Repro Session 12 Flashcards
What are almost all cases of cervical cancer related to?
High risk HPV strains 16 and 18
Describe the pathogenesis of CIN and cervical carcinoma from HPV infection.
Infection of immature metaplastic squamous cells in transformational zone –> production of viral proteins in E6&7 –> inability to repair damaged DNA and inhibited apoptosis
What are the risk factors for cervical carcinoma associated with increased risk of HPV infection?
Sexual intercourse, early 1st marriage, early 1st pregnancy, multiple births, multiple partners, promiscuous partner, long-term use of OCP
What are the risk factors for cervical carcinoma associated with the immune response to HPV infection?
Low SES class, smoking, immunosuppression
Why does having a partner with carcinoma of the penis increase the risk of developing cervical carcinoma?
Associated with HPV
What is cervical intraepithelial neoplasia?
Dysplasia of squamous cells within the cervical epithelium
Describe the progression of CIN.
Starts as CINI, most of which spontaneously regress but some develop into CINII and CINIII
What are the treatment options for the 3 stages of CIN?
I: follow-up +/- cryotherapy
II and III: superficial excision
How long does the progression of CIN typically take?
7 years
What are the outcomes of CINIII?
30% regress, 10% progress to invasive carcinoma
How does cervical carcinoma present?
~45% as screening abnormality or postcoital/intermenstrual/postmenopausal vaginal bleeding
What is the distribution of types of cervical carcinoma?
80% SCC, 15% adenocarcinomas
How does cervical carcinoma of either type spread?
Locally by invasion to paracervical soft tissues, bladder, ureters, rectum, vagina; via lymph to paracervical, pelvic or para-aortic nodes; distally
What is the treatment for microinvasive cervical carcinoma?
Cervical cone excision
What is the 5-year survival rate for treated microinvasive cervical carcinoma?
100%
What is the treatment for invasive cervical carcinoma?
Hysterectomy +/- lymph node dissection, radiation, chemotherapy
What is the 10-year survival rate for treated invasive cervical carcinoma?
62%
What frequently precedes endometrial adenocarcinoma?
Endometrial hyperplasia
What changes are seen in endometrial hyperplasia?
Increase in gland:stroma ratio +/- abnormal cells
What is endometrial hyperplasia associated with?
Prolonged oestrogen stimulation
What are risk factors for endometrial adenocarcinoma?
Anovulation, excess adipose tissue, OCP use
What are the treatment options for endometrial hyperplasia?
Simple: monitor
Complex/atypical/symptomatic: hysterectomy
What is the most common invasive cancer of the female genital tract?
Endometrial adenocarcinoma
When does endometrial adenocarcinoma usually present?
55-75 y.o.
How does endometrial adenocarcinoma typically present?
With irregular or postmenopausal vaginal bleeding
Why does endometrial adenocarcinoma have a high 10-year survival rate?
Early symptoms are alarming so pts present early
What are the two type of endometrial adenocarcinoma?
Endometrioid and serous carcinoma
What are the differences between the two type of endometrial adenocarcinoma?
Endometrioid: more common, mimics proliferative glands
Serous carcinoma: less common, poorly differentiated, aggressive with a worse prognosis
How does endometrioid endometrial adenocarcinoma spread?
Myometrial invasion, direct extension to adjacent structures, local lymph nodes and distant sites
How does serous carcinoma endometrial adenocarcinoma spread?
Tumour cells exfoliate and travel through Fallopian tubes where they can implant on peritoneal surfaces and cause death
Why is cervical carcinoma suitable for screening?
High incidence, simple and easy test, slow progression from identifiable precursor lesion and has a curative treatment
How is cervical carcinoma screening carried out?
Cells from transformational zone are scraped, stained with Papanicalou stain and examined by microscopy to look for dyskaryosis. Followed by colposcopy/biopsy if needed
Why are molecular methods of cervical cancer screening not currently used?
Test for HPV in cervical cells is not available for all high risk types
Why is cervical carcinoma screening required when there is an effective HPV vaccine in routine use?
Vaccine only protects for 10 years and is not effective against all high-risk types
Who is invited for cervical carcinoma screening?
25-50 y.o. Females 3-yearly
50-65 y.o. Females 5-yearly (unless abnormal result)
What is leiomyoma?
Benign tumour of smooth muscle
What are the S/S of leiomyoma of the myometrium?
Asymptomatic or heavy/painful periods, urinary frequency, infertility
Do leiomyomas of the myometrium undergo malignant transformation?
No
How does leiomyoma of the myometrium appear macroscopically?
Well circumscribed, round, firm and whitish
How does leiomyoma of the myometrium appear microscopically?
Well differentiated, appearing as normal smooth muscle
What is uterine leiomyosarcoma?
Uncommon tumour presenting at 40-60 y.o. and is highly malignant
Where does leiomyosarcoma metastasise to early in its disease process?
Lungs
Is uterine leiomyosarcoma associated with leiomyoma?
No
What is the treatment for leiomyosarcoma?
Total abdominal hysterectomy
Are the majority of ovarian tumours benign or malignant?
~80% benign
At what age do benign ovarian tumours tend to present?
20-45 y.o.
At what age do malignant ovarian tumours tend to present?
45-65 y.o.
Why is the prognosis of malignant ovarian tumours poor?
Often spread beyond ovary by the time of presentation