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Reproductive System > Cancers > Flashcards

Cancers Flashcards

1
Q

Define neoplasm

A

An abnormal growth of cells that persist after initial stimulus is removed

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2
Q

Define malignant neoplasm

A

An abnormal growth of cells that persists after the initial stimulus is removed
AND
Invades surrounding tissue wit potential to spread to distant sites

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3
Q

Define dysplasia

A

A potentially pre-neoplastic alteration where cells show disordered organisation + abnormal appearances
Can be reversible

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4
Q

Types of vulval cancers in order of prevalence

A
  • Squamous cell carcinoma
  • Basal cell carcinoma
  • Melanoma
  • Soft tissue tumours
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5
Q

What is the main causative factor of vulva cancer in pre-menopausal?

A

HPV 16 with invasion into developing field of vulval intraepithelial neoplasia

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6
Q

What is the main causative factor of vulva cancer in older women?

A

Unknown
Probably related to chronic inflammatory conditions e.g lichen sclerosus

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7
Q

Describe the spread of vulval cancer

A
  • Spread locally
  • Metastasises to inguinal lymph nodes
  • distant metastases to lungs + liver
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8
Q

Clinical features of vulval cancer

A
  • Lumps
  • Ulceration
  • Skin changes e.g. pigmentation, sensation
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9
Q

Features of squamous cell carinoma in histology

A

Atypical squamous cell
Keratin formation

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10
Q

Define vulval intraepithelial neoplasia

A

In situ precursor of vulval squamous cell carcinoma with no invasion through basement membrane (in situ)

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11
Q

What are the different epithelial lining of the cervix?

A
  • Ectocervix: stratified squamous epithelium to withstand low pH environment of vagina
  • Endocervix: simple columnar epithelium
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12
Q

What changes happen to the epithelium of the cervix as a woman ages?
What risk is within this?

A
  • Simple columnar epithelium becomes into contact with low vaginal pH > undergoes metaplasia > stratified squamous epithelium in transformation zone
  • Increased risk of dysplasia
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13
Q

How does HPV cause cervical cancer?

A
  • infection transformation zone of cervix produce viral proteins
  • inactivate tumor suppressor genes
  • causing uncontrolled cellular proliferation
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14
Q

What do cervical squamous cell carcinomas develop from?

A

Cervical intraepithelial neoplasia

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15
Q

What are the types of cervical cancers?

A

Squamous cell carcinoma (most common)
Adenocarcinoma

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16
Q

Risk factors for cervical carcinomas

A
  • increased risk of exposure to HPV: multiple sexual partners, early age of first intercourse, sexual interaction with person with HPV
  • early first pregnancy
  • multiple births
  • smoking
  • low socio-economic status
  • Immunosuppression
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17
Q

Treatment for cervical interepithelial neoplasia

A
  • CIN1: regresses spontaneously but follow up cervical smear
  • CIN2/3: colposcopy +/- large loop excision of transformation zone
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18
Q

Describe the cervical cancer screening programme

A
  • 25-49: every 3 years
  • 50-64: every 5 years
  • > 65: only if recent abnormality
    .
  • Brush used to scrape cells from transformation zone
  • tested for HPV
  • if positive, cells looked at under microscope
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19
Q

Describe the spread of cervical cancers

A
  • locally to ureters, bladder + rectum
  • spread to iliac then aortic lymph nodes
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20
Q

What does in situ mean?

A

Does not break through basement membrane

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21
Q

Presentation of cervical cancer

A
  • postcoital bleeding
  • intermenstrual bleeding
  • post menopausal bleeding
  • mass
  • screening
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22
Q

Treatment of invasive cervical cancer

A

Hysterectomy
Lymph node dissection
+/- chemoradiotheraphy

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23
Q

Describe HPV vaccine

A
  • recombinant vaccine
  • against HPV
  • given to 12-13 year olds
  • protects from cervical, vulval, oral + anal cancers
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24
Q

How are gynaecological cancers screened?

A

Figo

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25
Q

Define cervical intraepithelial neoplasia

A

Dysplasia of squamous cells in cervical epithelium

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26
Q

What is endometrial hyperplasia caused by?

A

Excessive oestrogen

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27
Q

Endogenous sources of excessive oestrogen

A
  • obesity (androgens > oestrogen)
  • early menarche
  • late menopause
  • oestrogen secreting tumours
  • irregular cycle e.g. PCOS
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28
Q

Exogenous sources of excessive oestrogen

A
  • unopposed oestrogen HRT
  • tamoxifen
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29
Q

What is the most common gynaecological tract cancer?

A

Endometrial cancer

30
Q

Types of endometrial cancer

A

Endometrioid adenocarcinoma (most common)
Serous adenocarcinoma

31
Q

Describe endometrioid adenocarcinoma

A
  • Most common type of endometrial cancer
  • commonly arises from endometrial hyperplasia due to excessive unopposed oestrogen
  • often in perimenopasual + older women
32
Q

Describe endometrial serous adenocarcinoma

A
  • Less common but more aggressive + worse prognosis
  • poorly differentiated cells
33
Q

Where can advanced endometrial cancer spread to?

