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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
Causes of excessive oestrogen
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
Which age group is at the highest risk of endometrial cancer?
65 to 70 yr olds
27
Endometrial cancer presentation
Bleeding: - Post menopausal - Inter menstrual Mass
28
Types of endometrial cancer
Endometrioid adenocarcinoma: - Resembles glands - common - due to hyperplasia Serous adenocarcinoma: - Less common - more aggressive - poorly differentiated cells
29
Stages of endometrioid adenocarcinoma
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
Spread of serous adenocarcinoma
Exfoliated malignant cells travel through the Fallopian tubes Deposit on the peritoneal surface via transcoelomic spread Associated with calcium collections - psammoma bodies
31
Psammoma bodies
Collection of calcium distinct to serous adenocarcinoma of the endometrium
32
Management of endometrial cancer
Hysterectomy Bilateral salpingo- oophorectomy Lymph node dissection Chemoradiotherapy
33
Leiomyoma
Benign tumour of the myometrium Common Pale, homogenous, well circumscribed Growth is oestrogen dependent and regresses after menopause
34
Presentation of leiomyoma
``` Asymptomatic Pelvic pain Menorrhagia Urinary frequency - bladder compression Infertility ```
35
Leiomyoma on microscopy
Whorled intersecting fascicles of benign smooth muscle
36
Leiomyosarcoma
Malignant tumour of myometrium Atypical cells Doesn’t come from fibroids Metastasis to lung
37
Origin of ovary cancers
Surface epithelium Germ cells Sex cord stromal elements
38
Presentation of ovarian cancer
Late symptoms: - abdominal pain - abdominal distension - urinary symptoms - GI symptoms - hormonal disturbances If tumour spreads to abdomen: - ascites - intestinal obstruction
39
Ovarian cancer markers
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
Surface epithelial tumours
Adenocarcinoma: Serous Mucinous Endometrioid Other: Clear cell Transitional cell
41
Presentation of ovarian epithelial tumours
Present as cystic masses contains fluid | Can be benign, borderline or malignant
42
Ovarian serous adenocarcinoma
Highly atypical cells Psammoma bodies Often spreads to peritoneal surface via transcoloemic spread
43
Ovarian mucinous adenocarcinoma
Atypical epithelial cells | Secrete mucin
44
Ovarian endometrioid adenocarcinoma
Form glands resembling endometrium May arise from endometriosis spread to ovary May have endometrial endometrioid adenocarcinoma
45
Germ cell tumours types
``` Teratoma - most common Dysgerminoma - equivalent of seminoma in testes Choriocarcinoma Embryonal carcinoma Yolk sac tumour ```
46
Markers of germ cell tumours
``` Alpha fetoprotein (AFP) Beta HCG ```
47
Teratoma types
Mature (benign) Immature (malignant) - Contains immature, embryonal tissue Monodermal - highly specialised
48
Mature teratoma
Dermoid cyst Contains fully differentiated, mature tissue from all germ cell layers Can be bilateral
49
Immature teratoma
Malignant
50
Sex cord stromal tumours
``` Granulosa cell carcinoma Thecoma Sertolli cell carcinoma Sertolli-Leydig carcinoma Steroid carcinoma ```
51
Theca and granulosa cell tumour presentation
Produce oestrogen - precocious puberty Post puberty - breast cancer - endometrial hyperplasia - endometrioid adenocarcinoma - short
52
Sertoli Leydig tumour presentation
Secretes testosterone Pre- puberty - prevents normal female changes: - defeminisation - masculinisation - amenorrhoea - infertility Post puberty: - infertile - amenorrhoea - hirsuitsm - male pattern baldness - breast atrophy
53
Common metastasise to ovary
Breast cancer Gastrointestinal cancer Gynae tumours - from structures derived from Müllerian duct e.g. uterus Krukenberg tumour
54
Krukenberg tumour
Metastatic GI cancer Often gastric Signet cells - big foamy cytoplasm
55
Testicular cancer risk factors, presentation and investigations
Risk factors: - cryptorchidism - undescended testicle Presentation Unilateral mass +/- pain Investigations - USS - Tumour markers
56
Testicular cancer markers
B - HCG - choriocarcinoma (germ cell) Alpha fetoprotein - yolk sac tumours
57
2 types of germ cell cancer in males
Seminomatous: - seminoma - spermatocyte seminoma Non seminomatous: - teratoma - yolk sac tumour - choriocarcinoma - embryonal carcinoma
58
2 types of non germ cell tumour
Sex cord stromal: benign - Leydig cell - Sertolli cell Other: - lymphoma - metastases

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