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Repro > Lecture 19 Tumours > Flashcards

Lecture 19 Tumours Flashcards

1
Q

Tumour

A

Clinically detectable lump or swelling

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2
Q

Neoplasm

A

Type of tumour

Abnormal growth of cells that persists after the initial stimulus is removed

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3
Q

Malignant neoplasms

A

An abnormal growth of cells that persists even after the initial stimulus is removed and invades into surrounding tissue with potential to spread to distal sites

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4
Q

Vulval cancers

A

Uncommon
3% of female cancers
Arise in older patients mid 80s

Most common type: squamous cell carcinoma (vulva is keratinised squamous cell)

  • basal cell carcinoma
  • melanoma
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5
Q

Clinical features of a vulval cancer

A

Lumps
Ulceration
Skin changes e.g. hyperpigmentation in a melanoma
Associated with long-standing inflammatory conditions such as lichen sclerosus

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6
Q

Vulval intraepithelial neoplasia

A

In situ precursor of vulval squamous cell carcinoma
Atypical cells
Basement membrane intact

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7
Q

How does vulval cancer spread?

A

Direct extension:

  • anus
  • vagina
  • bladder

Lymph nodes:

  • Inguinal
  • Iliac
  • para aortic

Distant metastases

  • lungs
  • liver
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8
Q

Parts of the cervix and associated cancer

A

Inner cervix : endocervix : glandular epithelium: adenocarcinoma
Outer cervix: ectocervix: stratifies squamous epithelium: SCC (most common)

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9
Q

Transformation zone

A

Meta plasma occurs between the 2 epithelial cell types

Risk of dysplasia is higher therefore risk of cancer is higher

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10
Q

HPV and cervical cancer

A

HPV causes infection of the metaplastic squamous cells in the transformation zone causing increased proliferation

  1. Infect transformation zone
  2. Produce viral proteins E6 and E7
  3. Inactivate tumour suppressor genes (p53 and Rb)
  4. Uncontrolled cellular division
  5. CIN
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11
Q

Dysplasia

A

Pre - neoplastic alteration in which cells show DISORDERED tissue organisation
Change is reversible

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12
Q

Cervical intraepithelial neoplasia

A

Dysplasia
Confined to the cervical epithelium in situ
Caused by HPV
SCC can develop

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13
Q

CIN 1, 2, 3 and SCC

A

CIN 1 : Mild dysplasia - bottom 1/3rd
CIN 2: Moderate dysplasia - affects bottom 2/3rds
CIN 3: Severe dysplasia - full thickness
SCC: invasive carcinoma - breaks through the basement membrane

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14
Q

Risk factors for CIN

A

Increased risk of exposure to HPV:

  • HPV sexual partners
  • Multiple partners
  • Early age of first intercourse
Early first pregnancy 
Multiple births 
Smoking 
Low socioeconomic status 
Immunosuppression
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15
Q

Treatment for CIN 1

A

Often regresses spontaneously as dysplasia is reversible

Therefore follow up cervical smear in 1 year

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16
Q

CIN 2 and 3 treatment

A

Large loop excision of transition zone

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17
Q

Cervical cancer screening

A
  1. Brush used to scrape cells from the transformation zone
  2. Tested for HPV
  3. If +ve, cells are looked at under the microscope
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18
Q

When to do cervical screen

A

Aged 25 - 49 - every 3 years
Aged 50 - 64 - every 5 years
Over 65 - if recent anomaly

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19
Q

Dysplastic cells

A

Large nuclei
Pleomorphism
Irregular membrane
Mitotic bodies

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20
Q

Vaccination against HPV

A

Gardasil- for HPV 6, 11, 16, 18 strains
Given aged 12 - 13
Protects from cervical, oral, vulval and anal cancers

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21
Q

Invasive cervical cell carcinoma presentation

A

Bleeding

  • post coital
  • inter menstrual
  • post menstrual

Mass

+ve screening

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22
Q

Invasive cervical cancer spread

A

Stage 1 : confined to cervix
Stage 2: beyond cervix but not to pelvic wall or lower 1/3rd of vagina
Stage 3: Disease to pelvic wall or lower 1/3rd of vagina
Stage 4: Invades bladder, rectum it metastasis

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23
Q

Treatment of invasive cervical cancer (3)

A

Hysterectomy
Lymph node dissection
- iliac
- aortic

Chemoradiotherapy

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24
Q

Endometrial hyperplasia

A

Thickened due to oestrogen
More than 11mm
Can be a precursor to endometrial cancer
Can cause inter menstrual or post menopausal bleeding

25
Q

Causes of excessive oestrogen

A

Endogenous:
Obesity - increased aromatisation of androgens
Early menarche or late menopause
Oestrogen secreting tumours
Polycystic ovary syndrome - irregular cycles

Exogenous:
COCP
Unopposed oestrogen replacement therapy
Tamoxifen (treats breast cancer)

26
Q

Which age group is at the highest risk of endometrial cancer?

