Cancers Flashcards
Define neoplasm
An abnormal growth of cells that persist after initial stimulus is removed
Define malignant neoplasm
An abnormal growth of cells that persists after the initial stimulus is removed
AND
Invades surrounding tissue wit potential to spread to distant sites
Define dysplasia
A potentially pre-neoplastic alteration where cells show disordered organisation + abnormal appearances
Can be reversible
Types of vulval cancers in order of prevalence
- Squamous cell carcinoma
- Basal cell carcinoma
- Melanoma
- Soft tissue tumours
What is the main causative factor of vulva cancer in pre-menopausal?
HPV 16 with invasion into developing field of vulval intraepithelial neoplasia
What is the main causative factor of vulva cancer in older women?
Unknown
Probably related to chronic inflammatory conditions e.g lichen sclerosus
Describe the spread of vulval cancer
- Spread locally
- Metastasises to inguinal lymph nodes
- distant metastases to lungs + liver
Clinical features of vulval cancer
- Lumps
- Ulceration
- Skin changes e.g. pigmentation, sensation
Features of squamous cell carinoma in histology
Atypical squamous cell
Keratin formation
Define vulval intraepithelial neoplasia
In situ precursor of vulval squamous cell carcinoma with no invasion through basement membrane (in situ)
What are the different epithelial lining of the cervix?
- Ectocervix: stratified squamous epithelium to withstand low pH environment of vagina
- Endocervix: simple columnar epithelium
What changes happen to the epithelium of the cervix as a woman ages?
What risk is within this?
- Simple columnar epithelium becomes into contact with low vaginal pH > undergoes metaplasia > stratified squamous epithelium in transformation zone
- Increased risk of dysplasia
How does HPV cause cervical cancer?
- infection transformation zone of cervix produce viral proteins
- inactivate tumor suppressor genes
- causing uncontrolled cellular proliferation
What do cervical squamous cell carcinomas develop from?
Cervical intraepithelial neoplasia
What are the types of cervical cancers?
Squamous cell carcinoma (most common)
Adenocarcinoma
Risk factors for cervical carcinomas
- 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
Treatment for cervical interepithelial neoplasia
- CIN1: regresses spontaneously but follow up cervical smear
- CIN2/3: colposcopy +/- large loop excision of transformation zone
Describe the cervical cancer screening programme
- 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
Describe the spread of cervical cancers
- locally to ureters, bladder + rectum
- spread to iliac then aortic lymph nodes
What does in situ mean?
Does not break through basement membrane
Presentation of cervical cancer
- postcoital bleeding
- intermenstrual bleeding
- post menopausal bleeding
- mass
- screening
Treatment of invasive cervical cancer
Hysterectomy
Lymph node dissection
+/- chemoradiotheraphy
Describe HPV vaccine
- recombinant vaccine
- against HPV
- given to 12-13 year olds
- protects from cervical, vulval, oral + anal cancers
How are gynaecological cancers screened?
Figo
Define cervical intraepithelial neoplasia
Dysplasia of squamous cells in cervical epithelium
What is endometrial hyperplasia caused by?
Excessive oestrogen
Endogenous sources of excessive oestrogen
- obesity (androgens > oestrogen)
- early menarche
- late menopause
- oestrogen secreting tumours
- irregular cycle e.g. PCOS
Exogenous sources of excessive oestrogen
- unopposed oestrogen HRT
- tamoxifen
What is the most common gynaecological tract cancer?
Endometrial cancer
Types of endometrial cancer
Endometrioid adenocarcinoma (most common)
Serous adenocarcinoma
Describe endometrioid adenocarcinoma
- Most common type of endometrial cancer
- commonly arises from endometrial hyperplasia due to excessive unopposed oestrogen
- often in perimenopasual + older women
Describe endometrial serous adenocarcinoma
- Less common but more aggressive + worse prognosis
- poorly differentiated cells
Where can advanced endometrial cancer spread to?
- Cervix, bladder + rectum
- Through peritoneal cavity (out via fallopian tubes) or lymph nodes
What is the lymphatic drainage of the cervix?
- superior portion - internal iliac
- inferior portion - sacral
Presentation of endometrial cancer
Post-menopausal bleeding
Intermenstrual bleeding
Mass
Management of endometrial cancer
- Hysterectomy
- Bilateral salpingo-oophorectomy
- +/- lymph node dissection
- +/- chemo radio therapy
What are leiomyoma?
Benign tumours of the myometrium
Pale, homogenous, well circumscribed mass
What is the most common tumour of the myometrium?
Leiomyoma
Symptoms of myometrial tumours
- Asymptomatic
- Pelvic pain
- Heavy menstrual loss
- menorrhagia
- infertility
- urinary frequency due to bladder compression
What is a leiomyosarcoma?
Malignant tumour of myometrium
Types of myometrial tumours
Leiomyoma - benign
Leiomyosarcoma - malignant
Where do leiomyosarcoma commonly spread to?
Lungs
Early symptoms of ovarian cancer
Vague + non specific causing delayed diagnosis
Late symptoms of ovarian cancer
Abdominal pain + distension
Urinary + GI symptoms
Hormonal disturbances
Types of ovarian tumours
- epithelial tumours (most common)
- germ cell tumours
- sex cord stromal tumours
Classification of epithelial ovarian tumours
- Serous
- Mucinous
- Endometriod
.
Further classificed into: - Benign
- Borderline
- Malignant
Why is prognosis of malignant epithelia tumours often poor?
- Do not present until late stage
- metastasise to abdomen > ascites, intestinal obstruction + death
Markers for familial ovarian epithelial carcinoma
BRCA1/2
What is the most common germ cell tumour?
Mature (benign) cystic teratoma (dermoid cyst)
Three subtypes of germ cell tumours
Mature - benign
Immature - malignant
Monodermal - highly specialised
The presence of what in a germ cell tumour indicates malignancy?
Immature tissue e.g. Primitive neuroepithelium
Types of germ cell tumours
- Mature cystic teratoma
- Dysgerminoma
- Choriocarcinoma
- Embryonal carcinoma
- Yolk sac tumour
(All by MCT are malignant)
Germ cell tumour markers
Alpha fetoprotein
Beta human chorionic gonadotropin
Describe the development of sex cord stromal tumours
Derived from ovarian stroma (which is derived from sex cords of embryonic gonads)
Types of sex cord stromal tumours
- Theca + granuloma cell tumours
- sertoli-leydig tumours
What do granuloma cell tumours produce?
Oestrogen
What can granuloma cell tumours cause?
Precocious puberty
Breast cancer
Endometrial hyperplasia + carcinoma
What do sertoli-leydig tumours produce?
testosterone
What do sertoli leydig tumours cause?
- Prevents normal female pubertal changes
- infertility
- amenorrhoea
- Hirsutism
- male pattern baldness
- breast atrophy
What types of cancers can metastases to the ovaries?
- Breast
- GI
- Endometrial, fallopian tube, other ovary
What are Krukenburg tumours?
Metastatic GI tumours within the ovaries
Often arise from stomach
Risk factor of testicular cancer
Cryptorchidism
Who is testicular cancer common in?
Men aged 15-34
Presentation of testicular cancer
Mass +/- pain
What is cryptorchidism?
Undescended testicles
What are the two groups of germ cell tumours
Seminomas
Non-Seminomatous
What are the classes of cervical intraepithelial neoplasia?
- 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
How often should you have a cervical cancer smear test?
- 25-49: every 3 years
- 50-64: every 5 years
- > 65: only if recent abnormality
What is the tumour marker for ovarian cancer?
CA 125
What is the tumour marker for breast cancer?
CA 15-3
