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M2 Endo/Repro > 2/21 Cancers of Female Repro Tract - Corbett > Flashcards

2/21 Cancers of Female Repro Tract - Corbett Flashcards

1
Q

cervical cancer

risk factors

A
  • multiple sexual factors (incr poss exposure to HPV)
  • start sexual intercourse at young age
  • smoking
  • HIV infection
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2
Q

anatomy of cervix

A

endocervix: simple columnar epithelium, produces mucus

transition zone

ectocervix: stratified squamous epithelium

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3
Q

change in vaginal epithelium during puberty

A

exposed columnar epi cells undergo metaplasia

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4
Q

transition zone

A

esp susceptible to HPV infection

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5
Q

HPV and invasive cervical cancer

progression numbers?

higher risk of progression?

histo connection

viral factors

A

higher risk if

  • HPV phenotype/course
  1. high risk HPV type (16 - 60%, 18 - 10%; - also 31, 33) - more likely to integrate into host genome
  2. persistent infection
  • immunocompromised state (5x if HIV+)
  • environmental factors (smoking, vit deficiency)

histologically: KOILOCYTES = HPV

HPV oncoproteins: resp for viral transformation

  • E7 : binds to Rb protein → release/activation of E2F tf → cells enter S phase
    • also binds p21 and other cyclins
  • E6 : binds to p53, causes its degradation → prevents cell growth check
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6
Q

HPV oncoproteins

A
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7
Q

CERVICAL INTRAEPITHELIAL NEOPLASIA

A

region of dysplasia extends further and further

assoc with failure of maturation

incr variabliilty in cell and nuclear size

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8
Q

invasive carcinoma of cervix

A

all linked to HPV

  • 80% squamous cell carcinoma
  • 15% adenocarcinoma (hard to detect w pap smear)
  • 5% neuroendocrine tumor

peak indicence: 45

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9
Q

presentation: cervical cancer

A
  1. abnormal pap smear (but most women are asymp)
  2. post-coital vaginal bleeding
  3. vag discomfort
  4. malodorous discharge
  5. dysuria

in advanced disease…

  • invasion of bladder and rectum
    • constipation, hematuria, fistula, ureteral obst (w, wout hydronephrosis)
    • triad suggesting pelvic wall: leg edema, pain, hydronephrosis
  • distant metastasis possible
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10
Q

cervical cancer screening/vaccine

A

screen at 21 or w/in first 3yr of sexual activity

  • cytology/pap smear + HPV testing 3yr-ly
    • neg? testing Q 5yr
    • pos? cervical cytology every 6-12mo

vaccination protects against HPV 16, 18

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11
Q

endometrium

A

two layers

  1. functional layer
    • most affected by changes in blood levels of estrogen/progesterone & spiral aa blood supply
    • partly/totally lost during menstruation
  2. basal layer
    • not affected by changes in blood levels of estrogen/progesterone
    • blood supply is from basal aa
    • not lost after menstruation → basal-fx layer boundary will serve as point of regeneration for fx layer after menstruation
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12
Q

changes in endometrium through menstrual cycle

A
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13
Q

tumors of myometrium

A
  1. benign (leiomyoma)
  2. malignant (leiomyosarcoma)
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14
Q

leiomyoma

A

LEIOMYOMA

  • estrogen-sensitive
  • often multiple: sharply circumscribed, discrete, round, firm gray white tumors
  • commonly asymp but can also present w
    • abnl uterine bleeding
    • urinary sx
    • pelvic pain

risk factors

  • race (AfAm)
  • estrogen (low parity, premenopausal, large in preg)
  • fam hx
  • obesity
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15
Q

leiomyosarcoma

A

rare tumor from stroma/smooth muscle

LEIOMYOMAS ARE NOT PRECURSOR LESIONS FOR LEIOMYOSARCOMA → have distinct karyotypes and gene mutations

pathologically:

  • nuclear atypia
  • mitotic index

clinical presentation:

  • bleeding
  • pelvic pain/pressure
  • pelvic mass
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16
Q

subtypes of endometrial cancer

A

endometrial cancer type 1 (80)

  • endometrioid
  • mimic proliferative endometrial glands
  • precursor lesion: endometrial hyperplasia
  • key risk factor:
    • unopposed extrogen exposure (tamoxifen or endog)
    • obesity, chronic anovulation, nulliparity
    • DM
    • HTN

endometrial cancer type 2

  • occurs in setting of endometrial atrophy in older women in 70s
  • poorly differentiated
    • all high grade
    • 90% have p53 mutation
  • serous: papillary architecture resembling serous carcinoma of ovary
    • psammoma bodies in 60%
    • marked nuclear atypia in 100%
  • clear cell
  • tumor exfoliates, often spread beyond uterus at dx
17
Q

