Genital Cancers - Ovary / Tube / Vulval Flashcards
Explain the roll of germ cells in the ovary.
The germ cells are totipotent cells forming oocytes.
What is the roll of stromal cells of the ovary.
The stromal cells support the germ cells and are hormone secreting.
Epithelial cancers of the ovary are what type of tumour?
Adenocarcinomas
What are the four types of adenocarcinomas of the epithelial cells of the ovary?
Serous
Mucinous
Endometrioid
Transitional
What gene mutation is associated with serous adenocarcinomas of the ovary?
BRCA
How do adenocarcinomas of the ovary present?
Abdominal swelling
Pressure symptoms e.g incontinence
Discomfort
GI disturbance
What investigation are carried out for suspected germ cell cancers?
Ca125
Ultrasound
CT of the abdo/pelvis
How do stromal cancers of the ovary present?
Abdominal swelling Pain Hormonal effects (increased oestrogen / testosterone secretion).
What are the main types of stromal cell cancer?
Granulosa cell tumours (malignant)
Thecomas (benign)
Sertoli-Leydig cell tumours (malignant)
What investigations are carried out in cases of suspected stromal cell cancers?
Ca125
Inhibin levels
Ultrasound of pelvis
CT abdo/pelvis
Ca125 is a marker of what?
Peritoneal irritation
What causes elevated levels of Ca125?
Menstruation, pregnancy, endometriosis, heart failure, pneumonia, peritoneal malignancy.
Endometriosis
Painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus (the endometrium) grows outside your uterus.
What are BRCA1 and BRCA2?
BRCA’s are DNA repair genes - increased risk of cancer if dmaged.
Tubal cancer is what type of cancer?
Serous ovarian cancer
What is the origin of most high grade serous ovarian cancer?
Tubal origin
What is the most common form of vulval cancer?
Squamous cell carcinoma
What is the most common cause of vulval squamous cell carcinoma?
HPV16
Lichen sclerosis
How does vulval cancer present?
With a vulval lump/ulcer
Usually painful
What investigations are carried out for suspected vulval cancer?
Biopsy from the edge of the lesion
Cancer of what cell is the most common form of ovarian cancer?
Epithelial cell
Benign tumour
Does not invade nearby tissue or spread to other parts of the body.
Serous cystadenoma
Benign serous epithelial tumours that are fluid filled cysts.
Mucinous cystadenoma
Benign mucinous epithelial cell tumours that for large mucus filled cysts.
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
