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Y2 - Repro > Lecture 17 - Tumours Of The Reproductive Tract > Flashcards

Lecture 17 - Tumours Of The Reproductive Tract Flashcards

(106 cards)

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1
Q

Go to the last slide and label the testes:

A

1 = vas deferens
2 = epididymis
3 = rete testes
4 = tail of epididymis
5 = Seminferous tubule
6 = tunica vaginalis
7 = tunica albuginea

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2
Q

What is a tumour?

A

Any clinically detectable lump or swelling

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3
Q

What is a neoplasm?

A

An abnormal growth of cells that persists after the initial stimulus is removed

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4
Q

What is a malignant neoplasm?

A

An abnormal growth of cells that perisist after the initial stimulus is removed and it invades surrounding tissue with potential to spread to distant sites

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5
Q

What is metastasis?

A

Malignant neoplasm that has spread to a distant site

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6
Q

What is metaplasia?

A

When 1 cell type differentiates into a another cell type

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7
Q

What is dysplasia?

A

A potentially pre-neoplastic alteration where cells show disordered organisation and abnormal appearances

May be reversible

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8
Q

How rare are vulval cancers?

Who do they arise most in?

A

Quite uncommon

Older patients

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9
Q

What is the most common type of vulva cancer and why?

A

Squamous cell carcinoma

The vulva is essentially just made of skin

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10
Q

What are the most common types of vulval cancers from most common to least common?

A

SQUAMOUS CELL CARCINOMA

Basal cell carcinoma

Melanoma

Soft tissue tumours

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11
Q

What are some clinical features of vulval cancers?

A

Lumps or bumps
Ulcerations
Skin changes (pigments, sensation or pain)

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12
Q

What are the 3 main layers to skin?
Superfical to deep?

A

Epidermis
Dermis
Subcutaneous tissue

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13
Q

What are the normal layers to normal skin/epidermis?

From deep to superficial

A

Basement membrane
Stratum basale (basal layer)
Stratum spinosum
Stratum granulosum
Stratum Corneum

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14
Q

Go to the last slide and label the layers of the epidermis:

A

1 = basement membrane
2 = stratum basale (basal layer)
3 = stratum spinosum
4 = stratum granulosum
5 = stratum Corneum (corny layer)

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15
Q

Go to the last slide and look at image 3 of vulval epidermal tissue:

What is being pointed at and what does this indicate?

A

Keratin formation = swirly appearance

Squamous cell carcinoma of the vulva

Since squamous cell carcinomas produce keratin

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16
Q

What is Vulval Intraepithelial Neoplasia (VIN)

A

In situ precursor of vulval squamous cell carcinoma

Where there are abnormal atypical cells that do not break through the basement membrane

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17
Q

What is meant by IN SITU?

A

Cells have not broken through the basement membrane

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18
Q

Is Vulval Intraepithelial neoplasia and vulval squamous cell carcinoma related to HPV?

A

Most are not (usually due to longstanding inflammation)

Some are (HPV16)

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19
Q

What are the 3 ways that vulval cancer can spread?

A

Direct extension (anus, vagina, bladder)

Lymph nodes ( Inguinal, iliac, para-aortic)

Distal metastases (lungs and liver)

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20
Q

What are the 2 parts of the cervix?

A

Endocervix
Ectocervix

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21
Q

What is the difference between the ectocervix and endocervix?

A

Endocervix not exposed to the acidic environment of the vagina
Ectocervix adapted to be exposed to the acidic environment of the vagina

Both have different cell types

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22
Q

What are the different cell types of the endocervix and ectocervix?

A

Endocervix = simple columnar epithelium

Ectocervix = stratified squamous epithelium

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23
Q

What can happen if the endocervix comes into contact with the acidic vaginal environment for a long time?

Why may this happen?

A

Metaplastic change to squamous epithelium

During menstruation n

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24
Q

What is the area called where metaplastic transition can occur at the cervix?

