Repro 12 Flashcards
What type of cancer are most carcinomas of the cervix?
Squamous
Adenocarcinoma 25-30%
What is required for cervical changes to be malignant?
HPV
What is CIN?
Cervical intraepithelial neoplasia.
Grade given based on mitotic activity, nuclear pleomorphism/hyperchromasia and nuclear/cytoplasmic ratio
What are the aetiology factors associated with carcinoma of the cervix?
Lifestyle - Number of sexual partners, promiscuity, low social class, smoking Immunocompromised OCP Number of pregnancies Familial
What is the aim of cervical screening?
Detect the pre-invasive lesion and to excise the involved area completely before a tumour can develop
Why is exfoliative cytology adequate for cervical screening?
Cells at surface level always affected no matter what CIN stage
What does cervical screening detect?
Cells with abnormally enlarged nuclei possessing abnormal chromatin
When are women referred for colposcopy?
Abnormal cells and HPV positive
What chemical is used in colposcopy?
Diluted acetic acid
How are abnormal cells commonly existed for biopsy?
Diathermy
How often and at what age are women screened for cervical cancer?
3 years age 25-50
5years age 50-65
What features determine the prognosis of carcinoma of the cervix?
Spread - depth of invasion, size (much more important that differentiation)
Where do cervical carcinomas tend to spread?
Iliac and aortic lymph nodes initially before wider systemic dissemination
Local - ureters, bladder, rectum (extemely distressing with pain and fistula formation)
Who receives the vaccination for HPV?
12-13 year old girls (not effective if already exposed)
What is the most common type of vulval tumour?
Squamous carcinoma
Rarer - adenocarcinoma, basal cell and malignant melanoma
What is the cause of vulval tumour?
HPV in pre-menopausal women
In older women, the causative agent is unknown but are probably related to chronic irritation and longstanding dermatoses such as lichen sclerosis and squamous hyperplasia
How might vulval squamous cell carcinoma present?
Scaly red patch Sore Itchy White Incidental finding in 30%
Where do vulval carcinomas commonly spread to?
locally and metastasise to the inguinal lymph nodes
Can vuval sqaumous cell carcinoma be cured?
Yes if caught early - vulvectomy
Describe extramammary Paget’s disease?
Commonly found in the vulva Grows downwards 24-30% associated with invasive neoplasm 0.2% vulval carcinoma Average age 63
How does vulval basal cell carcinoma present?
Pearly white/pigmented nodule
Ulcerated
Does vulval basal cell carcinoma have a positive prognosis?
Deeply infiltrative if neglected
Does not metastasise
Vulvectomy does not work
What is the common treatment of vulval squamous carcinomas?
Vulvectomy
Who commonly develops endometrial adenocarcinoma?
Perimenopausal and older women
What causes endometrial adenocarcinoma?
Unopposed oestrogen:
- obesity
- exogenous oestrogen administration
- hormone-secreting tumour
- late menopause/early menarche (long reproductive lifespan)
- Tamoxifen
What types of cancer may occur in the endometrium?
Adenocarcinoma
Adenosquamous
Malignant stroma
What does the prognosis of endometrial adenocarcinoma depend on?
Grade
Spread in the myometrium
Where does endometrial adenocarcinoma commonly spread to?
Invades myometrium and cervix Bladder Rectum Through peritoneal cavity Regional lymph nodes Adnex
When might adjuvant therapy be required to treat endothelial adenocarcinoma?
With involvement of more than half the myometrium depth
Who is endometrial carcinoma easier to treat in?
Younger women with type I (hormone related) as hormone dependent tumours are generally simpler to treat
Describe type II endometrial carcinoma.
Occurs in older women Not hormone related High grade Spontaneous Clear cell Uterine serous papillary
Describe the histology of endometrial adenocarcinoma.
Glands
Malignant epithelium
Squamous areas sometimes
What are fibroids?
Benign tumours of uterine smooth muscle
Leiomyomas. Can be single but more commonly multiple leiomyomas
What are the symptoms of fibroids?
Heavy menstrual loss Intermenstrual bleeding Pain Discharge Infertility
How do fibroids resolve?
