Cancers Of The Reproductive Tract

Question 1

What is cervical intraepithelial neoplasia?

Answer 1

Dysplasia of squamous cells in the cervical epithelium

Question 2

What are some of the risk factors of developing cervical intraepithelial neoplasia?

Answer 2

Increased risk of exposure to HPV (e.g multiple sexual partners), early first pregnancy, smoking, immunosuppression, multiple births

Question 3

Where is the lymphatic drainage of the cervix?

Answer 3

Superior portion- internal iliac nodes

Inferior portion- sacral nodes

Question 4

What type of cancer are most vulval tumours?

Answer 4

Squamous cell carcinoma

Question 5

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

Answer 5

HPV infection

Question 6

How will vulval intraepithelial neoplasia appear on histology?

Answer 6

Atypical cells but no invasion beyond the basement membrane

Question 7

To which lymph nodes will a vulval cancer spread to?

Answer 7

Inguinal lymph nodes

Question 8

What organs would a vulval cancer most likely metastisise to?

Answer 8

Liver, lungs

Question 9

What would be the most likely cause of vulval cancer in a patient presenting in her 80s?

Answer 9

Long standing inflammatory condition or chronic irritation

Question 10

What is the most common cancer of the cervix?

Answer 10

Squamous cell carcinoma

Question 11

How can someone with cervical cancer present?

Answer 11

Bleeding, palpable abdominal mass

Question 12

How does HPV cause cancerous changes in cervical epithelia?

Answer 12

Releasing viral proteins E6 and E7 which inhibit tumour suppressor genes

Question 13

Who is offered the vaccines against HPV and how long does their protection last?

Answer 13

12-13 year old girls, protection lasts 10 years

Question 14

Which lymph nodes do cervical cancers spread to?

Answer 14

Initially iliac then aortic lymph nodes

Question 15

What is the treatment for advanced cervical cancer?

Answer 15

Hysterectomy, lymph node removal +/- chemotherapy

Question 16

Which age of women is most commonly affected by endometrial cancer?

Answer 16

Perimenopausal and older women

Question 17

Which type of endometrial adenocarcinoma is endometrial hyperplasia a precursor for?

Answer 17

Endometrioid adenocarcinoma

Question 18

What are the differences between endometrioid and serous endometrial adenocarcinomas?

Answer 18

Endometrioid is more common and spreads through invasion. Serous is more aggressive, has a worse prognosis and exfoliates

Question 19

What does it means when a serous endometrial adenocarcinoma ‘exfoliates’?

Answer 19

Cells come off and spread transcoelimically trough the peritoneum

Question 20

What are the differences histologically between endometrioid and serous adenocarcinomas?

Answer 20

Endometrioid- looks like glandular tissue but glands are closely packed and has atypical cells
Serous- has collections of calcium called psammoma bodies (dark purple)

Question 21

What is the most probable aetiology for endometrial cancer of the perimenopausal woman?

Answer 21

Unopposed oestrogen from obesity/exogenous source/hormone-secreting tumour

Question 22

What is the treatment for advanced endometrial cancer?

Answer 22

Hysterectomy, salpingo oophorectomy (bilateral) +/- chemotherapy and lymph node removal

Question 23

What are fibroids?

Answer 23

Benign tumours of uterine smooth muscle (leiomyomas)

Question 24

What are symptoms of fibroids (leiomyomas)?

Answer 24

Heavy periods, pelvic pain, infertility. If big enough can press on bladder causing urinary frequency

Question 25

What generally happens to leiomyomas after menopause?

Answer 25

As their growth is oestrogen dependent they usually regress after the menopause

Question 26

What is a malignant tumour of the myometrium called?

Answer 26

Leiomyosarcoma

Question 27

Are leiomyomas precursors for leiomyosarcomas?

Answer 27

No

Question 28

Where are leiomyosarcomas most likely to metastisise?

Answer 28

The lungs

Question 29

What are tumours which are known to metastisise to the ovaries?

Answer 29

Breast and gastrointestinal carcinomas

Question 30

What are kruckenberg tumours?

Answer 30

Metastatic gastrointestinal tumours in the ovaries, usually from the stomach

Question 31

In postpubertal males what are the most likely testicular tumours?

Answer 31

Germ-cell tumours (50% seminomas) all of which are malignant

Question 32

What are the most common sex cord-stromal tumours seen in the testis? How common are these?

Answer 32

Leydig and Sertoli cell tumours, these are uncommon and benign

Question 33

What are some risk factors for testicular cancer?

Answer 33

Family history, cancer in the other testis, cryptorchidism (undescended testicle)

Question 34

How doe testicular cancer usually present?

Answer 34

A painless testicular mass

Question 35

What tumour marker can be used in detection of a yolk sac testicular tumour?

Answer 35

Alpha fetoprotein (AFP)

Question 36

What testicular tumour is associated with elevated levels of hCG?

Answer 36

Choriocarcinomas

Question 37

Where do seminomas spread to?

Answer 37

Lymphatics- iliac and paraortic lymph nodes

Question 38

What treatment would you use with seminomas compared to other germ cell tumours (NSGCTs) after radical orchiectomy?

Answer 38

Seminomas are treated with radiotherapy, other are treated with chemotherapy