A

65 to 70 yr olds

27
Q

Endometrial cancer presentation

A

Bleeding:

  • Post menopausal
  • Inter menstrual

Mass

28
Q

Types of endometrial cancer

A

Endometrioid adenocarcinoma:

  • Resembles glands
  • common
  • due to hyperplasia

Serous adenocarcinoma:

  • Less common
  • more aggressive
  • poorly differentiated cells
29
Q

Stages of endometrioid adenocarcinoma

A

Stage 1 - endometrium and myometrium
Stage 2 - spread to cervix
Stage 3 - spread to vagina, ovary and lymph nodes
Stage 4 - metastasised to distal sites e.g. liver

30
Q

Spread of serous adenocarcinoma

A

Exfoliated malignant cells travel through the Fallopian tubes
Deposit on the peritoneal surface via transcoelomic spread
Associated with calcium collections - psammoma bodies

31
Q

Psammoma bodies

A

Collection of calcium distinct to serous adenocarcinoma of the endometrium

32
Q

Management of endometrial cancer

A

Hysterectomy
Bilateral salpingo- oophorectomy
Lymph node dissection
Chemoradiotherapy

33
Q

Leiomyoma

A

Benign tumour of the myometrium
Common
Pale, homogenous, well circumscribed
Growth is oestrogen dependent and regresses after menopause

34
Q

Presentation of leiomyoma

A 
Asymptomatic 
Pelvic pain 
Menorrhagia 
Urinary frequency - bladder compression 
Infertility
35
Q

Leiomyoma on microscopy

A

Whorled intersecting fascicles of benign smooth muscle

36
Q

Leiomyosarcoma

A

Malignant tumour of myometrium
Atypical cells
Doesn’t come from fibroids
Metastasis to lung

37
Q

Origin of ovary cancers

A

Surface epithelium
Germ cells
Sex cord stromal elements

38
Q

Presentation of ovarian cancer

A

Late symptoms:

  • abdominal pain
  • abdominal distension
  • urinary symptoms
  • GI symptoms
  • hormonal disturbances

If tumour spreads to abdomen:

  • ascites
  • intestinal obstruction
39
Q

Ovarian cancer markers

A

Ca- 125 - serum marker for diagnosis and monitoring recurrence

BRCA1/2

  • tumour suppressor gene
  • associated with high grade serous cancers and breast cancer
  • perform prophylactic salpingo-oophrectomy
40
Q

Surface epithelial tumours

A

Adenocarcinoma:
Serous
Mucinous
Endometrioid

Other:
Clear cell
Transitional cell

41
Q

Presentation of ovarian epithelial tumours

A

Present as cystic masses contains fluid

Can be benign, borderline or malignant

42
Q

Ovarian serous adenocarcinoma

A

Highly atypical cells
Psammoma bodies
Often spreads to peritoneal surface via transcoloemic spread

43
Q

Ovarian mucinous adenocarcinoma

A

Atypical epithelial cells

Secrete mucin

44
Q

Ovarian endometrioid adenocarcinoma

A

Form glands resembling endometrium
May arise from endometriosis spread to ovary
May have endometrial endometrioid adenocarcinoma

45
Q

Germ cell tumours types

A 
Teratoma - most common 
Dysgerminoma - equivalent of seminoma in testes 
Choriocarcinoma 
Embryonal carcinoma
Yolk sac tumour
46
Q

Markers of germ cell tumours

A 
Alpha fetoprotein (AFP)
Beta HCG
47
Q

Teratoma types

A

Mature (benign)
Immature (malignant) - Contains immature, embryonal tissue
Monodermal - highly specialised

48
Q

Mature teratoma

A

Dermoid cyst
Contains fully differentiated, mature tissue from all germ cell layers
Can be bilateral

49
Q

Immature teratoma

A

Malignant

50
Q

Sex cord stromal tumours

A 
Granulosa cell carcinoma 
Thecoma
Sertolli cell carcinoma
Sertolli-Leydig carcinoma
Steroid carcinoma
51
Q

Theca and granulosa cell tumour presentation

A

Produce oestrogen
- precocious puberty

Post puberty

  • breast cancer
  • endometrial hyperplasia - endometrioid adenocarcinoma
  • short
52
Q

Sertoli Leydig tumour presentation

A

Secretes testosterone

Pre- puberty - prevents normal female changes:

  • defeminisation
  • masculinisation
  • amenorrhoea
  • infertility

Post puberty:

  • infertile
  • amenorrhoea
  • hirsuitsm
  • male pattern baldness
  • breast atrophy
53
Q

Common metastasise to ovary

A

Breast cancer
Gastrointestinal cancer
Gynae tumours - from structures derived from Müllerian duct e.g. uterus
Krukenberg tumour

54
Q

Krukenberg tumour

A

Metastatic GI cancer
Often gastric
Signet cells - big foamy cytoplasm

55
Q

Testicular cancer risk factors, presentation and investigations

A

Risk factors:
- cryptorchidism - undescended testicle

Presentation
Unilateral mass +/- pain

Investigations

  • USS
  • Tumour markers
56
Q

Testicular cancer markers

A

B - HCG - choriocarcinoma (germ cell)

Alpha fetoprotein - yolk sac tumours

57
Q

2 types of germ cell cancer in males

A

Seminomatous:

  • seminoma
  • spermatocyte seminoma

Non seminomatous:

  • teratoma
  • yolk sac tumour
  • choriocarcinoma
  • embryonal carcinoma
58
Q

2 types of non germ cell tumour

A

Sex cord stromal: benign

  • Leydig cell
  • Sertolli cell

Other:

  • lymphoma
  • metastases

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