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

Lecture 17 - Tumours Of The Reproductive Tract Flashcards

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
Q

What is there an increased risk of at the transformation zone where Metaplasia is occurring?

A

Dysplasia (pre-neoplastic change)

But is reversible

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26
Q

What type of virus is the Human Papilloma Virus (HPV)?

A

DNA virus

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27
Q

What are the 4 main types of HPV?

Which ones are low risk?
Which ones are high risk??

A

HPV 6,11,16,18

Low risk (warts) = HPV 6, 11

High risk (cancer) = HPV 16, 18

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28
Q

What part of the cervix does the high risk HPV 16 and 18 infect?

A

Transformation zone (which is already at an increased risk of Metaplasia then dysplasia)

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29
Q

What harmful proteins does HPV 16 and 18 produce once its infected the cervical transformation zone?

A

E6
E7

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30
Q

What affect does the production of the E6 and E7 proteins have once the cervical transformation zone has been infected?

A

E6 inhibits p53
E7 inhibits retinoblastoma gene

These are both TUMOUR SUPPRESSOR GENES
This leads to uncontrolled cellular proliferation

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31
Q

What is CIN (Cervical Intraepithelial Neoplasia)?

A

Dysplasia that is confined to the cervical epithelium (IN SITU)

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32
Q

What causes CIN (cervical Intraepithelial neoplasia)?

A

HPV infection
(E6 and E7 inhibiting p53 and Rb gene leading to uncontrolled proliferation)

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33
Q

What are the 3 division of CIN grading?

A

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

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34
Q

What are the risk factors for CIN and cervical carcinoma?

A

Inc risk to HPV exposure:
-sex with HPV
-multiple partners
-early first age intercourse

Early first birth
Multiple births
Smoking
Low socioeconomic status
Immunosupression

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35
Q

How is CIN 1 treated?

A

Often spontaneously reverses
(Dysplasia reversible at this stage)

Follow up cervical smear in a year

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36
Q

How is CIN 2 and 3 treated?

A

Needs treatment since could go onto to cause squamous cell carcinoma

Large loop excision of transformation zone

May do a colposcopy

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37
Q

What is the age range and frequency of screening for cervical cancer?

A

25 - 49 = 3years

50 - 64 = 5years

65+ only if there’s a recent abnormality

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38
Q

What type of cells are taken in a cervical screening?

A

Cells from transformation zone looking for HPV

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39
Q

What is cytology?

A

Study of individual cells

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40
Q

What changes can be seen in dysplasia/neoplastic cells in cytology?

A

Large nuclei
Pleomorphism
Irregular nuclear outlines
Hyperchromatic nuclei

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41
Q

What is the name of the HPV vaccine?

A

Gardasil

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42
Q

What HPV subtypes of vaccinated against by the Gardasil vaccine?

A

HPV 6,11,16,18

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43
Q

Why may the HPV vaccine be given to boys a well as girls?

A

It protects from oral and anal cancers as well as cervical and vulval cancers

44
Q

What is the most common type of invasive cervical cancer?

A

Squamous cell carcinoma (CIN is the precursor)

45
Q

What is the less common type of cervical cancer that’s not SQUAMOUS CELL CARCINOMA?

A

Adenocarcinoma from the endocervical glandular cells

46
Q

How does invasive cervical cancer present?

A

Bleeding (post coital, Intermenstrual or post menopausal)

Palpable mass

47
Q

How is cervical cancer staged?

A

TNM

Or FIGO system (used for gynae tract cancers)

48
Q

How is cervical cancer treated?

A

Hysterectomy

Lymph node dissection

Chemoradiotherapy

49
Q

Go to the last slide and label image 4:

What type of tissue is this?

A

1 = glands
2 = stroma

Endometrial tissue

50
Q

What is endometrial hyperplasia?

A

When the endometrium is thickened

Increased gland:stroma ratio

51
Q

What can endometrial hyperplasia be a precursor to?

