Cancer Flashcards
Where can reproductive tract cancers occur in women?
- vulva
- cervix
- endometrium
- myometrium
- ovaries
What type of cancer are vulval tumours and how common are they?
Quite uncommon
Squamous cell carcinoma
What is the most common cause of vulval tumours in pre menopausal and post menopausal women?
pre: HPV (peak incidence in 60s)
post: long standing inflammation and hyperplastic conditions such as lichen sclerosis and squamous hyperplasia
What is vulvar intraepithelial neoplasia?
Atypical squamous cells within the epidermis (no invasion)- theyre a precursors to squamous cell carcinomas. They look like raised legions, somtimes hyper or hypopigmented and can be associated with burning, itching, painful sex ect
Where do vulval squamous cell carcinomas spread to?
Inguinal, pelvic, illiac and paraaortic nodes.
Also to lung and liver.
How are vulval tumours treated?
excision and removal of lymph nodes
What is lichen sclerosis?
A chronic inflammatory disorder of the genitalia, usually first seen in children causing white, raised plaques of skin. Cause is unknown.
What types of cancer can occur at the cervix?
Adenocarcinoma (15%) and sqamous cell carcinoma (80%)
How do cervical carcinomas present?
screening, intermenstrual bleeding, post coital bleeding, post menopausal bleeding
What is the main cause of cervical cancer?
HPV16 and 18
How does HPV cause cancer?
Has proteins E6 and E7 which interfere w/ P53 and retinoblastoma protein respectively.
What is CIN?
cervical intraepithelial neoplasia- precancerous, noninvasive squamous cell neoplasia
Which part of the cervix is most commonly affected by CIN/ HPV/ cervical cancer?
The transformation zone where the epithelium is changing from squamous cell to columnar
How is cervical cancer being prevented?
- screening and excision of invasive malignancies by diathermy
- HPV vaccine to all 12 and 13 y/o girls
how is cervical cancer treated?
hysterectomy, lymph node excision, if advanced: radio and chemotherapy
What is the most common type of endometrial cancer?
endometriod endometrial adenocarcinoma (most common invasive cancer of repro tract)
Why does endometriod endometrial adenocarcinoma occur?
unopposed oestrogen:
- obesity (more adipose tissue creating oestrogen)
- exogenous oestrogen (HRT, Pill, tamxoifen from breast cancer treatment)
- hormone secreting tumours
It causes endometrial hyperplasia which can progess to cancer
what does endometrial cancer most commonly present with?
irregular or post menopausal bleeding
How can endometrial cancer spread?
myometrial invasion, extension to adjacent structures, local lymph nodes and distant sites
What is the name for the benign and the malignant tumour of the myometrium?
Benign: leiomyoma (fibroid)
Malignant: uterine lyeimyosarcoma - these do not arise frmo leiomyomas, their aetiology is unknown
How may leimyomas present?
Often asymptomatic and you may have many and never know.
Or: bleeding, heavvy periods, urinary frequency (compress bladder) or infertility
How common is uterine leiomyosarcoma? what is the prognosis like?
very rare
prognosis bad as aggressive, commonly goes to lungs .
What are the 4 types of ovarian tumours?
- mullerian epithelium (inc endometriosis)- most common
- germ cells
- sex cord stromal
- mets
What are the 3 types of mullerian ovarian tumours?
- serous
- mucinous
- endometroid
What causes serous ovarian tumours?
repeated breaking and repair of the serous membrane due to ovulation
What protects you from serous ovarian tumours?
the pill, pregnancy and low age (fewer ovulations the better)
How do serous ovarian tumours commonly present?
with ascites due to spread through peritoneum. also abdo pain, distension, urinary and GI symptoms
What are mucinous ovarian tumours like?
large cystic masses which are filled with sticky thick fluid (mucus)
What type of tumours are most germ cell ovarian tumours? What else can you get?
Teratomas- benign
Can also get dysgerminoma, yolk sac tumour, choriocarcinoma ect
What are the three types of teratomas?
mature (common)- benign
Immature (uncommon)- malignant and resemble fetal tissue
Monodermal (highly specialised)
All three can be cystic, contain hair and teeth and occur in young women
What can granulosa cell tumours cause?
commonly secrete oestrogen so can cause endometrial hyperplasia and adenocarcinoma as well as precocious puberty
Where are the most common primary sites for ovarian mets?
Mullerian epitheilum tumours, GI and breast
What is a kruckenberg tumour?
Metastaic cancers in the ovaries originating from the GI tract, most commonly the stomach
What are the 2 origins of testicular cancers?
germ cell or sex cord stromal, lymphomas can also affect the testis
How common are sex cord stromal cell cancers in the testis?
Theyre uncommon and benign. They arise from the sertoli or leydig cells.
What may increase risk of testicular cancer?
some genes and also cryptorchidism (undecended testis) and the surgery to repair it
What are the two groups of germ cell tumours?
Seminomas and non seminomas (roughly 50% are each)
In what age groups do seminomas, yolk sac tumours, choriocarcinomas, embryonal carcinomas and teratomas arise in?
Seminomas= 40-50y/os
Yolk sac= young children
Embryonal and choriocarcinomas= young adults
Teratomas= any age
What is the alpha fetoprotein and hCG status in seminomas?
a- fetoprotein is normal
hCG is raised in 10% cases
Where do seminomas metastasis to?
illiac or paraortic nodes- this is only after many yrs and further spread is rare
How are seminomas treated?
radiotherapy and/ or radial orchiectomy (cut it out)
What is the a- fetoprotein and hCG status in yolk sac tumours?
a- fetoprotein almost always high
hCG sometimes high
What tumour almost always raised hCG?
choriocarcinoma
What is the AFP and hCG status in someone with a teratoma?
AFP and hCG almost never raised
Where do non seminomas metastasis to and how commonly to they do it?
Regional lymphatics and to other areas by blood vessels. This is relatively common and my be the presentation as the testicular lumps may be undetectable
How are non seminomas treated?
chemotherapy after an orchiectomy
