Neoplasms of the Reproductive Tract Flashcards
Where can gynaecological tumours arise?
Vulva
Cervix
Endometrium
Myometrium
Ovary
What % of vulval cancers are linked to HPV?
30%
Usually HPV 16
What type of cancer usually effects the vulva?
Squamous cell carcinoma
In what nature does vulval cancer spread?
Initially to inguinal, pelvic, iliac, para-aortic lymph nodes
Then lungs and liver
Almost all cases of cervical carcinoma are related to what?
High risk HPV 16
What are the risk factors for cervical intraepithelial neoplasia and cervical carcinoma?
Sexual intercourse
Early first marriage
Early first preg
Multiple births
Many partners
Promiscuous partner
Long term use of OCP
Partner with carcinoma of the penis
Smoking
Immune suppression
Why is cervical screening successful?
Cervix easily accessible
Slow progression to invasive cancer
Papanicolaou (pap) test detects precursor lesions and low stage cancers
Allows early diagnosis and curative therapy
What is cervical intraepithelial neoplasia?
dysplasia of squamous cells within the cervical epithelium
induced by high risk HPVs
Dyskaryosis = abnormal nuclei
Not malignant
Progresses to invasive cervical carcinoma
There are diff types of cervical intraepithelial neoplasia (CIN), how long does it take to progressive from T1 to T3?
Several years
What is invasive cervical carcinoma?
Average age 45 y/o
80% squamous cell carcinoma
15% adenocarcinomas (also caused by high risk HPVs)
may be exophytic or infiltrative
Spreads – para-cervical, pelvic, para aortic and then distally
Presents: screening abnormality, post coital, intermenstrual or post menopausal vaginal bleeding
Outline the pathophysiology of HPV
HPV infects immature squamous cells undergoing metaplasia in transition zone
produce viral proteins (E6 and E7)
interact with tumour suppressor proteins (p53 and retinoblastoma protein)
cells can’t repair any damaged DNA
= promote hallmarks of carcinoma
How is cervical intraepithelial neoplasia (CIN) treated?
Follow up
Cryotherapy
Superficial excision of transformation zone
How is invasive cervical carcinoma treated?
Cervical cone excision
Hysterectomy
Lymph node dissection
Radiation/chem
How does endometrial adenocarcinoma present?
Irregular or postmenopausal vaginal bleeding
What are the pathological features of endometrial adenocarcinoma?
Increased gland to stroma ratio
Prolonged oestrogenic stimulation
Exogenous oestrogen
Polyploidy
Infiltrative
How is endometrial adenocarcinoma treated?
Complex/atypical = hysterectomy
What is the most common tumour of the myometrium?
Leiomyoma = benign tumour of the uterine smooth muscle
What is a leiomyosarcoma?
Malignant tumour of the myometrium
Mets to the lungs
Uncommon
Bad prognosis
How does a leiomyoma present?
May be asymptomatic
Heavy/painful periods
Urinary frequency (due to bladder compression)
Infertility
Can be massive = filling the pelvis
How does an ovarian tumour present?
Abdo pain
Abdo distension
Ascites
Urinary/GI symptoms
Menstrual disturbances = prod male/female sex hormones
Roughly 50% of ovarian tumours spread to where?
The other ovary
How are ovarian tumours diagnosed?
Serum CA-125
BRCA mutations
How can ovarian tumours be classified?
Mullerian epithelium
Germ cells
Sex cord stromal cells
Metastases
Describe a mullerian epithelial ovarian tumour
Risk factors = null/low parity, OCP, endometriosis, smoking
Serous type = bilateral, if rubbed will flake off
Mucinous type = large cystic mass, sticky fluid filled
Endometriod type = looks like endometrial tissue, can arise in endometriosis
Describe germ cell ovarian tumours
Mature = hair, sebaceous material, teeth (benign)
Immature (malignant)
Monodermal = rare, stuma ovari: can be functional and prod thyroid hormone = hyperthyroidism
Describe sex cord-stomal cell ovarian tumours
Derived from sex cord of embryonic gonads
granulosa/theca cell = post-menopausal, high oestrogen
leydig cell = block normal female sexual devel, defeminisation, peak incidence in teens/twenties
Describe metastasis to the ovary
Most common are mullerian tumours fromother areas in repro tract
Can get metastases from: GI tumours (colon, stomach, biliary tract, pancreas, appendix) and breast
Krukenberg tumour = metastatic GI tumour, usually from stomach, often bilateral
How can testicular tumours be classified?
Germ cell = seminomas, non-seminomatus germ cell
Sex cord stromal tumours = sertoli, leydig
Lymphomas
If a mass is derived from 3 germ cell layers what is the diagnosis?
Teratoma
Define cervical intraepithelial neoplasia III
dysplasia of squamous cell, carcinoma in situ
From which tissue does endometrial adenocarcinoma arise?
endometrium
What is the most common invasive cancer of the female genital tract?
endometrial adenocarcinoma
What are the risk factors for devel endometrial cancer?
history of polycystic ovary syndrome
increased years of menstruation
What is the most significant risk factor for the development of germ cell tumors?
cryptorchidism
undescended testis