Oestrogen dependent and usually regress after the menopause
How do fibroids appear histologically?
Interlacing bundles of smooth muscle
Rounded ends to nuclei
Fibrotic or myloid stroma
Atypical types
Compare leiomyoma and leiomyosarcoma.
Present with similar symptoms but leiomyosarcoma usually single
What is the aetiology of leiomyosarcoma?
Unknown
How do leiomyosarcoma appear histologically?
Massively increased mitotic activity
Cellular atypia
Infiltrative growth pattern
Where do leiomyosarcomas metastasise to?
Lung by blood stream and systemically
What is the aetiology of ovarian carcinoma?
Super ovulation (IVF) HRT Smoking Obesity Endometriosis Prior cysts Talcum powder used to carry risk (asbestos)
Where might tumours of the ovary arise from?
Epithelium (most common)
Stroma
Germ cells
Sex cord elements
Why is there currently no screening for ovarian cancer?
No accepted pre-cursor lesion
Although, CA125 and ultrasonography is currently being investigated
How does ovarian cancer tend to present?
Does not present until late
IBS symptoms initially
Spread within the abdomen where they can cause ascites, intestinal obstruction, perforation and death
How are ovarian cancers typed?
Epithelium (serous, mucinous, endometrioid, transitional)
Benign, Low malignant potential or malignant
What genes have been associated with ovarian cancer?
BRCA1 and 2 associated with familial ovarian epithelial carcinoma but this accounts for less than 1% of cases
What is the most common type of germ cell tumour?
Mature (benign) cystic teratoma that contains skin, hair, teeth, bone and other tissue
What is and immature germ cell tumour?
Malignant such as primitive neuroepithelium
Risk of intra abdominal spread and potential cause of death
How should immature germ cell tumours be treated?
Chemo
What other malignant germ cell tumours are there?
Dysgerminoma
Yolk sac tumour
Choriocarcinoma
Embryonal carcinomas
How should dysgerminoma be treated?
Radiotherapy
What is alpha-fetoprotein?
Plasma protein produced by the yolk sac - can be used to determine yolk sac tumours
What is beta human chorionic gonadotrophin hormone?
Hormone secreted in pregnancy but also in certain cancers e.g. ovarian
What are granulosa cell tumours?
Resemble the cells lining the ovarian follicle and are thus sex cord tumours
What other diseases are associated with granulosa cell tumours and why?
Endometrial adenocarcinoma
Iso-sexual precocious puberty
Commonly produce oestrogens
Where might granulosa cell tumours spread to and when might they recur?
Intra-abdominally
Can recur within 5 years or up to 20 years later
What are thecomas?
Benign tumours derived from ovarian stroma. May also produce oestrogen and give rise to similar conditions as granulosa cell tumours
What are fibromas?
Stromal tumours that cause pressure symptoms and sometimes ascites
What is Meig’s syndrome and when is it commonly seen?
Ovarian tumour with ascites and pleural effusion that resolves after resection of the tumour. Most commonly produced by benign ovarian tumours
Why can some tumours cause defeminisation?
Secrete androgens eg rare sex cord stromal tumours, Leydig cell tumours
Amenhorroea, masculinisation and infertility
What are hydatidiform moles?
Gestational tumours from a chromosomal defect in the conceptus. Associated atypical trophoblastic hyperplasia and these tumours have the propensity for myometrial penetration
What results from hydatidiform moles?
Oedema of the placental chorionic villi.
May persist, invade, metastasise and kill
Significant risk of development of choriocarcinoma and placental site trophoblastic tumour
What is choriocarcinoma and where might it metastasise to?
A malignant tumour of placenta composed of syncytio and cytotrophoblast without villi
Genital tract, lungs and brain
What is placental site trophoblastic tumour?
A rare variant of trophoblastic malignancy resembling intermediate trophoblast
What is a complete hydatidiform mole?
Diploid chromosomal defect.
Most villi involved, with or without vessels
Atypical trophoblastic proliferation
p57 negative
What is partial hydatidiform mole?
Partial triploid (1 egg, 2 sperm) Some normal villi Geographical profile Epithelial inclusion Circumferential proliferation p57 positive
