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
What are the types of ovarian tumours
Epithelial tumour
Germ cell tumour
Sex cord stromal tumour
Describe the subtypes of ovarian epithelial tumours and how ovarian tumours typically present
Ovarian tumours usually present as cystic mass
Serous tumour - highly atypical, pleomorphic cells. Often have psammoma bodies. Spread into peritoneal body via transcoelomic spread
Mucinous tumour - atypical epithelilal cells that secrete mucin
Endometrioid tumour - similar to endometrial endometrioid. Have glands resembling endometrium
Subtypes can be benign, malignant or borderline
Describe the subtypes of teratomas (germ cell tumours) and what tumour markers are used for teratomas
Mature/dermatoid cyst - benign. Contain fully mature, differentiated tissue from all germ cell layers
Immature - malignant. Contains immature, embryonic tissue
Mono-dermal - contains high specialised, differentiated tissue. Most common is thyroid tissue which is benign but can cause thyroid problems
Markers - AFP, beta-hCG
Name some other germ cell tumours, other than teratoma. Are these benign or malignant
Are all malignant
Dysgerminoma
Choriocarcinoma
Embryonal carcinoma
Yolk sac tumour
Name and describe the two types of sex cord stromal tumours
Theca and granuloma cell tumours - produce oestrogen so cause symptoms relating to oestrogen production. Pre-pubtery: precocious puberty. Post-puberty: breast cancer, endometrial hyperplasia/carcinoma
Sertoli-Leydig cell tumours - produce testosterone. Pre-puberty: prevents normal female pubertal changes. Post-puberty: sterility, amenorrhoea, hirsutism, male pattern baldness, breast atrophy
What cancers metastasise to the ovary
Breast cancer
GI cancers
Gynae cancers - endometrial, ovarian, fallopian
Krukenburg
What predisposes a patient to testicular cancer and how does testicular cancer present
Cryptorchidism pre-disposes patient to any type of testicular cancer
Patients present with testicular mass +/- pain (usually painless)
Which tumours markers are produced by testicular cancers and for which types of testicualr cancer
Beta-hCG - choriocarcinoma
AFP - yolk sac tumours
What are the types of testicular cancers
Germ cell - seminomatous and non-seminomatous
Non-germ cell - sex cord stromal and other
Describe testicular germ cell tumours
All malignant in post-pubertal males
Have familial predisposition
Cancer in one testis is associated with increased risk of cancer in the other
Divided into seminomas and non-seminomatous germ cell tumours
Describe seminomas
50% of germ cell tumours
Peak age is 40-50
Often confined to testis for long periods of time
Metastasise to lymph nodes: commonly iliac and para-aortic
Describe the types of NSGCTs
Yolk sac tumours - occur in young children. Good prognosis
Embryonal carcinomas, choriocarcinomas and mixed NSGCTs occur in young adults
Teratomas - occur in all ages. If pre-pubertal usually benign, if post-pubertal then malignant
What is the management of testicular cancer
Radical orchiectomy with further treatment depending on whether tumour is seminoma or NSGCT
Seminomas are radiosensitive -> radiotherapy
NSGCTs treated with chemo after surgery
What do you look for in histology of cancer biopsies
Pleomorphic cells
Hyperchromatic cells
Increased nuclear to cytoplasmic ratio
Irregular nuclear outlines
Coarse speckled/abnormal chromatin appearance