A

Transformation zone

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25
What is there an increased risk of at the transformation zone where Metaplasia is occurring?
Dysplasia (pre-neoplastic change) But is reversible
26
What type of virus is the Human Papilloma Virus (HPV)?
DNA virus
27
What are the 4 main types of HPV? Which ones are low risk? Which ones are high risk??
HPV 6,11,16,18 Low risk (warts) = HPV 6, 11 High risk (cancer) = HPV 16, 18
28
What part of the cervix does the high risk HPV 16 and 18 infect?
Transformation zone (which is already at an increased risk of Metaplasia then dysplasia)
29
What harmful proteins does HPV 16 and 18 produce once its infected the cervical transformation zone?
E6 E7
30
What affect does the production of the E6 and E7 proteins have once the cervical transformation zone has been infected?
E6 inhibits p53 E7 inhibits retinoblastoma gene These are both TUMOUR SUPPRESSOR GENES This leads to uncontrolled cellular proliferation
31
What is CIN (Cervical Intraepithelial Neoplasia)?
Dysplasia that is confined to the cervical epithelium (IN SITU)
32
What causes CIN (cervical Intraepithelial neoplasia)?
HPV infection (E6 and E7 inhibiting p53 and Rb gene leading to uncontrolled proliferation)
33
What are the 3 division of CIN grading?
CIN 1 = mild dysplasia (bottom 1/3) CIN 2 = moderate dysplasia (bottom 2/3s) CIN 3 = severe dysplasia (full thickness dysplasia) Squamous cell carcinoma (cervix) invades the basement membrane
34
What are the risk factors for CIN and cervical carcinoma?
Inc risk to HPV exposure: -sex with HPV -multiple partners -early first age intercourse Early first birth Multiple births Smoking Low socioeconomic status Immunosupression
35
How is CIN 1 treated?
Often spontaneously reverses (Dysplasia reversible at this stage) Follow up cervical smear in a year
36
How is CIN 2 and 3 treated?
Needs treatment since could go onto to cause squamous cell carcinoma Large loop excision of transformation zone May do a colposcopy
37
What is the age range and frequency of screening for cervical cancer?
25 - 49 = 3years 50 - 64 = 5years 65+ only if there’s a recent abnormality
38
What type of cells are taken in a cervical screening?
Cells from transformation zone looking for HPV
39
What is cytology?
Study of individual cells
40
What changes can be seen in dysplasia/neoplastic cells in cytology?
Large nuclei Pleomorphism Irregular nuclear outlines Hyperchromatic nuclei
41
What is the name of the HPV vaccine?
Gardasil
42
What HPV subtypes of vaccinated against by the Gardasil vaccine?
HPV 6,11,16,18
43
Why may the HPV vaccine be given to boys a well as girls?
It protects from oral and anal cancers as well as cervical and vulval cancers
44
What is the most common type of invasive cervical cancer?
Squamous cell carcinoma (CIN is the precursor)
45
What is the less common type of cervical cancer that’s not SQUAMOUS CELL CARCINOMA?
Adenocarcinoma from the endocervical glandular cells
46
How does invasive cervical cancer present?
Bleeding (post coital, Intermenstrual or post menopausal) Palpable mass
47
How is cervical cancer staged?
TNM Or FIGO system (used for gynae tract cancers)
48
How is cervical cancer treated?
Hysterectomy Lymph node dissection Chemoradiotherapy
49
Go to the last slide and label image 4: What type of tissue is this?
1 = glands 2 = stroma Endometrial tissue
50
What is endometrial hyperplasia?
When the endometrium is thickened Increased gland:stroma ratio
51
What can endometrial hyperplasia be a precursor to? What can it cause?
Can be precursor to endometrial cancer Canc cause Intermenstrual / post menstrual bleeding
52
What generally causes endometrial hyperplasia?
Excess oestrogen
53
What are the endogenous causes of excessive oestrogen leading to endometrial hyperplasia?
Obesity (more androgens to oestrogens by adipocytes) Early menarche late menopause (inc lifetime oestrogen exposure) Oestrogen secreting tumours
54
What are some exogenous causes of inc oestrogen causing endometrial hyperplasia?
Unopposed oestrogen HRT (no progesterone just oestrogen) Tamoxifen
55
What is tamoxifen used to treat? What is its down side?
Treat oestrogen receptor postive BREAST cancer Increases risk of endometrial cancer
56
What condition increases risk of endometrial cancer?
Polycystic ovary syndrome
57
How does endometrial cancer present?
Bleeding (post + Intermenstrua) Palpable mass The most common type of gynae cancer
58
What are the 2 types of endometrial cancer?
Endometrioid adenocarcinoma Serous adenocarcinoma
59
What is the most common type of endometrial cancer?
Endometrioid adenocarcinoma
60
What usually causes Endometrioid adenocarcinoma? How does it look on histology?
From endometrial hyperplasia The tissue resembles normal endometrial glands
61
How does serous adenocarcinoma differ to Endometrioid adenocarcinoma in histological appearance?
Serous adenocarcinoma is more aggressive and has poorly differentiated cells that dont resemble normal glands (hyper chromatic)
62
Look at the last slide and identify the 2 different types of endometrial cancer from image 5 and image 6: Why?
5 = Endometrioid adenocarcinoma 6 = serous adenocarcinoma 5 is much more well differentiated and resembles endometrial glands more 6 is much more poorly differentiated (hyperchromatic, pleomorphic) and doesn’t resemble glandular tissue
63
How does Endometrioid adenocarcinoma spread?
Direct invasion Lymph Blood
64