MUST KNOW

postmenopausal bleeding and cancer

A

20% of postmenopausal bleeding is due to cancer

  • MUST ELIMINATE CANCER IN THESE PTS
18
Q

ovary review

A

plus a few more review pics

19
Q

ovarian cancer

risk factors

A
  • BRCA1, BRCA2 (8-10% of all ovarian cancers)
  • NHPCC
  • incr estrogen exposure
    • nulliparity
    • delayed menopause
20
Q

symptoms

(triad) and others

A

symptom triad (43% if they had all 3)

  1. bloating
  2. incr abdominal girth
  3. urinary sx
  • bloating/abd distention
  • early satiety
  • pressure effects on bladder/rectum
  • SOB/fatigue
21
Q

origins of ovarian tumors

memorize

A
  1. surface epithelium x5
  • 90% malignancy
  • 65-70% benign
  1. germ cells x5
  2. sex cord-stroma x6
22
Q

surface epithelial cell tumors

A
23
Q

serous tumors

A

70% benign: serous CYSTadenomas

  • younger women
  • simple cysts w cuboidal epithelium

30% malignant: serous cystadenocarcinomas

  • postmenopausal women
  • proliferative cyst lining “shaggy”
  • spread via diffuse peritoneal seeding (85% extra-ovarian at dx)
  • common assoc with ascites

commonly bilateral

psammoma bodies (though not specific)

24
Q

mucinous tumors

A
  • 90% benign, low malignant potential
    • less likely to involve ovary surface
    • 5% bilat
  • LARGE and multilobulated and filled with gelatinous fluid
  • assoc with K-Ras mutations
  • solid areas of growth? → malignancy
25
Q

endometrioid tumors

A
  • marked by tubular glands bearing close resemblance to benign or malignant endometrium
    • 15-20% arise in setting of endometriosis
    • 15-30% of ovarian endometriod carcinoms occur with endometrial carcinoma
  • usually young women
  • microsatellite instability (DNA MMR mutations, ex. Lynch syndrome)
26
Q

transitional cell tumors

Brenner tumors

A

mostly benign

uncommon

solid, encapsulated, unilateral

abundant stroma containing nests of transitional-type epithelium

27
Q

ovarian cancers summary

surface epitheilum-stroma

A
28
Q

germ cell tumors

A
  1. “embryo-like”
    • teratoma: mature (BENIGN) & immature
    • dysgerminoma (immature germ cells) → LDH
    • bHCG → embryonal carcinoma
  2. “placenta-like”
    • yolk sac → AFP
    • bHCG → choriocarcinoma

generally younger women (10-30y)

  • 70% of ovarian neoplasms in this age group
  • malignant OGCNs more freq among Asian/Pacific Islander, Hispanic women
29
Q

teratomas

A

15-20% of all benign ovarian neoplasms

most common ovarian tumor in women in 20s/30s

most likely in younger women (under 20)

over 95% are benign cystic teratomas

  • contain mature tissue from all three germ cell layers, lined by epidermis
  • can undergo malignant transformatoin → squamous cell carcinoma (usually)
  • 90% unilat (R > L)
30
Q

specialized teratomas

struma ovarii

carcinoid

A

struma ovarii

  • mature thyroid tissue
  • can be fxal → 30% of pts will have clinical hyperthyroidism

carcinoid

  • can cause carcinoid syndrome if large (even w/out hepatic metastases)
31
Q

germ cell origin + metastases to ovary

summary

A
32
Q

sex cord stromal tumors

A

derived from ovarian stroma (sex cords of embryonic gonad)

undifferentiated gonadal mesenchyme…

  • male (Sertoli, Leydig) : secrete androgens → VIRILIZING
  • female (granulosa, theca) : secrete androgens → FEMINIZING
33
Q

granulosa cell tumors

A

mostly in adults

presence of gland-like structures: Call-Exner bodies

may pump out lots of estrogen → dysfx uterine bleeding, 10-15% develop endometrial cancer

inhibit: tumor marker

97% have mutation in FOXL2 gene: imp to granulosa cell devpt

34
Q

Sertoli-Leydig cell tumors

A

often androgen-secreting: recap testicular Sertoli cells

peak: 20-30y

unilateral

over 50% have mutation sin DICER1 (microRNA processing)

can lead to “defeminization” or virilization

  • breast atrophy
  • amenorrhea
  • hair loss
  • infertility
35
Q

all ovarian cancer cancers

A

M2 Endo/Repro (20 decks)

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