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Kofi: Pure Clinical Sem 3 > Repro: Cancer > Flashcards

Repro: Cancer Flashcards

1
Q

Where can gynaecological tumours arise?

A
  • Vulva
  • Cervix
  • Endometrium
  • Myometrium
  • Ovary
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2
Q

What are the clinical features of vulval tumours?

A
  • Uncommon
  • Women over 60 makes 2/3 of patient
  • Usually Squamous cell carcinoma
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3
Q

How are vulval squamous neoplastic lesions related to HPV infection?

A
  • 30% related to HPV infection and it usually HPV 16

- 70% are unrelated to HPV. Most occur due to longstanding inflammation and hyper plastic conditions of the vulva

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4
Q

What is VIN?

A
  • Vulvar intraepithelial neoplasia
  • Atypical squamous cells in the epidermis
  • In situ precursor of vulval squamous cell carcinoma
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5
Q

How does Vulval squamous cell carcinoma spread?

A
  • Spreads initially to inguinal, pelvic, iliac and para-aortic lymph nodes
  • Also spreads to lungs and liver
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6
Q

What are the treatment options for vulval squamous cell carcinoma?

A

Less than 2cm

-Vulvectomy and lymphadenectomy

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7
Q

What is the likely causes of CIN or cervical carcinoma?

A

-Almost all cases related to High risk HPVs

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8
Q

What are the most important high risk HPV in the pathogenesis of cervical carcinoma?

A
  • HPV 16

- HPV 18

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9
Q

What is the pathogenesis of HPV in CIN or cervical carcinoma?

A
  • Infection of immature metaplastic squamous cells in transformation zone
  • Production of viral proteins E6 and E7
  • These interfere with tumour suppressor proteins (p53 and RB) to cause inability of repair damaged DNA and increased proliferation of cells
  • Most genital HPV infectious transient and eliminated by immune response in months
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10
Q

What are the risk factors of Vulval squamous cell carcinoma, CIN, and Cervical Carcinoma?

A
  • Sexual intercourse
  • Early first marriage
  • Early first pregnancy
  • Multiple births
  • Many partners
  • Promiscuous partner
  • Long term use of OCP
  • Partner with carcinoma of the penis
  • Low socio-economic class
  • Smoking
  • Immunosuppression
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11
Q

What does cervical screening involve?

A
  • Cells from the transformation zone are scraped off
  • Stained with Papanicolaou stain
  • Examined microscopically

-Can also test for HPV DNA in cervical cels through molecular method of screening

Start at age 25 and do it every 3 years till 50
Then every 5 years 50-65

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12
Q

What is done if an abnormal cervical screening is observed?

A
  • Coloscopy

- Biopsy

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13
Q

What is cervical intraepithelial neoplasia?

A

-Dysplasia of squamous cells within the cervical epithelium, induced by infection with high risk HPVs

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14
Q

What is the grading of cervical intraepithelial neoplasia?

A

CIN 1 - most regress spontaneously. Few progress
CIN 2 - proportion progresses to
CIN 3 - Carcinoma in situ. 10% Progresses to invasive carcinoma in 2-10 yrs and 30% regress

CIN 1 to CIN 3 takes 7 years

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15
Q

What is the treatment for CIN?

A
  • CIN 1: Follow up or cryotherapy

- CIN 2 and CIN 3: Superficial excision of transformation zone

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16
Q

What are the types of invasive cervical carcinoma?

A
  • Squamous cell carcinoma (80%)
  • Adenocarcinoma (15%)

Average Age - 45 years
May be exophytic or infiltrative

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17
Q

How does cervical carcinoma spread?

A
  • Locally to para-cervical soft tissues, bladder, ureters, rectum, vagina
  • Lymph nodes (para-cervical, pelvic, para-aortic)
  • Distally
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18
Q

How does cervical carcinoma present?

