(12.1+2) Gynaecological Tumours Flashcards
Suggest some causes of Cervical cancer.
- HPV (types 16, 18)
- Multiple partners
- Smoking
- Early/multiple pregnancies
- OCP
- Low socioeconomic class
What is the precursor of Cervical Adenocarcinomas?
Cervical glandular intraepithelial neoplasia (CGIN)
What is the precursor of Cervical Squamous Cell Carcinomas?
Cervical intraepithelial neoplasia (CIN)
What is the most common type of Cervical cancer?
Squamous cell carcinoma (much more common than adenocarcinoma)
Where do squamous cell cancers of the cervix usually occur?
Transformation zone between cervix and vagina (at the external os during puberty, moves up cervical canal as age)
- Upper: simple columnar
- Lower: stratified squamous non-keratinised
Where do cervical cancer commonly spread? By what route?
- Lymphatics to Iliac nodes, advanced to Para-aortic nodes
- Directly to bladder, ureters, rectum
Suggest some common symptoms of cervical cancer.
- Dysparaneuria
- Discharge
- Bleeding - post coital, intermenstrual, post menopausal
Describe the underlying pathology of Squamous cell cervical cancer
- Invasion of squamous epithelium
- Cervical expansion
- Ulcers and/or nodules
What are the four types of Ovarian epithelial tumours? Which is the most common?
- Serous (most common)
- Mucinous
- Endometroid
- Brenner (transitional)
What are some of the risk factors of Ovarian cancer?
- HRT (over proliferation of endometriosis)
- Super-ovulation following IVF
- Smoking
- Obesity
- Prior cyst
What can the symptoms of an Ovarian tumour commonly be confused with?
Irritable bowel syndrome (IBS)/Pre-menstrual syndrome
- Heavy bleeding
- Pelvic/abdominal pain
- Nausea/difficult eating
How do ovarian cancers commonly spread? What can this cause?
Transcoelmically (through the peritoneum):
- Ascites
- Obstruction
- Perforation (risk of Peritonitis)
Explain how you would determine whether serous ovarian tumours are benign, borderline or malignant.
- Benign: no mitosis
- Borderline: mitotic -> proliferation
- Malignant: invasive -> through basement membrane, stroma, capsule and eventually peritoneum
Describe an endometrioid ovarian tumour. What is the risk factor and its prognosis.
- Tumours of the ovary resemble the endometrial lining to the uterus
- HRT -> rapid proliferation -> endometriosis (normal internal uterine tissue grows on outside)
- Mostly malignant
What may be the complications of a Granulosa cell ovarian tumour.
- Oestrogen producing -> Endometrial tumours / iso-sexual precocious puberty
- Spread intra-abdominally
What are the risk factors of vulval cancers in the young different from the middle-aged/elderly?
- Pre-menopausal: HPV (types 16, 18) same as cervical cancer
- Post-menopausal: Lichen sclerosis / Squamous hyperplasia / Paget’s disease of vulva
What is the pre-invasive state of vulval squamous cell carcinoma known as?
Vulval intraepithelial neoplasia (VIN)
How does vulval intraepithelial neoplasia present?
- Sore & red
- Scaly
- Itchy
- Spots of white
Why wouldn’t you do a vulvectomy in basal cell carcinoma of the vulva?
It grows slowly, rarely metastasis
What is the most common type of Vulval cancer? What does it look like?
- Squamous cell carcinoma
- Warty & ulcerated
What are the four main types of Vulval cancer?
- Squamous cell
- Basal cell
- Adenocarcinoma
- Melanoma
What does basal cell carcinoma of the vulva commonly look like?
Pearly/translucent appearance (most basal cell carcinomas do)
Describe how a squamous cell carcinoma of the vulva can result in unilateral gangrene of parts of the lower limb.
Erosion into femoral artery -> ischaemia of parts of the leg
What are the main types of cancer of endometrium?
- Adenocarcinoma
- Carcinosarcoma
- Stromal sarcoma
Suggest two ways Endometrial Adenocarcinomas spread.
- Directly to fallopian tubes, cervix and myometrium
- Lymphatics
Describe the Endometrial carcinosarcomas. How’s its prognosis?
- Mixed type tumour of Epithelial (carcinoma) + connective (sarcoma) tissues
- Poor prognosis
What is the difference between homologous and heterologous endometrial carsinosarcomas.
- Homologous: sarcoma sections made up of tissues that are identifiable as from parts of the uterus
- Heterologous: sarcoma sections made up of extrauterine tissues e.g. cartilages, muscles, bones
In which groups of woman do Endometrial carcinosarcomas commonly occur? Which other cancer are these women at risk of?
- Post-menopausal who takes HRT
- Same risk factors of adenocarcinoma
How do endometrial stromal sarcomas spread?
Bloodstreams -> highly vascular organs e.g. lungs, liver, brain
Describe how Leisarcomyomas occur.
Arise de novo as a single mass, not from Leimyomas
What is the other name for a mature teratoma?
Dermoid cyst
What is a hydratidiform mole?
Where a non-viable pregnancy implants, but won’t be alive at term
