11. Tumours Of The Reproductive Tract Flashcards
What are the possible vulval cancers and which is the most common?
Squamous cell carcinoma (most common)
Basal cell carcinoma
Melanoma
Soft tissues tumours (rare)
What are the clinical features in vulval cancers?
Lumps
Ulceration
Skin changes (sensation, pain, redness)
What are the histological changes in squamous cell carcinoma?
No distinguishing between layers of skin (dermis, epidermis)
Atypical squamous cells
Loss of architecture
Keratin produced
What is VIN?
Vulval intraepithelial neoplasia
In situ precursor of vulval squamous cell carcinoma
Atypical cells, no invasion through basement membrane
Can VIN and vulval SCC be related to HPV?
Yes in 30% of cases - peak onset 60s
No in 70% of cases - usually relate to longstanding inflammatory conditions, peak onset 80s
How does vulval cancer spread?
Direct extension to anus, vagina and bladder
Lymph nodes - inguinal, iliac, para-aortic
Distant metastases - lungs, liver
What is an ectropian?
Simple columnar epithelium being irritated by acidic vagina
Simple columnar then undergo metaplastic change and become squamous epithelium, does increase risk of dysplasia
What are low risk HPV and what do they cause?
HPV 6 and 11
Cause warts
What are high risk HPV and what can they cause?
HPV 16 and 18
Can cause cancer
How do HPV 16 and 18 cause cancer?
Infect transformation zone of cervix
Produce viral proteins
Inactivated tumour suppressor genes
What is cervical intraepithelial neoplasia?
Dysplasia
Confined to cervical epithelium (in situ)
Caused by HPV infection
Divided into CIN1/2/3
What are the risk factors for CIN and cervical carcinoma?
Increased risk of exposure to HPV - sexual partner with HP, multiple partners, early age of first intercourse Early first pregnancy Multiple births Smoking Low socio-economic status Immunosuppression
What is the treatment for CIN 1?
Often regresses spontaneously
Follow up cervical smear in 1 year
What is the treatment for CIN 2 and 3?
Needs treatment - colposcopy, large loop excitation of transformation zone (LLETZ)
Describe the cervical cancer screening programme
Brush used to scrape cells from transformation zone - tested for HPV, if positive cells looked a under microscope
Age 25-49 every 3 years
Age 50-64 every 5 years
Over 65 only if recent abnormality
What do HPV vaccinations protect against?
HPV 6, 11, 16, 18
Protects from cervical, vulval, oral and anal cancers
What are the types of invasive cervical cancer and which is the most common?
Squamous cell carcinoma (most common)
Adenocarcinoma - arise from endocervical glandular cells
How does invasive cervical cancer present?
Bleeding - post coital, intermenstrual, post menopausal
Mass
Screening
What is the treatment for invasive cervical cancer?
If advanced: hysterectomy, lymph node dissection, chemoradiotherapy
What is endometrial hyperplasia?
Increased gland:stroma ratio
Thickened endometrium >7mm
Can be a precursor to endometrial cancer
What is endometrial hyperplasia caused by?
Caused by excessive oestrogen
- endogenous: obesity, early menarche/late menopause, oestrogen secreting tumours
- exogenous: unopposed oestrogen HRT, tamoxifen
- irregular cycle: PCOS
How can endometrial cancer present?
Bleeding - postmenopausal, intermenstrual
Mass
What are the 2 types of endometrial cancer?
Endometrioid adenocarcinoma (most common) - commonly arises from hyperplasia Serous adenocarcinoma - more aggressive, poorly differentiated cells
How does serous adenocarcinoma spread?
Exfoliates
Travels through Fallopian tubes
Deposits on peritoneal surface (transcoelomic spread)
Associated with collections of calcium (psammoma bodies)
What is the management for endometrial cancer?
Hysterectomy
Bilateral salpingo-oophorectomy
+/- lymph node dissection
+/- chemoradiotherapy
What is a leiomyoma?
Most common tumour of myometrium
Benign
Pale, homogenous, well circumscribed mass
How does leiomyoma present?
Asymptotic
Pelvic pain
Heavy periods
Urinary frequency
What is a leiomyosarcoma?
Malignant tumour of smooth muscle
Atypical cells
Doesn’t arise from a leiomyoma
Metastasis to lung
What is the presentation of ovarian cancer?
Early - vague and non-specific, delayed diagnosis
Later - abdominal pain, abdominal distension, urinary symptoms, GI symptoms, hormonal disturbances
What are the types of tumours of the ovary?
Epithelial tumours
Germ cell tumours
Sex cord stromal tumours
What are ovarian epithelial tumours?
Often present as cystic mass
Subtypes - serous, mucinous, endometrioid (all adenocarcinoma)
Can be benign, borderline or malignant
Describe serous adenocarcinoma (ovarian)
Highly atypical cells
Often show psammoma bodies
Often spread to peritoneal surface
What is a teratoma?
Most common germ cell tumour
3 subs types: mature (benign), immature (malignant), monodermal (highly specialised)
Describe a mature teratoma (dermoid cyst)
Contain fully mature, differentiated tissue from all germ cell layers
Can be bilateral
Often contains skin and hair structures
What are some other less common germ cell tumours?
Dysgerminoma
Choriocarcinoma
Embryonal carcinoma
Yolk sac tumour
All malignant
What are the sex cord cells in testes?
Sertoli cells, leydig cells
What are the sex cord cells in ovaries?
Granulosa cells
Theca cells
What do theca and granulosa cell tumours produce?
Oestrogen
How do theca and granulosa cell yours present?
Patient pre-puberty - precocious puberty
Patient post-puberty - breast cancer, endometrial hyperplasia, endometrial carcinoma
What do Sertoli and leydig tumours produce?
Testosterone
How do Sertoli-Leydig tumours present in women?
Patient pre-puberty - present normal female pubertal changes
Patient post-puberty - infertility, amenorrhoea, hirsuitism, male pattern baldness, breast atrophy
Which cancers can cause metastases to the ovary?
Breast cancer
GI cancers
Other gynae tumours - endometrial, other ovary, Fallopian tube
Krukenberg tumour - metastatic GI tumour
What is an important risk factor for testicular cancer?
Cryptorchidism (undescended testicle)
How does testicular cancer present?
Mass +/- pain
What are the investigations for testicular cancer?
Scans (USS)
Tumour markers
When are testicular cancer tumour markers useful?
In germ cell tumours - for diagnosis, response to treatment, monitoring for recurrence
What are the testicular cancer tumour markers?
Beta hCG - choriocarcinoma Alpha fetoprotein (AFP) - yolk sac tumours
What are the seminomatous germ cell testicular cancers?
Seminoma (most common)
Spermatocytic seminoma
What are the non-seminomatous germ cell testicular cancers?
Teratoma
Yolk sac tumour
Choriocarcinoma
Embryonal carcinoma