A
  • Screening abnormality

- Post-coital, intermenstrual or post-menopausal vaginal bleeding

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19
Q

How is invasive cervical carcinoma treated?

A

Microinvasive (5 yr survival = 100%)
-Treated with cervical cone excision

Invasive carcinoma (62% ten year survival)
-Treated with hysterectomy, lymph node dissection and if advanced, radiation and chemotherapy
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20
Q

What is endometrial hyperplasia?

A
  • Increased gland to stroma ratio
  • Frequent precursor to endometrial carcinoma
  • Endometrium line the internal cavity of uterus
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21
Q

What is associated with endometrial hyperplasia?

A
  • Annouvulation
  • Increased oestrogen from endogenous sources
  • Exogenous oestrogen
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22
Q

How is endometrial hyperplasia treated if complex and atypical?

A

Hysterectomy

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23
Q

What are the clinical features of endometrial adenocarcinoma?

A
  • Common invasive cancer of the genital tract

- Usually 55-75

24
Q

What is the presentation of endometrial adenocarcinoma?

A

-Irregular or post menopausal vaginal bleeding

Early detection and cure often possible.

25
Q

What are the macroscopic features of endometrial adenocarcinoma?

A

-Can be polyploid or infiltrative

26
Q

What types of endometrial adenocarcinoma are there?

A
  • Endometrioid (more common)

- Serous carcinoma

27
Q

What are the features of endometrioid adenocarcinoma?

A
  • Mimics proliferative glands
  • Arises from endometrial hyperplasia
  • Associated with unopposed oestrogen ad obesity
  • Spread by myometrial invasion and direct extension to adjacent structures, to local lymph nodes and distant sites
28
Q

What are features of Serous Carcinoma?

A
  • Poorly differentiated, aggressive, worse prognosis

- Exfoliates, travels through Fallopian tubes and implants on peritoneal surfaces

29
Q

What is the commonest tumour of the myometrium?

A
  • Leiomyoid = fibroid
  • Benign tumour of myometrium
  • Often multiple
  • Tiny to massive, filling the pelvis
30
Q

What is the presentation of leiomyoma?

A
  • Asymptomatic
  • Can cause heavy/painful periods
  • Urinary frequency
  • Infertility
31
Q

What is a malignant tumour of myometrium?

A

Uterine leimyosarcoma

  • Uncommmon (40-60 yrs)
  • Highly malignant
  • Doesn’t arise from leiomyomas
  • Metastasise to lungs
32
Q

What are clinical features of ovarian tumours?

A
  • Approximately 80% are benign and generally occur at 20-45 yrs
  • Malignant tumours generally occur at 45-65 yrs
  • Malignant tumours generally occur at 45-65 yrs
  • Many are bilateral
33
Q

How do ovarian tumours present?

A
  • Most are non-functional. Only produce symptoms when they become large and invade adjacent structures or metastasise
  • Hormonal problems
34
Q

What are the symptoms of large non-functional tumours?

A
  • Abdominal pain
  • Abdominal distension
  • Urinary and Gastrointestinal symptoms
  • Ascites
35
Q

What are the hormonal problems of ovarian tumours?

A
  • Menstrual disturbances

- Inappropriate sex hormones

36
Q

What are the clinical features of malignant ovarian tumours?

A
  • 50% spread to other ovary
  • Spread to regional nodes and elsewhere
  • Some associated with BRCA mutations (carriers treated with prophylactic sapling-oophrectomy)
37
Q

What is used in diagnosis of malignant ovarian tumours?

A

CA-125

-Monitor disease recurrence and progression

38
Q

How are ovarian tumour classified?

A
  • Mullerian (ovarian) epithelium (endometriosis)
  • Germ cell
  • Sex cord-stromal cells
  • Metastases
39
Q

What are the 3 main histological types of ovarian epithelial tumours?

A
  • Serous
  • Mucinous
  • Endometrioid

Many are cystic

40
Q

What are risk factors for ovarian epithelial tumours?

