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2.3.2. Reproductive System > Neoplasms of the Reproductive Tract > Flashcards

Neoplasms of the Reproductive Tract Flashcards

1
Q

Where can gynaecological tumours arise?

A

Vulva

Cervix

Endometrium

Myometrium

Ovary

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2
Q

What % of vulval cancers are linked to HPV?

A

30%

Usually HPV 16

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3
Q

What type of cancer usually effects the vulva?

A

Squamous cell carcinoma

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4
Q

In what nature does vulval cancer spread?

A

Initially to inguinal, pelvic, iliac, para-aortic lymph nodes

Then lungs and liver

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5
Q

Almost all cases of cervical carcinoma are related to what?

A

High risk HPV 16

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6
Q

What are the risk factors for cervical intraepithelial neoplasia and cervical carcinoma?

A

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

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7
Q

Why is cervical screening successful?

A

Cervix easily accessible

Slow progression to invasive cancer

Papanicolaou (pap) test detects precursor lesions and low stage cancers

Allows early diagnosis and curative therapy

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8
Q

What is cervical intraepithelial neoplasia?

A

dysplasia of squamous cells within the cervical epithelium

induced by high risk HPVs

Dyskaryosis = abnormal nuclei

Not malignant

Progresses to invasive cervical carcinoma

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9
Q

There are diff types of cervical intraepithelial neoplasia (CIN), how long does it take to progressive from T1 to T3?

A

Several years

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10
Q

What is invasive cervical carcinoma?

A

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

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11
Q

Outline the pathophysiology of HPV

A

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

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12
Q

How is cervical intraepithelial neoplasia (CIN) treated?

A

Follow up

Cryotherapy

Superficial excision of transformation zone

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13
Q

How is invasive cervical carcinoma treated?

A

Cervical cone excision

Hysterectomy

Lymph node dissection

Radiation/chem

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14
Q

How does endometrial adenocarcinoma present?

A

Irregular or postmenopausal vaginal bleeding

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15
Q

What are the pathological features of endometrial adenocarcinoma?

A

Increased gland to stroma ratio

Prolonged oestrogenic stimulation

Exogenous oestrogen

Polyploidy

Infiltrative

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16
Q

How is endometrial adenocarcinoma treated?

A

Complex/atypical = hysterectomy

17
Q

What is the most common tumour of the myometrium?

A

Leiomyoma = benign tumour of the uterine smooth muscle

18
Q

What is a leiomyosarcoma?

A

Malignant tumour of the myometrium

Mets to the lungs

Uncommon

Bad prognosis

19
Q

How does a leiomyoma present?

A

May be asymptomatic

Heavy/painful periods

Urinary frequency (due to bladder compression)

Infertility

Can be massive = filling the pelvis

20
Q

How does an ovarian tumour present?

A

Abdo pain

Abdo distension

Ascites

Urinary/GI symptoms

Menstrual disturbances = prod male/female sex hormones

21
Q

Roughly 50% of ovarian tumours spread to where?

A

The other ovary

22
Q

How are ovarian tumours diagnosed?

A

Serum CA-125

BRCA mutations

23
Q

How can ovarian tumours be classified?

A

Mullerian epithelium

Germ cells

Sex cord stromal cells

Metastases

24
Q

Describe a mullerian epithelial ovarian tumour

A

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

25
Q

Describe germ cell ovarian tumours

A

Mature = hair, sebaceous material, teeth (benign)

Immature (malignant)

Monodermal = rare, stuma ovari: can be functional and prod thyroid hormone = hyperthyroidism

26
Q

Describe sex cord-stomal cell ovarian tumours

A

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

27
Q

Describe metastasis to the ovary

A

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

28
Q

How can testicular tumours be classified?

A

Germ cell = seminomas, non-seminomatus germ cell

Sex cord stromal tumours = sertoli, leydig

Lymphomas

29
Q

If a mass is derived from 3 germ cell layers what is the diagnosis?

A

Teratoma

30
Q

Define cervical intraepithelial neoplasia III

A

dysplasia of squamous cell, carcinoma in situ

31
Q

From which tissue does endometrial adenocarcinoma arise?

A

endometrium

32
Q

What is the most common invasive cancer of the female genital tract?

A

endometrial adenocarcinoma

33
Q

What are the risk factors for devel endometrial cancer?

A

history of polycystic ovary syndrome

increased years of menstruation

34
Q

What is the most significant risk factor for the development of germ cell tumors?

A

cryptorchidism

undescended testis

2.3.2. Reproductive System (20 decks)

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