Cancers Flashcards
What type of cancer are vulval cancers usually and how do they commonly appear
Usually SCC but can have melanoma and basal cell carcinoma
SCC appear as lumps, ulcers or other skin changes
What are some predisposing factors for vulval cancers
Squamous hyperplasia
Lichen sclerosus
VIN
What is vulval intraepithelial neoiplasia
In situ precursor of vulval SCC
Is a risk factor for SCC but may or may not develop into SCC
Have atypical squamous cells but no invasion of basement membrane
How is HPV infection related to vulval cancers
HPV infection is a cause of VIN and vulval SCC in pre-menopausal women
No relation to HPV in post-menopausal women with VIN or vulval SCC
Where does vulval cancer typically spread to
Direct extension: anus, vagina, bladder
Lymph nodes: inguinal, iliac, para-aortic
Distant metastases: lung, liver
Which infection causes cervical cancers, which subtypes and how does it cause cancer
HPV infection in the transitional zone
Subtypes 16 and 18 are high risk subtypes
These subtypes produce E6 and E7 proteins that inactive p53 and Rb protein (tumour suppressor genes) -> causes uncontrolled cell growth and proliferation
What is cervical intraepithelial neoplasia
Dysplasia of cervical epithelium that does not invade through the basement membrane
Caused by HPV infection
Divided into CIN 1,2,3 with increasing thickness of dysplasia and increasing risk fo progression to invasive SCC
What are the risk factors for CIN and cervical carcinomas
Increased risk of exposure to HPV: sexual partner with HPV, multiple partners, early age of 1st intercourse
Multiple births
Early first pregnancy
Smoking
Low socio-economic class
Immunosuppression
How does invasive cervical cancer present, what staging system is used for it and what is the treatment
Presentation: post-coital, post-menopausal or inter-menopausal bleeding, may have mass
Uses FIGO staging system
Treatment: hysterectomy, lymph node dissection, chemoradiotherapy
What is endometrial hyperplasia, what are the symptoms and what are the causes
Endometrial thickening >11mm. Can be precursor to endometrial cancer
Symptoms are non-specific, e.g. inter-menstrual/post-menopausal bleeding
Caused by excessive oestrogen:
Endogenous - obestiry, early menarche, late menopause, oestrogen secreting tumour
Exogenous - unopposed oestrogen HRT, tamoxifen
Irregular cycles - polycystic ovary syndrome
What are the two types of endometrial cancer and describe their features
Endometrioid adenocarcioma - has enlarged glands which appear fused with no visible stroma. Commonly arises from endometrial hyperplasia
Serous carcinoma - more aggressive. Is poorly differentiated. It spreads via transcoelomic spread into peritoneum -> deposits found on peritoneal surface. Has psammoma bodies
How are endometrial cancers managed
Hysterectomy
Bilateral salphingo-oophrectomy
Lymph node dissection
Chemoradiotherapy
How do leiomyomata present
Asymptomatic
Pelvic pain
Heavy periods
Urinary frequency/GI symptoms due to secondary mass effects
Infertility
What are the symptoms of ovarian cancer
Often vague and non-specific
Later symptoms usually caused by mass effect from the tumour
Can have hormonal disturbances
Which tumour marker is used in ovarian cancer and which mutation is associated with ovarian cancer
Ca-125 is a serum marker for ovarian cancer
BRCA1/2 mutations
