leading to increase proliferation by producing viral proteins (E6 and E7) and inactivating tumour suppressor genes (p53 and Rb)
- can also develop from cervical intraepithelial neoplasia (CIN)
- CIN staging
- risk factors: multiple partners, early first pregnancy, multiple births, smoking, immunosuppression, poor
- cervical screening detects dyskaryotic cells
- aim is to detect pre-invasive lesions and excise the involved area completely before malignancy can develop
- loop biopsy can be done to detect
- carcinoma initially spreads to iliac and aortic lymph nodes before wider systemic dissemination
- local spread involves the ureters, bladder and rectum which can involve pain and fistula formation
- treatment: if CIN1 then it regresses but if CIN 2 and 3 need large loop excision
See gynae tumours slide 17-32
How would invasive cervical carcinoma present and how would you treat it?
- presentation: bleeding, mass, screening
- treatment: hysterectomy, lymph node dissection, chemoradiotherapy
See gynae tumours slide 33-36
Describe tumours of the endometrium
-adenocarcinomas in endometrium occur in peri-menopausal and older women
-two main histological types: endometroid and serous
-perimenopausal group aetiology: unopposed oestrogen from obesity, exogenous oestrogen administration, or a hormone-secreting tumour, PCOS
-another cause: tamoxifen
-unopposed oestrogen will lead to endometroid endometrial adenocarcinoma
-serous Endometrial carcinomas are less common yet more aggressive, worse prognosis
-associated with collection of calcium (Psammoma bodies)
-presents as a bleeding mass
-management: hysterectomy, bilateral saplings-oophorectomy
See gynae tumours slide 37-48
Describe tumours of the myometrium
- leiomyoma aka fibroid is the most common tumour of myometrium but is benign
- symptoms: heavy menstrual loss, menorrhagia and infertility
- histology shows whorls and intersecting fasCicles
- multiple leiomyomas are more common and can cause massive uterine enlargement
- will result in pressure symptoms in the pelvis
- growth is oestrogen dependent and they usually regress after the menopause
- leiomyosarcoma: malignant tumour of the myometrium, has atypical cells
- present with similar symptoms to fibroids
- infiltrate locally with metastasis by the blood stress to the lungs and then systemically
See gynae tumours slide 49-53
Describe epithelial tumours of the ovary
- majority of primary ovarian tumours are epithelial
- classified as SEROUS, MUCINOUS OR ENDOMETROID
- can be further classified as benign, borderline or malignant
- malignant ones don’t present until late stage and prognosis is often poor
- malignant ones spread within abd where they cause ascites, intestinal obstruction and death
- BRCA1 and BRCA2 are markers
See gynae tumours slide 54-63
Describe germ cell tumours of the ovary
- usually benign in women
- most common type is mature cystic teratoma aka dermoid cyst
- these tumours can contain tissues from any of the 3 germ layers
- will have things such as skin, hair, teeth, bone, muscle, cartilage, etc
- presence of IMMATUURE tissue will indicate malignancy and a risk for intra-abd spread and potential to cause death
- other tumour types: dysgerminoma, yolk sac tumour, choriocarcinoma, embryo also carcinomas
- AFP and hCG are markers
See gynae tumours slide 64-68
Describe sex-cord stromal tumours of the ovary
Granulosa cell tumours
- resemble the cells lining the ovarian follicle
- commonly produce oestrogen and may be responsible for endometrial hyperplasia and adenocarcinoma and iso-sexual precocious puberty
Sertoli-Leydig cell tumours
- rare sex-cord stromal tumours
- produce androgens and cause defeminisation, masculinization, amenorrhoea and infertility
- can also metastatise to the ovaries
- GI and breast carcinomas can also metastasize to the ovaries
See gynae tumours slide 69-73
What are the two main types of tumours in testicles?
- germ cell tumours and non-germ cell tumours
- testicle tumours are most common in young men
- lymphomas can also affect testes
See gynae tumours slide 74-80
Describe non-germ cell tumours of the testes
- sex cord-stromal tumours are a type of non-germ cell tumour
- most common types of these are Sertoli and Leydig cell tumours
- but overall they are uncommon and benign
Describe germ cell tumours of the testes
- in postpubertal males, most testicular tumours are germ cell and are malignant
- aetiology unknown but possible familial predisposition
- increased risk if pt. Has cryptorchidism (failure of testicular descent into scrotum)
- orchiopexy: surgical placement of the undescended testis into scrotum
- if orchiopexy is done before puberty it will decrease the risk of cancer
- usually presents with a painless testicular mass
- intratubular germ cell neoplasia: a pre-invasive precursor of germ cell tumours
What are the two groups of germ cell tumours in the testes?
Seminoma and Nonseminomatous germ cell tumours (NSGCTs)
Describe Seminoma in the testes
- peak age for Seminoma is 40-50 years
- remain confined to the testes for long periods of time
- metastasise through lymphatics most commonly to the iliac and paraortic lymph nodes
- has chicken wire vasculature and cytoplasm is clear
Describe NSGCTs
- classified as yolk sac tumours, embryonal carcinomas, choriocarcinomas and teratoma
- many NSGCTs are MIXED and contain different components
Yolk sac
- occur in young kids with good prognosis
- AFP is a marker
Embryonal carcinomas, choriocarcinomas, mixed NSGCTs
- occurs in young adults
- choriocarcinomas will have raised hCG as a marker
- mixed NSGCTs will have both raised AFP and hCG
Teratoma
- occurs in men of all ages
- if it happens in prepubertal men then it’s usually benign
- if it happens in postpubertal men then usually malignant
- NSGCTs metastasise early through lymphatics and blood vessels
- primary tumour may not be palpable
What is the management for testicular tumours?
- treated by radical orchiectomy
- further treatment depends on whether tumour is a Seminoma or NSGCT
- Seminoma: radisensitvie so treated with radiotherapy, best prognosis
- NSGCT: treated with aggressive chemo
- treatment often successful