A
  • Cervix, bladder + rectum
  • Through peritoneal cavity (out via fallopian tubes) or lymph nodes
34
Q

What is the lymphatic drainage of the cervix?

A
  • superior portion - internal iliac
  • inferior portion - sacral
35
Q

Presentation of endometrial cancer

A

Post-menopausal bleeding
Intermenstrual bleeding
Mass

36
Q

Management of endometrial cancer

A
  • Hysterectomy
  • Bilateral salpingo-oophorectomy
  • +/- lymph node dissection
  • +/- chemo radio therapy
37
Q

What are leiomyoma?

A

Benign tumours of the myometrium
Pale, homogenous, well circumscribed mass

38
Q

What is the most common tumour of the myometrium?

A

Leiomyoma

39
Q

Symptoms of myometrial tumours

A
  • Asymptomatic
  • Pelvic pain
  • Heavy menstrual loss
  • menorrhagia
  • infertility
  • urinary frequency due to bladder compression
40
Q

What is a leiomyosarcoma?

A

Malignant tumour of myometrium

41
Q

Types of myometrial tumours

A

Leiomyoma - benign
Leiomyosarcoma - malignant

42
Q

Where do leiomyosarcoma commonly spread to?

A

Lungs

43
Q

Early symptoms of ovarian cancer

A

Vague + non specific causing delayed diagnosis

44
Q

Late symptoms of ovarian cancer

A

Abdominal pain + distension
Urinary + GI symptoms
Hormonal disturbances

45
Q

Types of ovarian tumours

A
  • epithelial tumours (most common)
  • germ cell tumours
  • sex cord stromal tumours
46
Q

Classification of epithelial ovarian tumours

A
  • Serous
  • Mucinous
  • Endometriod
    .
    Further classificed into:
  • Benign
  • Borderline
  • Malignant
47
Q

Why is prognosis of malignant epithelia tumours often poor?

A
  • Do not present until late stage
  • metastasise to abdomen > ascites, intestinal obstruction + death
48
Q

Markers for familial ovarian epithelial carcinoma

A

BRCA1/2

49
Q

What is the most common germ cell tumour?

A

Mature (benign) cystic teratoma (dermoid cyst)

50
Q

Three subtypes of germ cell tumours

A

Mature - benign
Immature - malignant
Monodermal - highly specialised

51
Q

The presence of what in a germ cell tumour indicates malignancy?

A

Immature tissue e.g. Primitive neuroepithelium

52
Q

Types of germ cell tumours

A
  • Mature cystic teratoma
  • Dysgerminoma
  • Choriocarcinoma
  • Embryonal carcinoma
  • Yolk sac tumour
    (All by MCT are malignant)
53
Q

Germ cell tumour markers

A

Alpha fetoprotein
Beta human chorionic gonadotropin

54
Q

Describe the development of sex cord stromal tumours

A

Derived from ovarian stroma (which is derived from sex cords of embryonic gonads)

55
Q

Types of sex cord stromal tumours

A
  • Theca + granuloma cell tumours
  • sertoli-leydig tumours
56
Q

What do granuloma cell tumours produce?

A

Oestrogen

57
Q

What can granuloma cell tumours cause?

A

Precocious puberty
Breast cancer
Endometrial hyperplasia + carcinoma

58
Q

What do sertoli-leydig tumours produce?

A

testosterone

59
Q

What do sertoli leydig tumours cause?

A
  • Prevents normal female pubertal changes
  • infertility
  • amenorrhoea
  • Hirsutism
  • male pattern baldness
  • breast atrophy
60
Q

What types of cancers can metastases to the ovaries?

A
  • Breast
  • GI
  • Endometrial, fallopian tube, other ovary
61
Q

What are Krukenburg tumours?

A

Metastatic GI tumours within the ovaries
Often arise from stomach

62
Q

Risk factor of testicular cancer

A

Cryptorchidism

63
Q

Who is testicular cancer common in?

A

Men aged 15-34

64
Q

Presentation of testicular cancer

A

Mass +/- pain

65
Q

What is cryptorchidism?

A

Undescended testicles

66
Q

What are the two groups of germ cell tumours

A

Seminomas
Non-Seminomatous

67
Q

What are the classes of cervical intraepithelial neoplasia?

A
  • CNI: mild dysplasia in situ - most regress spontaneously
  • CNII: moderate dysplasia in situ
  • CNIII: severe dysplasia in situ
  • SCC: invasive carcinoma - has invaded through basement membrane
68
Q

How often should you have a cervical cancer smear test?

A
  • 25-49: every 3 years
  • 50-64: every 5 years
  • > 65: only if recent abnormality
69
Q

What is the tumour marker for ovarian cancer?

A

CA 125

70
Q

What is the tumour marker for breast cancer?

A

CA 15-3

Reproductive System (20 decks)

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