How does serous adenocarcinoma spread?
The cells exfoliate (break off from main tumour) They then pass through the fallopian tubes to the peritoneal space TRANSCOELOMIC SPREAD
65
Look at image 6 on last slide: What is the arrow pointing to which is common in Serous adenocarcinoma of the endometrium?
Psammoma bodies which are deposits of calcium
66
How is endometrial cancer managed?
Hysterectomy Bilateral salpingo-oophorectomy Lymph node dissection Chemoradiotherapy
67
What is a hysterectomy?
Removal of cervix and uterus
68
What is a bilateral salpingo-oophrectomy?
Removing both fallopian tubes and ovaries
69
What is a benign tumour of the myometrium called?
Leiomyoma (fibroid)
70
What do leiomyomas look like?
Pale Homogenous (look same all the way through) Well circumscribed
71
How do Leiomyomas present?
Depends on size Asymptomatic Pelvic pain Heavy periods Urinary frequency
72
How do leiomyomas appear on histological image? Look at slide 56
Intersecting fasicles of benign smooth muscle cells
73
What is a malignant tumour of smooth muscle (myometrium) called?
Leiomyosarcoma
74
What is the most common metastatic location of a leiomyosarcoma?
Lung
75
What are some early symptoms of ovarian cancer?
Vague and non specific symptoms Whic lead to a delayed diagnosis
76
What are some late symptoms of ovarian cancer which are dependant on location?
Abdominal pain Abdominal distension/bloating Urinary symptoms GI symptoms HormonaL disturbances
77
What is the main tumour marker released by ovarian cancers?
Ca-125 Cancer antigen 125
78
What is the tumour suppressor gene that is mutated indicating high grade serous cancers?
BRCA1/2
79
If a BRCA1/2 mutation is detected what is a prophylactic measure that is often taken?
Prophylactic salpingo-oophrectomy
80
What cells make up the ovary and so can become cancerous?
Epithelial lining (epithelial tumours) Germ cells (germ cell tumours) Stromal cells (sex cord stromal tumours)
81
What is a cyst?
Sac lined by epithelium containing a fluid
82
What are the 3 main ovarian epithelial tumours?
All ADENOCARINOMAS: Serous Mucinous Endometrioid
83
How can ovarian serous adenocarcinoma constrict the intestines producing GI symtoms?
Cells exfoliate Enter into peritoneum through Fimbriae spreading to the peritoneal space
84
Look at the last slide at image 7 and 8: Which one is ovarian Endometrioid adenocarcinoma and which one is ovarian mucinous adenocarcinoma and why?
7 = ovarian Endometrioid adenocarcinoma 8 = ovarian mucinous adenocarcinoma 7 can see glands resembling endometrium 8 can see goblet cells producing mucin
85
What is endometriosis? Where is its most common location?
Endometrioid tissue outside the uterus Ovaries
86
What is the most common germ cell tumour?
Teratoma
87
What are the 3 subtypes of teratoma?
Mature (benign) Immature (malignant) Monodermal (highly specialised)
88
How does a mature teratoma/dermoid cyst appear?
Contains fully mature differentiated tissue from all germ layers Can have hair, skin, teeth, GI tissues etc
89
What are some other germ cell tumours?
Dysgerminoma (like seminoma in testis) Choriocarcinoma Embryoblast carcinoma Yolk sac tumour
90
What are some sex cord stromal tumours from ovarian stroma?
Ovaries: -granulosa cells (convert androgens to oestrogen) -theca cells (make androgens) Testes: -Sertoli cells (spermatogenesis) -leydig cells (testosterone production)
91
What affect do theca and granulosa cell tumours have on someone before they reach puberty and why?
Precocious puberty Since produce oestrogen
92
What affect do theca and granulosa cell tumours have on someone after they have reached puberty and why?
Breast cancer Endometrial hyperplasia Endometrial carcinoma Elevated oestrogen
93
What affect do sertoli and leydig cell tumours have on women before puberty and why?
Prevents normal female pubertal changes since produces testosterone
94
What affect do sertoli and leydig cell tumours have on women after puberty and why?
Infertility Amenorrhoea Hirsuitism Male pattern baldness Breast atrophy Produce testosterone
95
What structure is a common metastatic location?
Ovary
96
What is a krukenberg tumour?
Metastatic GI tumour often from the stomach (gastric) that goes to the ovary
97
What is the main risk factor for testicular cancer?
Cryptorchidism (undescended testicle)
98
How do testicular cancers present? What investigations are done?
Palpable mass which may be painful Scans like ultrasound Tumour markers
99
What are some testicular cancer tumour markers?
B-HCG AFP (Alpha fetoprotein)
100
What germ cell tumour is B-HCG indicative of?
Choriocarcinoma (can be testicular or ovarian)
101
What tumour marker is AFP (alpha fetoprotein) elevated in?
Yolk sac germ tumour
102
Why is AFP not a perfect indication of Yolk sac tumours?
Elevated in liver cancer too
103
What are the subtypes of testicular cancers?
Germ cell or non germ cell Germ cell split into seminomatous and non seminomatous Non germ cell split into sex cord stromal and other
104
What is the most common type of testicular cancer? What category is this part of?
Seminoma Germ cell tumour which is seminomatous
105
What are some germ cell non-seminomatous testicular cancers?
Teratoma Yolk sac tumour Choriocarcinoma Embryonic carcinoma
106
What are the 2 non germ cell sex cord stromal testicular cancers?
Leydig cell tumour and sertol cell tumour

Y2 - Repro (19 decks)

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