Cancers Of The Reproductive Tract Flashcards
What is cervical intraepithelial neoplasia?
Dysplasia of squamous cells in the cervical epithelium
What are some of the risk factors of developing cervical intraepithelial neoplasia?
Increased risk of exposure to HPV (e.g multiple sexual partners), early first pregnancy, smoking, immunosuppression, multiple births
Where is the lymphatic drainage of the cervix?
Superior portion- internal iliac nodes
Inferior portion- sacral nodes
What type of cancer are most vulval tumours?
Squamous cell carcinoma
What is the main causative factor of vulval cancer in pre-menopausal women?
HPV infection
How will vulval intraepithelial neoplasia appear on histology?
Atypical cells but no invasion beyond the basement membrane
To which lymph nodes will a vulval cancer spread to?
Inguinal lymph nodes
What organs would a vulval cancer most likely metastisise to?
Liver, lungs
What would be the most likely cause of vulval cancer in a patient presenting in her 80s?
Long standing inflammatory condition or chronic irritation
What is the most common cancer of the cervix?
Squamous cell carcinoma
How can someone with cervical cancer present?
Bleeding, palpable abdominal mass
How does HPV cause cancerous changes in cervical epithelia?
Releasing viral proteins E6 and E7 which inhibit tumour suppressor genes
Who is offered the vaccines against HPV and how long does their protection last?
12-13 year old girls, protection lasts 10 years
Which lymph nodes do cervical cancers spread to?
Initially iliac then aortic lymph nodes
What is the treatment for advanced cervical cancer?
Hysterectomy, lymph node removal +/- chemotherapy
Which age of women is most commonly affected by endometrial cancer?
Perimenopausal and older women
Which type of endometrial adenocarcinoma is endometrial hyperplasia a precursor for?
Endometrioid adenocarcinoma
What are the differences between endometrioid and serous endometrial adenocarcinomas?
Endometrioid is more common and spreads through invasion. Serous is more aggressive, has a worse prognosis and exfoliates
What does it means when a serous endometrial adenocarcinoma ‘exfoliates’?
Cells come off and spread transcoelimically trough the peritoneum
What are the differences histologically between endometrioid and serous adenocarcinomas?
Endometrioid- looks like glandular tissue but glands are closely packed and has atypical cells
Serous- has collections of calcium called psammoma bodies (dark purple)
What is the most probable aetiology for endometrial cancer of the perimenopausal woman?
Unopposed oestrogen from obesity/exogenous source/hormone-secreting tumour
What is the treatment for advanced endometrial cancer?
Hysterectomy, salpingo oophorectomy (bilateral) +/- chemotherapy and lymph node removal
What are fibroids?
Benign tumours of uterine smooth muscle (leiomyomas)
What are symptoms of fibroids (leiomyomas)?
Heavy periods, pelvic pain, infertility. If big enough can press on bladder causing urinary frequency
What generally happens to leiomyomas after menopause?
As their growth is oestrogen dependent they usually regress after the menopause
What is a malignant tumour of the myometrium called?
Leiomyosarcoma
Are leiomyomas precursors for leiomyosarcomas?
No
Where are leiomyosarcomas most likely to metastisise?
The lungs
What are tumours which are known to metastisise to the ovaries?
Breast and gastrointestinal carcinomas
What are kruckenberg tumours?
Metastatic gastrointestinal tumours in the ovaries, usually from the stomach
In postpubertal males what are the most likely testicular tumours?
Germ-cell tumours (50% seminomas) all of which are malignant
What are the most common sex cord-stromal tumours seen in the testis? How common are these?
Leydig and Sertoli cell tumours, these are uncommon and benign
What are some risk factors for testicular cancer?
Family history, cancer in the other testis, cryptorchidism (undescended testicle)
How doe testicular cancer usually present?
A painless testicular mass
What tumour marker can be used in detection of a yolk sac testicular tumour?
Alpha fetoprotein (AFP)
What testicular tumour is associated with elevated levels of hCG?
Choriocarcinomas
Where do seminomas spread to?
Lymphatics- iliac and paraortic lymph nodes
What treatment would you use with seminomas compared to other germ cell tumours (NSGCTs) after radical orchiectomy?
Seminomas are treated with radiotherapy, other are treated with chemotherapy
