Cancers of the Genital Tracts

Question 1

Aetiology of vulva cancer. (5)

Answer 1

Uncommon, mostly in older women.
Caused in pre-menopausal women by HPV causing vulval intraepithelial neoplasia (precursor to squamous cell carcinoma.
Caused in post-menopausal women by chronic inflammation ie lichen sclerosusor. Causing squamous cell hyperplasia.

Question 2

Pathophysiology of vulval cancer. (3)

Answer 2

Mostly squamous cell carcinoma (90%) but can be melanoma or basal cell carcinoma. Can spread locally to other organs or lymph nodes.

Question 3

Detection and treatment of vulval cancer. (2)

Answer 3

Lumps/ulcers/lesions can be detected by the woman, or in examinations.
Curative surgery would include removing primary tumour and local nodes.

Question 4

Pathophysiology of cervical cancer. (3)

Answer 4

Squamous cell cercinoma (80%) but some are adenocarcinomas. Appear in the transition zone which is the metaplasia between simple columnar and striatified squamous.

Question 5

Aetiology of cervical cancer. (4)

Answer 5

HPV causing proliferation in the transition zone, or cervical intraepithelial neoplasia. Can spread to local nodes, local organs (causing fistulae), or be widespread.

Question 6

Risk factors for CIN or carcinoma. (5)

Answer 6

Increased HPV risk, smoking, multiple births, early first pregnancy or sex, immunosuppresion.

Question 7

Explain why the HPV vaccination is controversial. (3)

Answer 7

Men can still get oral and anal cancer that is related to HPV but they don’t get the vaccine, which wipes out the herd immunity effects.

Question 8

Detection of cervical cancer. (4)

Answer 8

Cervical screening detects abnormal cells and premalignant lesions.
25-49: every 3 years
50-64: every 5 years
65+: if abnormalities indicated.

Question 9

Aetiology of endometrial cancer. (4)

Answer 9

Predisposed by endometrial hyperplasia caused by excessive oestrogen.
Endogenous - obesity (fat turns androgen to oestrogens)
Exogenous - oestrogen only HRT, tamoxifen.
Irregular - polycystic ovarian syndrome.

Question 10

Presentation of endometrial cancer (2)

Answer 10

Intermenstrual bleeding, postmenopausal bleeding.

Question 11

Pathophysiology of endometrial cancer. (2)

Answer 11

Commonly endometrioid adenocarcinoma or serous carcinoma.

Question 12

Management of endometrial cancer. (3)

Answer 12

Hysterectomy +- salpingooophrectory +- lymph nodes.

Question 13

Pathophysiology of leiomyomata. (3)

Answer 13

Benign myometrial cancer, well differentiated, pale.

Question 14

Presentation of leiomyomata (4)

Answer 14

Can be asymptomatic, but can cause pelvic pain, heavy periods (increased SA), urinary frequency (bladder compression).

Question 15

Pathophysiology of leiomyosarcoma (2)

Answer 15

Malignant tumours of the myometrium, poorly differentiated, often with lung mets.

Question 16

Presentations of ovarian cancer. (6)

Answer 16

Often vague symptoms.
Abdominal pain, distension, urinary or GI symptoms, hormonal disturbances.
Ca-125 is a tumour marker used in diagnosis.
Some assocaited with BRCA1/2 mutations.

Question 17

Describe three types of epithelial ovarian tumour of the ovary. (9)

Answer 17

Serous - pleomorphic cells, often with spcalcified Psammoma bodies. Often spread to peritoneal surface
Mucinous - atypical cells secreting mucin creating white blobs in cells.
Endometrioid - glands resembling endometrium that may arise in endometriosis.

Question 18

Describe types of germ cell tumours of the ovary. (4)

Answer 18

Yolk sac
Embryonal carcinoma
Choriocarcinoma
Teratoma

Question 19

Describe stroma cell tumours of the ovary. (4)

Answer 19

Granulosa cell
Thecoma
Fibroma
Sertoli and Leydig cells (yes even in ovary’

Question 20

Describe the 3 types of teratoma found in the ovary. (11)

Answer 20

Mature (dermoid cyst) - contains fully differentiates tissue from all germ layers. Often contains skin or hair. Benign.
Immature - immature embryonal tissue, malignant.
Monodermal - one fully differentiated tissue type, most commonly thyroid. Benign but can cause hyperthyroidism.

Question 21

Describe the presentations of the different types of stroma tumour. (8)

Answer 21

Theca and granulosa cell tumours can produce excess oestrogen leading to precocious puberty, breast cancer, endometrial hyperplasia and carcinoma.
Sertoli and Leydig cell tumours can produce excess testosterone leading to prevention of female puberty (if prepubescent), sterility, amenorrhoea, breast atrophy, hirsuitism.

Question 22

Risk factor for all testicular cancers. (1)

Answer 22

Cryptorchidism (undescended testicle). Can make cancer in both.

Question 23

Presentation for testicular cancer. (2)

Answer 23

Mass +- pain.

Question 24

Diagnosis of testicular cancer (2)

Answer 24

USS, tumour markers.

Question 25

Explain why biopsy of testicular masses is rare. (2)

Answer 25

Benign tumours are really rare, and with a malignant one, if you biopsy it, you give a really high risk of seeding to the other testicle or scrotum or somewhere else.

Question 26

Describe common tumour markers for germ cell tumours. (2)

Answer 26

``` Beta hCG - choriocarcinoma Alpha fetoprotein (AFP) - yolk sac tumours. ```

Question 27

What other sort of cancer can ovaries have in them? (2)

Answer 27

Mets from somewhere else: breast, GI, other gynae.

Question 28

Describe seminomas. (6)

Answer 28

Type of germ cell tumour. Peak age is 40-50, often remains confined to testes for a long time, but can met to nodes. Further spread is rare. Associated with a rise in hCG.

Question 29

Describe the types of non-seminomatous germ cell tumours. (10)

Answer 29

Yolk sac tumours - occurs in young children with a good prognosis, all release AFP as a tumour marker. Embryonal carcinomas, choriocarcinomas and mixed NSGCTs occur in young adults. Chorio have raised hCG, mixed can have raised hCG and AFP. Teratoma occur in men of all ages. If postpubertal they’re malignant.

Question 30

Metastatic potential of NSGCTs. (2)

Answer 30

Tend to metastasise early (before primary tumour palpable) through lymphatics and blood vessels.

Question 31

Management of testicular tumours. (3)

Answer 31

Radical orchiectomy. Seminomas also with radiotherapy. NSGCTs also with chemotherapy.

Question 32

Types of non-germ cell tumours. (2)

Answer 32

Sertoli and Leydig cell | Mets