Genital Cancers - Ovary / Tube / Vulval Flashcards by Ethan Thrower

Explain the roll of germ cells in the ovary.

The germ cells are totipotent cells forming oocytes.

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What is the roll of stromal cells of the ovary.

The stromal cells support the germ cells and are hormone secreting.

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Epithelial cancers of the ovary are what type of tumour?

Adenocarcinomas

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What are the four types of adenocarcinomas of the epithelial cells of the ovary?

Serous
Mucinous
Endometrioid
Transitional

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What gene mutation is associated with serous adenocarcinomas of the ovary?

BRCA

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How do adenocarcinomas of the ovary present?

Abdominal swelling
Pressure symptoms e.g incontinence
Discomfort
GI disturbance

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What investigation are carried out for suspected germ cell cancers?

Ca125
Ultrasound
CT of the abdo/pelvis

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How do stromal cancers of the ovary present?

Abdominal swelling
Pain 
Hormonal effects (increased oestrogen / testosterone secretion).

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What are the main types of stromal cell cancer?

Granulosa cell tumours (malignant)
Thecomas (benign)
Sertoli-Leydig cell tumours (malignant)

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What investigations are carried out in cases of suspected stromal cell cancers?

Ca125
Inhibin levels
Ultrasound of pelvis
CT abdo/pelvis

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Ca125 is a marker of what?

Peritoneal irritation

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What causes elevated levels of Ca125?

Menstruation, pregnancy, endometriosis, heart failure, pneumonia, peritoneal malignancy.

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Endometriosis

Painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus (the endometrium) grows outside your uterus.

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What are BRCA1 and BRCA2?

BRCA’s are DNA repair genes - increased risk of cancer if dmaged.

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Tubal cancer is what type of cancer?

Serous ovarian cancer

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What is the origin of most high grade serous ovarian cancer?

Tubal origin

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What is the most common form of vulval cancer?

Squamous cell carcinoma

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What is the most common cause of vulval squamous cell carcinoma?

HPV16

Lichen sclerosis

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How does vulval cancer present?

With a vulval lump/ulcer

Usually painful

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What investigations are carried out for suspected vulval cancer?

Biopsy from the edge of the lesion

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Cancer of what cell is the most common form of ovarian cancer?

Epithelial cell

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Benign tumour

Does not invade nearby tissue or spread to other parts of the body.

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Serous cystadenoma

Benign serous epithelial tumours that are fluid filled cysts.

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Mucinous cystadenoma

Benign mucinous epithelial cell tumours that for large mucus filled cysts.

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Cystadenocarcinoma indicates what type of tumour?

Malignant

What is characteristic of Mucinous and Serous cystadenocarcinoma's?

Inflamed/Swollen lining | Common in post menopausal women

Endometrioid tumours

Ectopic cysts filled with dark blood.

If endometrioid tumours are malignant where do they commonly spread to?

Fallopian tubes and the peritoneal cavity

Transitional tumours aka

Brenner tumours

What type of cells make up transitional tumours?

Transitional cells normally found lining the bladder, usually solid.

What increases the risk of ovarian cancer?

Increased risk with conditions such as endometriosis and PCOS. BRCA1/BRCA2 mutations Lynch syndrome Increased risk with cumulative time spent in ovulation.

What are the diagnostic methods used for ovarian cancer?

Tumour markers e.g B-hcg Transvaginal ultrasound Biopsy - determine benign/malignant CT or MRI scan

When is surgery an ideal treatment for ovarian cancer?

When the tumour is confined to the ovary

When is chemotherapy an ideal treatment for ovarian cancer?

When it has spread

Ca125 stands for...

Carbohydrate antigen 125

What is Ca125 produced by?

Produced by ovarian tumours therefore it's level is tracked in the blood.

What results in decreased risk of ovarian cancer?

Pregnancy / Breastfeeding / Oral contraceptives | ~ decreases number of ovulations

Germs cells are totipotent, multipotent or pluripotent?

Pluripotent

What are the different types of germ cell ovarian cancer?

Tertomas Yolk sac tumour Choriocarcinoma Dysgerminoma

What are the two types of teratoma?

Mature cystic teratoma | Immature teratoma

Outline mature cystic teratomas

Most common ovarian tumour in young women and are formed from tissue that comes from any of the three germ layers.

Immature teratomas are derived from what?

Neuro-ectoderm cells | Tend to be malignant and metastasise quickly.

Yolk sac tumours are also known as...

Endodermal sinus tumours

Schiller-duval bodies are formed by what type of ovarian cancer?

Yolk sac tumour

What are schiller-duval bodies?

Rings of cells around a central blood vessel

Choriocarcinomas are germ cells formed from what cells?

Syncytiotrophoblast cells

What are characteristics of choriocarcinomas?

Bleed easily and spread

Choriocarcinomas produce what hormones and what can this lead to?

B-hcg excess production can lead to the formation of ovarian cysts

Dysgerminomas

Oocytes grow uncontrollably

Sex cord-stromal ovarian cancer

Cancer of the follicular cells of the ovary or the stromal connective tissue.

What are the most common malignant stromal tumours?

Granulosa-theca cell tumours

Stromal tumours leads to an excess production of...

Estradiol

What symptoms are seen as a result of estradiol overproduction in stromal tumours?

Uterine bleeding Breast tenderness Early puberty in young girls

Fibromas are made up of what cells?

Fibroblasts (Benign)

What are the three types of stromal ovarian tumour?

Fibromas Granulosa-theca cell tumours Sertoli-Leydig cell tumours

Sertoli-leydig cell tumours are made up of what? | ~ what is the significance of this?

Primative gonadal stroma | ~ the cells can secrete androgens e.g testosterone

What are the main symptoms of ovarian cancer?

``` Abdominal distension Bloating Abdominal / pelvic pain (due to ovarian torsion) Ascites Abdominal masses Bowel obstruction Dyspareunia Sister mary joseph nodule ```

Sister Mary Joseph nodule

When a cancer metastasises to the umbilicus.

Outline standard vaginal cancers

Typically Squamous carcinoma's associated with HPV infection | 16 and 18

What is clear cell adenocarcinoma?

A form of vaginal cancer developing from the glandular cells of the vagina.

What are the symptoms of vaginal cancer?

``` Usually asymptomatic Abnormal vaginal bleeding (postmenopausal/postcoital) Watery blood tinged vaginal discharge Pelvic pain Urinary frequency Constipation ```

How is vaginal cancer diagnosed?

Vaginal colposcopy | Biopsy

What is the most common type of ovarian cancer for young women?

Germ cell ovarian cancers

Teratomas aka

Ovarian dermoid cysts

Ascites

Ascites is the accumulation of protein-containing (ascitic) fluid within the abdomen.

RMI

Risk of Malignancy index

RMI =

RMI = Ultrasound score x Menopausal score x Ca125