What can it cause?

A

Can be precursor to endometrial cancer

Canc cause Intermenstrual / post menstrual bleeding

52
Q

What generally causes endometrial hyperplasia?

A

Excess oestrogen

53
Q

What are the endogenous causes of excessive oestrogen leading to endometrial hyperplasia?

A

Obesity (more androgens to oestrogens by adipocytes)

Early menarche late menopause (inc lifetime oestrogen exposure)

Oestrogen secreting tumours

54
Q

What are some exogenous causes of inc oestrogen causing endometrial hyperplasia?

A

Unopposed oestrogen HRT (no progesterone just oestrogen)

Tamoxifen

55
Q

What is tamoxifen used to treat?

What is its down side?

A

Treat oestrogen receptor postive BREAST cancer

Increases risk of endometrial cancer

56
Q

What condition increases risk of endometrial cancer?

A

Polycystic ovary syndrome

57
Q

How does endometrial cancer present?

A

Bleeding (post + Intermenstrua)

Palpable mass

The most common type of gynae cancer

58
Q

What are the 2 types of endometrial cancer?

A

Endometrioid adenocarcinoma

Serous adenocarcinoma

59
Q

What is the most common type of endometrial cancer?

A

Endometrioid adenocarcinoma

60
Q

What usually causes Endometrioid adenocarcinoma?

How does it look on histology?

A

From endometrial hyperplasia

The tissue resembles normal endometrial glands

61
Q

How does serous adenocarcinoma differ to Endometrioid adenocarcinoma in histological appearance?

A

Serous adenocarcinoma is more aggressive and has poorly differentiated cells that dont resemble normal glands (hyper chromatic)

62
Q

Look at the last slide and identify the 2 different types of endometrial cancer from image 5 and image 6:

Why?

A

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
Q

How does Endometrioid adenocarcinoma spread?

A

Direct invasion
Lymph
Blood

64
Q

How does serous adenocarcinoma spread?

A

The cells exfoliate (break off from main tumour)

They then pass through the fallopian tubes to the peritoneal space

TRANSCOELOMIC SPREAD

65
Q

Look at image 6 on last slide:

What is the arrow pointing to which is common in Serous adenocarcinoma of the endometrium?

A

Psammoma bodies which are deposits of calcium

66
Q

How is endometrial cancer managed?

A

Hysterectomy

Bilateral salpingo-oophorectomy

Lymph node dissection

Chemoradiotherapy

67
Q

What is a hysterectomy?

A

Removal of cervix and uterus

68
Q

What is a bilateral salpingo-oophrectomy?

A

Removing both fallopian tubes and ovaries

69
Q

What is a benign tumour of the myometrium called?

A

Leiomyoma (fibroid)

70
Q

What do leiomyomas look like?

A

Pale
Homogenous (look same all the way through)
Well circumscribed

71
Q

How do Leiomyomas present?

A

Depends on size

Asymptomatic
Pelvic pain
Heavy periods
Urinary frequency

72
Q

How do leiomyomas appear on histological image?

Look at slide 56

A

Intersecting fasicles of benign smooth muscle cells

73
Q

What is a malignant tumour of smooth muscle (myometrium) called?

A

Leiomyosarcoma

74
Q

What is the most common metastatic location of a leiomyosarcoma?

A

Lung

75
Q

What are some early symptoms of ovarian cancer?

A

Vague and non specific symptoms

Whic lead to a delayed diagnosis

76
Q

What are some late symptoms of ovarian cancer which are dependant on location?

A

Abdominal pain
Abdominal distension/bloating
Urinary symptoms
GI symptoms
HormonaL disturbances

77
Q

What is the main tumour marker released by ovarian cancers?

A

Ca-125
Cancer antigen 125

78
Q

What is the tumour suppressor gene that is mutated indicating high grade serous cancers?

A

BRCA1/2

79
Q

If a BRCA1/2 mutation is detected what is a prophylactic measure that is often taken?

