19 Tumours of the Reproductive Tract Flashcards
How common are vulval cancers?
Uncommon (3% all female cancers)
Tend to arise in older patients
What types of vulval cancer are there? (4)
What clincal feastures might you get for a vulval cancer?
Lumps
Ulceration
Skin changes
What is shown in the following histology?
What is vulval intraepithelial neoplasia? (VIN)
In situ precursor of vulval squamous cell carcinoma
Atypical cells- no invasion through basement membrane
May or may not develop into squamous cell carcinoma
Are vulval squamous cell carcinomas (and VIN) linked to HPV?
How does vulval cancer spread?
Fill in the missing labels for a pre-menarchal cervix:
What happens to the cells around the external os as a woman enter reproductive age?
Give 2 high risk subtypes for HPV (human papilloma virus) and 2 low risk subtypes:
How does HPV (16 and 17) increase someones risk of neoplasia? (think viral proteins and tumour supressor genes)
What is cervical intraepithelial neoplasia? (analogous to VIN)
What are the risk factors for cervical intraepithelial neoplasia and cervical carcinoma?
- HPV exposure
- Eg early first age sexual intercourse, multiple partners
- Early first pregnancy
- Multile births
- Smoking
- Low socioeconomic status
- Immunosuppression
How is CIN staged?
How is CIN treated? (screening- smear)
CIN 1- follow up with cervical smear- 1 year
CIN 2 & 3- treatment- large loop excision of transformation zone
How is cervical cancer screened for?
Can HPV be vaccinated against?
Yes gardasil- age 12-13
(protects from cervical, vulval, oral, anal cancers)
What are the 2 types of invasive cell carcinoma?
How might an invasive cell carcinoma present?
- Bleeding:
- post coital
- inter menstrual
- post menopausal
- Mass
- (seen on screening)
How does invasive cervical cancer spread?
Pelvic side wall –> rectum / bladder
How is invasive cervical cancer treated if advanced?
Fill in the missing label:
A thickened endometrium can be a precursor to endometrial cancer. What thickness is the cut off for normal thickness of the endometrium? What might a woman present with?
11mm
If >11mm- suggests thickened endometrium
Presentation:
- Inter-menstrual bleeding
- Post-menopausal bleeding
Endometrial hyperplasia is caused by excessive oestrogen (exposure). Give some causes of excessive oestrogen. (6)
(think Endogenous, exogenous and irregular cycle)
What is the most common gynaecological tract cancer?
Endometrial
When are women at the highest risk of contracting endometrial carcinoma?
Post menopausal
How might endometrial cancer present? (2)
What are the 2 types of endometrial cancer?
Endometrioid adenocarcinoma
Serous adenocarcinoma
Which is the more aggresive of the 2 types of endometrial cancer?
Serous adenocarcinoma
Which of the following histologies is endometroid adenocarcinoma and which is serous adenocarcinoma?
Outline how an endometrioid adenocarcinoma spreads.
Cervix –> vagina –> lymph nodes –> bowel/bladder/other organs
Outline how a serous adenocarcinoma spreads:
Transcoelomic spread
How is an endometrial cancer managed?
Hysterectomy
Bilateral salpingo-oophrectomy (ovaries and fallopian tubes)
+/- lymph node dissection
+/- chemo/radiotherapy
What are the 2 types of tumours of the myometrium (1 benign, 1 malignant)
Benign= leiomyoma (fibroids)
Malignant= leiomyosarcoma
What is the most common tumour of the myometrium?
leiomyoma (fibroids)
What does a leiomyoma look like?
Pale
Homogenous
Well circumscribed mass
How might a patient with fibroids (leiomyoma) present? (4)
- Asymptomatic
- Pelvic pain
- Heavy periods
- Urinary frequency (bladder compression)
How does a leiomyoma appear histologically?
Elongated, cigar shaped nuclei
Benign smooth muscle cells= whorled, intersecting, fascicles
What is a leiomyosarcoma?
Malignant tumour of smooth muscle cells
doesn’t arise from a leiomyoma
Can metastasise to lung
Why does ovarian cancer often have a delayed diagnosis?
Early symptoms= vague and non-specific
What are the later symptoms that someone with ovarian cancer would present with?
- Abdominal pain
- Abdominal distension
- Urinary symptoms
- GI symptoms
- Hormonal disturbances
What 2 serum markers are tested for ovarian cancer?
What 3 categories of tumours can be found in the ovary?
A tumour can be benign, malignant or borderline. What does borderline mean? (ie what is the tumour like)
Increased atypia
No stromal invasion
What are the different types of ovarian tumours? How do the sex cord stromal tumours present?
Name some tumours that metastasise to the ovary
What is the main risk factor for testicular cancer?
Cryptorchidism (undescended testicle)
How does testicular cancer usually present and how is it investigated?
Testicular cancer tumour markers can be useful in diagnosis/monitoring treatment. Give 2 examples of cancer tumour markers.
What are the subtypes of testicular cancer?
What sort of tumour is shown here?
Mature teratoma
The following image shows an ovarian tumour. What type of tumour is it?
Endometrioid adenocarcinoma
The following image shows an ovarian tumour. What type of tumour is it?
Epithelial - Mucinous adenocarcinoma
