24) Gynaecological Tumours Flashcards
What is the main cause of cervical cancer?
High risk HPVs: HPV16, HPV18
Where does the HPV virus infect and what effects does it have?
Immature metaplastic squamous cells in transformation zone
Produces E6 and E7 proteins that interfere with TS genes
What is the transformation zone?
Area in cervix where there is metaplasia from glandular to squamous epithelium
What are some risk factors for cervical cancer?
Sex, long term OCP, low class, smoking, immunosuppression
Describe the screening procedure for cervical cancer:
Colposcopy to visualise cervix then scrap cells from TZ and stain. Can detect HPV DNA from cervical cells
Describe the screening programme for cervical cancer in the UK:
From 25 every 3 years until 50, then every 5 years from 50-65
What vaccine can be given to protect against cervical cancer? Who is it given to?
Gardasil to girls aged 12-13
What is cervical intraepithelial neoplasia?
Dysplasia of squamous cells in cervical epithelium, induced by HPV infection
How is CIN staged?
CIN I progressing to CIN II progressing to CIN III which can become invasive carcinoma
What is the treatment for CIN?
CIN I - cryotherapy
CIN II and III - superficial excision, removing TZ
What are the types of invasive cervical carcinoma?
Squamous cell carcinoma and adenocarcinoma
What is the average age of presentation with invasive cervical carcinoma?
45
Where is invasive cervical carcinoma likely to spread?
Cervical, pelvic and para-aortic nodes
Bladder, uterus , rectum and vagina
How is invasive cervical carcinoma treated?
Microinvasive - cervical cone excision
Invasive - hysterectomy, LN dissection (radio and chemo if advanced)
What is the typical presentation of invasive cervical carcinoma?
Screening abnormality or vaginal bleeding
What is the precursor to endometrial adenocarcinoma?
Endometrial hyperplasia
What are some causes of endometrial adenocarcinoma?
Prolonged oestrogen: anovulation, adipose causing oestrogen secretion (obesity) and exogenous oestrogen
How does endometrial adenocarcinoma present and at what ages?
Usually 55-75
Irregular or post-menopausal vaginal bleeding
What is the treatment for endometrial adenocarcinoma?
Hysterectomy
What are the types of endometrial adenocarcinoma?
Endometrioid, serous carcinoma
Describe endometrioid endometrial adenocarcinoma: (include where it spreads)
Mimics proliferative glands
Spread by myometrial invasion to cervix, bladder and rectum, local LNs and distant sites
Describe serous endometrial adenocarcinoma: (include where it spreads)
Poorly differentiated, exfoliates and travels through Fallopian tubes to peritoneal surfaces
What are some tumours of the myometrium?
Leiomyoma (fibroids)
Leiomyosarcoma
How does leiomyoma present?
Heavy/painful periods, urinary frequency, infertility (can be asymptomatic)
When is leiomyosarcoma likely to present?
40-60
Where does leiomyosarcoma commonly metastasise to?
Lungs
When do ovarian tumours commonly present?
Benign: 20-45
Malignant: 45-65
Generally, how do ovarian tumours present?
Abdominal pain, distension, urinary and GIT symptoms, ascites, intestinal obstruction
What is the marker for ovarian tumours?
Serum CA-125
How can ovarian tumours be classified?
Mullerian epithelium
Germ cells
Sex cord stromal cells
Metastasis
What are the types of epithelial ovarian tumours?
Serous, mucinous or endometrioid
What are the risk factors for developing epithelial ovarian tumours?
Nulliparity, OCP is protective, heritable mutations (BRCA), smoking, endometriosis
Describe serous epithelial ovarian tumours:
Spread to peritoneal surfaces and omentum, associated with ascites
Describe mucinous epithelial ovarian tumours:
Large, cystic mass with sticky fluid, often benign or borderline
Describe endometrioid epithelial ovarian tumours:
With tubular glands like endometrium, can be due to endometriosis
What is pseudomyoxma peritonei?
Originating from appendix, cancer cells that produce mucus and mucinous ascites. Often involves the ovaries and colon
What are the types of germ cell ovarian tumours?
Mature, immature (malignant) and monodermal teratomas, non-gestational choriocarcinoma
Describe a mature teratoma:
Contain hair, sebaceous material and sometimes teeth, often in young women
What is struma ovarii?
Teratoma composed of thyroid tissue can cause hyperthyroidism
What are some examples of sex cord-stromal tumours?
Sertoli-Leydig tumours, granulosa tumours, theca tumours
What are the features of granulosa tumours?
Large amount of oestrogen produced so can cause endometrial and breast disease (mainly post-menopausal)
If in pre pubertal girls - precocious puberty
What are the features of Sertoli-Leydig tumours?
In children can block female development In adults (teens or 20s): breast atrophy, amenorrhoea, hirsutism, voice changes
Where are metastasis to ovary commonly from?
Mullerian tumours: uterus, fallopian tubes, other ovary, peritoneum
GIT including colon, stomach, pancreas
Describe the causes of vulval tumours:
HPV16, occur in 6th decade
Long standing inflammation and hyperplasia, occur in 8th decade
Where do vulval tumours spread?
Inguinal, pelvic, iliac and para-aortic nodes
Lung and liver
What is the treatment for vulval tumours?
Vulvectomy and lymphadenectomy
Give examples of tumours of gestation:
Hydatidiform mole (complete or partial), invasive mole and choriocarcinoma
What is hydatidiform mole?
Cystic swelling of chorionic villi and trophoblastic proliferation
In what groups does hydatidiform mole commonly present?
Teens and 40-50
What is gestational choriocarcinoma?
Malignant neoplasm of trophoblastic cells, associated with abortion and complete moles
How does gestational choriocarcinoma present?
Vaginal spotting and high hCG levels
How is gestational choriocarcinoma treated?
Uterine evacuation and responds well to chemo
How is hydatidiform mole treated?
Curettage and hCG monitoring
