Lecture 23- Reproductive tract tumours Flashcards
Tumour-
any clinically detectable lump or swellingTumour- any clinically detectable lump or swelling
Neoplasm –
an abnormal growth of cells that persists after the initial stimulus is removed
Malignant neoplasm-
an abnormal growth of cells that persists after the initial stimulus is removed and invades surround tissue with potential to spread to distant sites
Metastasis-
malignant neoplasm that has spread to a distant site
Dysplasia-
a potentially pre- neoplastic alteration which cells show disordered organisation and abnormal appearances. May be reversible
Metaplasia-
conversion in cell type
features of vulval tumours
- External vagina
- Rare – 3% of female cancers
- Older people (peak onset 80-84)
- Skin cancer
vulval cancer is most commonly
squamous cell carcinoma (skin cancer)
- Can also see basal cell carcinoma or malignant melanoma less commonly
- Rarely see soft tissue tumours
- From fat cells, blood vessels and nerves
Precursor to vulval squamous cell carcinoma =
Vulval intraepithelial neoplasia (VIN)
Vulval intraepithelial neoplasia (VIN)
- In Situ precursor of vulval squamous cell carcinoma
- In situ= atypical cells which doesn’t invade basement membrane
- May or may not progress to SCC

presentation of vulval tumours
- Lumps, bumps, ulceration, skin changes (pigmentation, sensation, pain)
- May be delayed presentation (due to it being in older patients and also due to the intimate nature of the cancer)

are VIN and Vulval SCC related to HPV?
30% of cases are/ 70% are not
- usually HPV 16
- mostly in pre-menopasual women
Vin and vulval SCC are usually asscoiated with
longstanding inflammtory conditions
- Lichen sclerosus
- Squamous hyperplasia
what are the layer sof skin from outr to inner
epidermis
dermis
subcutaenous

Squamous cell carcinoma histology
- Loss of architecture
- Cannot distinguish between dermis and epidermis
- Atypical squamous cells
- Keratin formation by squamous cells

How does vulval cancer spread? Locally
-
Direct extension
- Anus
- Vagina
- Bladder
-
Lymph nodes
- Inguinal (predominantly)
- Iliac
- Para-aortic
-
Distant metastases via blood vessels
- Lungs
- Liver
Vulval cancer histology
- Normal tissue laterally and medially
- Cancer in the middle
- Architecture completely loss- no distinction between dermis and epidermis
- Cell look very abnormal
- Formation of keratin (pink)
Vulval intraepithelial neoplasia (VIN) histology
- Cells look abnormal- no maturation
- Pleiomorphic
- Large nuclei (immature)
- irregular nuclear outline
- No breaking though basement membrane (IN SITU)
- May develop into SCC

Vulval cancer treatment
- Definitive surgery would include removing the primary tumour and nodes, with a higher survival rate in smaller lesions.
- Excision affects cure
before the onset of menstruation the cervix is divisible into 2 parts
the ectocervix
endocervix
ectocervix
- communicates with vagina (low pH)
- Stratified squamous

endocervix
- not in contact with vagina
- Simple columnar (doesn’t need protecting from acidic vagina)

At menstruation, oestrogen causes an anatomical change in the cervix-
eversion of the cervix

eversion of the cervix
- Simple columnar epithelium of the endocervix is now exposed to acidic environment of the vagina –> not v appropriate to cope with acidic environment
- Inflammation






