A

Prophylactic salpingo-oophrectomy

80
Q

What cells make up the ovary and so can become cancerous?

A

Epithelial lining (epithelial tumours)
Germ cells (germ cell tumours)
Stromal cells (sex cord stromal tumours)

81
Q

What is a cyst?

A

Sac lined by epithelium containing a fluid

82
Q

What are the 3 main ovarian epithelial tumours?

A

All ADENOCARINOMAS:
Serous
Mucinous
Endometrioid

83
Q

How can ovarian serous adenocarcinoma constrict the intestines producing GI symtoms?

A

Cells exfoliate
Enter into peritoneum through Fimbriae spreading to the peritoneal space

84
Q

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?

A

7 = ovarian Endometrioid adenocarcinoma
8 = ovarian mucinous adenocarcinoma

7 can see glands resembling endometrium
8 can see goblet cells producing mucin

85
Q

What is endometriosis?

Where is its most common location?

A

Endometrioid tissue outside the uterus

Ovaries

86
Q

What is the most common germ cell tumour?

A

Teratoma

87
Q

What are the 3 subtypes of teratoma?

A

Mature (benign)

Immature (malignant)

Monodermal (highly specialised)

88
Q

How does a mature teratoma/dermoid cyst appear?

A

Contains fully mature differentiated tissue from all germ layers

Can have hair, skin, teeth, GI tissues etc

89
Q

What are some other germ cell tumours?

A

Dysgerminoma (like seminoma in testis)

Choriocarcinoma
Embryoblast carcinoma
Yolk sac tumour

90
Q

What are some sex cord stromal tumours from ovarian stroma?

A

Ovaries:
-granulosa cells (convert androgens to oestrogen)
-theca cells (make androgens)

Testes:
-Sertoli cells (spermatogenesis)
-leydig cells (testosterone production)

91
Q

What affect do theca and granulosa cell tumours have on someone before they reach puberty and why?

A

Precocious puberty

Since produce oestrogen

92
Q

What affect do theca and granulosa cell tumours have on someone after they have reached puberty and why?

A

Breast cancer
Endometrial hyperplasia
Endometrial carcinoma

Elevated oestrogen

93
Q

What affect do sertoli and leydig cell tumours have on women before puberty and why?

A

Prevents normal female pubertal changes since produces testosterone

94
Q

What affect do sertoli and leydig cell tumours have on women after puberty and why?

A

Infertility
Amenorrhoea
Hirsuitism
Male pattern baldness
Breast atrophy

Produce testosterone

95
Q

What structure is a common metastatic location?

A

Ovary

96
Q

What is a krukenberg tumour?

A

Metastatic GI tumour often from the stomach (gastric) that goes to the ovary

97
Q

What is the main risk factor for testicular cancer?

A

Cryptorchidism (undescended testicle)

98
Q

How do testicular cancers present?

What investigations are done?

A

Palpable mass which may be painful

Scans like ultrasound

Tumour markers

99
Q

What are some testicular cancer tumour markers?

A

B-HCG

AFP (Alpha fetoprotein)

100
Q

What germ cell tumour is B-HCG indicative of?

A

Choriocarcinoma (can be testicular or ovarian)

101
Q

What tumour marker is AFP (alpha fetoprotein) elevated in?

A

Yolk sac germ tumour

102
Q

Why is AFP not a perfect indication of Yolk sac tumours?

A

Elevated in liver cancer too

103
Q

What are the subtypes of testicular cancers?

A

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
Q

What is the most common type of testicular cancer?

What category is this part of?

A

Seminoma

Germ cell tumour which is seminomatous

105
Q

What are some germ cell non-seminomatous testicular cancers?

A

Teratoma
Yolk sac tumour
Choriocarcinoma
Embryonic carcinoma

106
Q

What are the 2 non germ cell sex cord stromal testicular cancers?

A

Leydig cell tumour and sertol cell tumour

Y2 - Repro (19 decks)

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