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Reproductive > 11. Tumours Of The Reproductive Tract > Flashcards

11. Tumours Of The Reproductive Tract Flashcards

1
Q

What are the possible vulval cancers and which is the most common?

A

Squamous cell carcinoma (most common)
Basal cell carcinoma
Melanoma
Soft tissues tumours (rare)

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2
Q

What are the clinical features in vulval cancers?

A

Lumps
Ulceration
Skin changes (sensation, pain, redness)

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3
Q

What are the histological changes in squamous cell carcinoma?

A

No distinguishing between layers of skin (dermis, epidermis)
Atypical squamous cells
Loss of architecture
Keratin produced

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4
Q

What is VIN?

A

Vulval intraepithelial neoplasia
In situ precursor of vulval squamous cell carcinoma
Atypical cells, no invasion through basement membrane

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5
Q

Can VIN and vulval SCC be related to HPV?

A

Yes in 30% of cases - peak onset 60s

No in 70% of cases - usually relate to longstanding inflammatory conditions, peak onset 80s

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6
Q

How does vulval cancer spread?

A

Direct extension to anus, vagina and bladder
Lymph nodes - inguinal, iliac, para-aortic
Distant metastases - lungs, liver

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7
Q

What is an ectropian?

A

Simple columnar epithelium being irritated by acidic vagina

Simple columnar then undergo metaplastic change and become squamous epithelium, does increase risk of dysplasia

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8
Q

What are low risk HPV and what do they cause?

A

HPV 6 and 11

Cause warts

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9
Q

What are high risk HPV and what can they cause?

A

HPV 16 and 18

Can cause cancer

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10
Q

How do HPV 16 and 18 cause cancer?

A

Infect transformation zone of cervix
Produce viral proteins
Inactivated tumour suppressor genes

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11
Q

What is cervical intraepithelial neoplasia?

A

Dysplasia
Confined to cervical epithelium (in situ)
Caused by HPV infection
Divided into CIN1/2/3

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12
Q

What are the risk factors for CIN and cervical carcinoma?

A 
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
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13
Q

What is the treatment for CIN 1?

A

Often regresses spontaneously

Follow up cervical smear in 1 year

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14
Q

What is the treatment for CIN 2 and 3?

A

Needs treatment - colposcopy, large loop excitation of transformation zone (LLETZ)

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15
Q

Describe the cervical cancer screening programme

A

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

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16
Q

What do HPV vaccinations protect against?

A

HPV 6, 11, 16, 18

Protects from cervical, vulval, oral and anal cancers

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17
Q

What are the types of invasive cervical cancer and which is the most common?

A

Squamous cell carcinoma (most common)

Adenocarcinoma - arise from endocervical glandular cells

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18
Q

How does invasive cervical cancer present?

A

Bleeding - post coital, intermenstrual, post menopausal
Mass
Screening

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19
Q

What is the treatment for invasive cervical cancer?

A

If advanced: hysterectomy, lymph node dissection, chemoradiotherapy

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20
Q

What is endometrial hyperplasia?

A

Increased gland:stroma ratio
Thickened endometrium >7mm
Can be a precursor to endometrial cancer

21
Q

What is endometrial hyperplasia caused by?

A

Caused by excessive oestrogen

  • endogenous: obesity, early menarche/late menopause, oestrogen secreting tumours
  • exogenous: unopposed oestrogen HRT, tamoxifen
  • irregular cycle: PCOS
22
Q

How can endometrial cancer present?

A

Bleeding - postmenopausal, intermenstrual

Mass

23
Q

What are the 2 types of endometrial cancer?

A 
Endometrioid adenocarcinoma (most common) - commonly arises from hyperplasia
Serous adenocarcinoma - more aggressive, poorly differentiated cells
24
Q

How does serous adenocarcinoma spread?

A

Exfoliates
Travels through Fallopian tubes
Deposits on peritoneal surface (transcoelomic spread)
Associated with collections of calcium (psammoma bodies)

25
Q

What is the management for endometrial cancer?

A

Hysterectomy
Bilateral salpingo-oophorectomy
+/- lymph node dissection
+/- chemoradiotherapy

26
Q

What is a leiomyoma?

A

Most common tumour of myometrium
Benign
Pale, homogenous, well circumscribed mass

27
Q

How does leiomyoma present?

A

Asymptotic
Pelvic pain
Heavy periods
Urinary frequency

28
Q

What is a leiomyosarcoma?

A

Malignant tumour of smooth muscle
Atypical cells
Doesn’t arise from a leiomyoma
Metastasis to lung

29
Q

What is the presentation of ovarian cancer?

A

Early - vague and non-specific, delayed diagnosis

Later - abdominal pain, abdominal distension, urinary symptoms, GI symptoms, hormonal disturbances

30
Q

What are the types of tumours of the ovary?

A

Epithelial tumours
Germ cell tumours
Sex cord stromal tumours

31
Q

What are ovarian epithelial tumours?

A

Often present as cystic mass
Subtypes - serous, mucinous, endometrioid (all adenocarcinoma)
Can be benign, borderline or malignant

32
Q

Describe serous adenocarcinoma (ovarian)

A

Highly atypical cells
Often show psammoma bodies
Often spread to peritoneal surface

33
Q

What is a teratoma?

A

Most common germ cell tumour

3 subs types: mature (benign), immature (malignant), monodermal (highly specialised)

34
Q

Describe a mature teratoma (dermoid cyst)

A

Contain fully mature, differentiated tissue from all germ cell layers
Can be bilateral
Often contains skin and hair structures

35
Q

What are some other less common germ cell tumours?

A

Dysgerminoma
Choriocarcinoma
Embryonal carcinoma
Yolk sac tumour

All malignant

36
Q

What are the sex cord cells in testes?

A

Sertoli cells, leydig cells

37
Q

What are the sex cord cells in ovaries?

A

Granulosa cells

Theca cells

38
Q

What do theca and granulosa cell tumours produce?

A

Oestrogen

39
Q

How do theca and granulosa cell yours present?

A

Patient pre-puberty - precocious puberty

Patient post-puberty - breast cancer, endometrial hyperplasia, endometrial carcinoma

40
Q

What do Sertoli and leydig tumours produce?

A

Testosterone

41
Q

How do Sertoli-Leydig tumours present in women?

A

Patient pre-puberty - present normal female pubertal changes
Patient post-puberty - infertility, amenorrhoea, hirsuitism, male pattern baldness, breast atrophy

42
Q

Which cancers can cause metastases to the ovary?

A

Breast cancer
GI cancers
Other gynae tumours - endometrial, other ovary, Fallopian tube
Krukenberg tumour - metastatic GI tumour

43
Q

What is an important risk factor for testicular cancer?

A

Cryptorchidism (undescended testicle)

44
Q

How does testicular cancer present?

A

Mass +/- pain

45
Q

What are the investigations for testicular cancer?

A

Scans (USS)

Tumour markers

46
Q

When are testicular cancer tumour markers useful?

A

In germ cell tumours - for diagnosis, response to treatment, monitoring for recurrence

47
Q

What are the testicular cancer tumour markers?

A 
Beta hCG - choriocarcinoma
Alpha fetoprotein (AFP) - yolk sac tumours
48
Q

What are the seminomatous germ cell testicular cancers?

A

Seminoma (most common)

Spermatocytic seminoma

49
Q

What are the non-seminomatous germ cell testicular cancers?

A

Teratoma
Yolk sac tumour
Choriocarcinoma
Embryonal carcinoma

Reproductive (22 decks)

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