A
  • Nulliparity or low parity
  • OCP protective
  • Heritable mutations eg BRCA1 and BRCA2
  • Smoking
  • Endometriosis
41
Q

What are serous ovarian tumours?

A

-Often spread to peritoneal surfaces and omentum and commonly associated with ascites

42
Q

What are mucinous ovarian tumours?

A
  • Often large, cystic masses which can be more than 25 kg
  • Filled with sticky, thick fluid
  • Usually benign or borderline
43
Q

What is pseudomyxoma peritonei? (thought to be from micnous but not)

A
  • Extensive mucinous ascites
  • Epithelial implants on peritoneal surfaces
  • Frequent involvement f ovaries
  • Can cause intestinal obstruction
  • Most likely is extra-ovarian usually appendix
44
Q

What is endometrioid ovarian tumour?

A
  • Tumour has tubular gland resembling endometrial glands
  • Can arise in endometriosis
  • 15-30% have associated endometrial endometrial endometriod adenocarcinoma probably arising separately
45
Q

What are Germ cell ovarian tumours?

A
  • 15-20% of all ovarian neoplasms
  • Most are teratomas which are usually benign
  • Other types are malignant and include dysgerminoma, Yolk sac tumour, Choriocarcinoma, Embryonal carcinoma
46
Q

What are the types of ovarian teratoma?

A
  • Mature (benign) is most common
  • Mono-dermal (highly specialised)
  • Immature (malignant) is rare and composed to tissues that resemble immature foetal tssue
47
Q

What are the clinical features of ovarian mature teratomas?

A
  • Most are cystic
  • Most contain skin lie structures
  • Usually occur in young women
  • Bilateral in 10-15% of cases
48
Q

What is usually contain in ovarian mature teratomas?

A
  • Contain hair and sebaceous material and can contain tooth structures
  • Often also tissue from other germ laters such as cartilage, bone, thyroid and neural tissue
49
Q

What is the most common mono-dermal ovarian teratoma?

A

Struma ovarii

  • Benign
  • Composed entirely of mature thyroid tissue
  • May be functional and cause hyperthyroidism
50
Q

What are ovarian sex cord-strumal tumours?

A
  • Derived from ovarian stroma
  • Produces Sertoli and Leydig cells leading cell in testes and Granulosa and Theca cells in the ovaries
  • Tumours reselling all of these four cell types can be found in the ovary
  • These tumours can be feminising or masculinising
51
Q

What are the clinical features of granulosa cell tumours?

A
  • Most occur in post-menopausal women

- May produce large amounts of oestrogen

52
Q

What may be produced in pre-pubertal girls and adult women due to granulosa cell tumours?

A
  • Precocious puberty in pre-pubertal girls

- Endometrial hyperplasia, endometrial carcinoma and breast disease in adult women

53
Q

What are the clinical features of ovarian-sertoli leading cell tumours?

A

Often functional. Peak incidence in teens or twenties

  • In children, may block normal female sexual development
  • In women can cause defeminisation and masculinisation
54
Q

What tumours occur in the testes?

A
  • Germ cell tumours
  • Sex cord-stromal tumors (Sertoli cell tumours, Leydig cell tumours)
  • Lymphomas
55
Q

What are types of germ cell tumours occurring in men?

A
  • Seminomas

- Non-seminomatous germ cell tumours (Yolk sac tumours, Embryonal carcinomas, Choriocarcinomas, Teratomas)

56
Q

Which tumours commonly metastasise to the ovaries?

A

Mullerian tumours from

  • Uterus
  • Fallopian tubes
  • Contralateral ovary
  • Pelvic peritoneum
57
Q

What other tumours metastasise to the ovaries?

A
  • Gastrointestinal tumour and breast
  • Krukenberg tumour : metastatic gastrointestinal tumour within the ovaries which is often bilateral and from the stomach

Kofi: Pure Clinical Sem 3 (44 decks)

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