L20: tumours of the reproductive tracts Flashcards
Describe vulval tumours
Relatively uncommon, most are squamous cell carcinomas & affect older women
Older women -> causative agents are unknown, but are probably related to chronic irritation & longstanding dermatoses
Pre-menopausal women -> HPV with invasion developing from the precursor, vulval intraepithelial neoplasia
Describe the spread and treatment of vulval tumours
Tumour spreads locally & metastasises predominantly to the inguinal lymph nodes
Definitive surgery would include removing the primary tumour and nodes, with higher survival rate in smaller lesions
Areas of intraepithelial neoplasia may be detected by the patient herself or during gynaecological examination
Describe the location of cervical carcinomas
Inner part of the cervix (endocervix) is made of simple columnar epithelium, whereas the outer part of the cervix (ectocervix) is covered by stratified squamous epithelium
Transformation zone is where metaplasia occurs between the two epithelial types -> important when thinking about cervical carcinoma
Describe cervical carcinomas
Most are squamous cell carcinomas, followed by adenocarcinomas
Both have common aetiology of HPV infection, which causes infection in the metaplastic squamous cells in the transformation zone -> increased proliferation
Squamous cell carcinomas can also develop from cervical intraepithelial neoplasia (CIN)
Describe vaccination for HPV
Since 2008, girls aged 12-13 have been offered vaccination against high-risk HPVs
Vaccination offers protection against HPV infection for up to 10 years
Describe cervical screening
Detects cells with abnormally enlarged nuclei possessing abnormal chromatin
Aim – detect the pre-invasive lesion & to excise the involved area completely before an invasive malignancy can develop
Indication for referral for colposcopy where abnormal areas can be identified – excised by diathermy
Describe where cervical carcinomas can spread
Spreads initially to the iliac & then aortic lymph nodes, before wider systemic dissemination
Local spread can involve the ureters, bladder and rectum
Extremely distressing with pain and fistula formation
Describe the different types of endometrial carcinoma
Endometrial adenocarcinoma – tumour of peri-menopausal and older women
2 main types are endometroid and serous
Describe endometrioid endometrial adenocarcinoma
Perimenopausal women – unopposed oestrogen from obesity, exogenous oestrogen administration or hormone-secreting tumour (tamoxifen may also be implicated)
Unopposed oestrogen results in endometrial hyperplasia -> can progress into endometrioid endometrial adenocarcinoma
Describe serous endometrial adenocarcinoma
Less common, but more aggressive & worse prognosis
Advanced endometrial carcinoma spreads to cervix, bladder & rectum, through the peritoneal cavity & to regional lymph nodes
What are fibroids?
Benign tumours of uterine smooth muscle (leiomyomas)
Symptoms: heavy menstrual loss, menorrhagia & infertility
Single or multiple leiomyomas can cause massive uterine enlargement and this results in pressure symptoms in the pelvis
Growth is oestrogen dependent & usually regress after menopause
Describe a leiomyosarcoma
Malignant tumour of the myometrium
Present with similar symptoms to fibroids
Aetiology is not known
Like other sarcomas, they infiltrate locally with metastasis by the blood stream to the lungs & then systemically
Describe epithelial tumours of the ovaries
Majority of primary ovarian tumours
Classified by the type of epithelium present – serous, mucinous or endometrioid
Malignant epithelial tumours do not present until late stage & prognosis is often poor -> spread within the abdomen where they cause ascites, intestinal obstruction and death
BRCA1 and BRCA2 genes have been identified as markers for familial ovarian epithelial carcinoma (less than 1% of cases)
Describe germ cell tumours of the ovaries
Usually benign, most common is a mature cystic teratoma = dermoid cyst
- contain tissues from any of the three germ layers
- presence of immature tissue indicates malignancy, a risk for intra-abdominal spread & potential to cause death
Describe germ cell tumours more commonly found in testes
Seminoma Yolk sac tumours Choriocarcinoma Embryonal carcinomas Useful tumours markers – alpha-fetoprotein (AFP) & beta-human chorionic gonadotropin (hCG)
Describe granulosa cell tumours
Resemble the cells lining the ovarian follicle
Commonly produce oestrogen & may be responsible for endometrial hyperplasia, adenocarcinoma & iso-sexual precocious puberty
Describe Sertoli-Leydig cell tumours
Rare sex-cord stromal tumours
May produce androgens & cause defeminisation, masculinisation, amenorrhoea & infertility
Describe testicular tumours
Commonest tumours in men aged 15-34
Can be classified as germ cell tumours and sex cord-stromal tumours
Lymphomas can also affect the testes
Describe non-germ cell tumours in the testis
Sex cord-stromal tumours
Most common types seen in the testes are Sertoli or Leydig cell tumours
Uncommon & benign
Describe germ cell tumours in the testis
Post-pubertal males and all tumours are malignant
Aetiology is unknown, but familial predisposition is well recognised
Increased risk of testicular cancer in cryptorchidism (failure of testicular descent into the scrotum)
Orchiopexy (surgical placement of the undescended testis into the scrotum) before puberty decreases this risk of cancer
List the different types of germ cell tumours in males
Present with a painless testicular mass
Pre-invasive precursor of germ cell tumours has been recognised = intratubular germ cell neoplasia
Two groups:
1) Seminomas
2) Nonseminomatous (tend to metastasise early & do so via lymphatic and blood vessels) - yolk sac tumours, embryonal carcinomas, choriocarcinomas & teratomas
Describe seminomas
Approx. 50% of germ cell tumours are seminomas
Peak age of development is 40-50 years
Often remain confined to the testis for long periods of time
When they do metastasise it is by lymphatics, most commonly the iliac & paraaortic lymph nodes
Describe yolk sac tumours
Occur in young children & have a very good prognosis
Almost all of them produce alpha fetoprotein (AFP) which can be detected in the blood as a tumour marker
Describe embryonal carcinomas, choriocarcinomas and mixed NSGCTs
Occur in young adults
Choriocarcinomas – associated with elevated serum concentrations of the tumour marker B-hCG
Most mixed NSGCTs – associated with elevated serum concentrations of both AFP & B-hCG
Describe teratomas in men
Occur in men of all ages
If in prepubertal men, usually benign
If in postpubertal men, malignant
10% are associated with raised serum concentrations of hCG – syncytiotrophoblast cells that produce hCG are present
Describe the management of testicular tumours
Radical orchiectomy
Seminomas – very radiosensitive and treated with radiotherapy (best prognosis)
NSGCTS – after surgery, treated with aggressive chemotherapy
Treatment if often successful & results in a cure
