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Reproductive System > Reproductive Tract Cancers > Flashcards

Reproductive Tract Cancers Flashcards

1
Q

Define a tumour

A

Any clinically detectable lump or swelling

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2
Q

Define neoplasm

A

An abnormal growth of cells that persists after the initial stimulus is removed

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3
Q

What is a malignant neoplasm?

A

An abnormal growth of cells that persists after the initial stimulus is removed and invades surrounding tissue with potential to spread to distant sites

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4
Q

In what demographic are vulval cancers most common?

A

Tend to arise in older patients

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5
Q

What is the most common type of vulval cancer?

A

Squamous Cell Carcinoma (90%)

Note Atypical squamous cells - large nuclei, mitotic bodies, irregular borders and keratin formation (whirls and swirls)

Others are Basal Cell Carcinoma, Melanoma and Soft tissue tumours

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6
Q

What is the main causative factor for vulval tumours in pre-menopausal women?

A

HPV (human papilloma virus)

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7
Q

Which lymph nodes would vulval cancers predominantly metastasis to?

A

Inguinal lymph nodes

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8
Q

What is vulval intraepithelial neoplasia?

A

An in situ precursor of vulval squamous cell carcinoma

Has not invaded through the basement membrane. May or may not develop into SCC

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9
Q

Are VIN and Vulval SCC related to HPV?

A

Yes and No!

Yes:

  • 30% of cases, usually HPV 16
  • Peak onset age 60s

No:

  • 70% of cases
  • Usually associated with long term inflammatory conditions e.g. lichen scleosus
  • Peak onset age 80s
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10
Q

Which direct extensions sites can vulval cancer spread to?

A
  • Anus
  • Bladder
  • Vagina
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11
Q

Explain how the cell types of the cervix change in normal anatomy

A

The Transformation Zone is the area where the epithelium changes from columnar epithelium in the endocervix to squamous epithelium in the ectocervix

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12
Q

How does the transformation zone change throughout the womans life?

A

Premenarche: Well defined ecto and endo cervix

Early reproductive age: Rises in oestrogen cause the endocervix to evert so columnar epithelium is exposed to the acidic environement of the vagina

In their 30s: Metaplasia from simple columnar to stratified squamous columnar in the transformation zone

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13
Q

Which HPV strains are high risk?

A

HPV 16 & 18

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14
Q

How does the HPV virus cause uncontrolled cellular proliferation?

A
  • HPV strains 16 &17 infect the transformation zone which is already at risk of dysplasia
  • Produces viral proteins E6 and E7
  • Viral proteins inactivate tumour suppressor genes p53 and Rb
  • Causes uncontrolled cellular proliferation
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15
Q

What is cervical intraepithelial neoplasia?

A

Dysplasia of cells of the cervix confined to the cervical epithelium. Does not break through the basement membrane. Caused by HPV infection

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16
Q

What are the main types of cancer of the cervix?

A
  • Squamous cell carinoma (80%)
  • Adenocarcinoma (15%)
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17
Q

What factors increase risk of exposure to HPV?

A
  • Sexual partner with HPV
  • Multiple sexual partners
  • Early age of first intercourse
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18
Q

What are some of the risk factors for CIN and Cervical Carcinoma?

A
  • Increased risk of exposure to HPV
  • Early 1st pregnancy
  • Multiple births
  • Smoking
  • Low socio-economic status
  • Immunosuppression
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19
Q

How would you target the treatment of the different types of CIN?

A

CIN 1: often regresses spontaneously, follow up with smear 1 year later

CIN 2&3: need treatments, large loop excision of transformation zone

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20
Q

Explain the principles of the cervical cancer screening programme

A

Brush used to scrape cells from the transformation zone and tested for HPV

If positive for HPV cells are looked at under microscope

Age 25-49: done every 3 years
Age 50-64: every 6 years
Over 65: only if recent abnormality

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21
Q

What features of this histology slide indicate neoplasia?

A
  • Pleomorphism
  • Large nucleus size
  • Presence of nucleoli
22
Q

Explain the basics of the HPV vaccination programme

A
  • Girls aged 12-13 offered vaccination against high risk HPV subtypes HPV 6/11/16/18
  • Protects aginst HPV infection for up to 10 years
  • Protects against cervical, vulval, oral and anal cancers
23
Q

How would invasive cervical cancer present?

A
  • Bleeding
    • ​Post coital
    • Inter menstrual
    • Post menopausal
  • Mass
  • Detected on screening
24
Q

Which lymph nodes would carcinoma of the cervix spread to?

A

Iliac and then aortic lymph nodes

25
Q

How can you treat invasive cervical cancer?

A
  • Hysterectomy if advanced
  • Lymph node dissection
  • +/- Chemoradiotherapy
26
Q

What is the main type of tumour of the endometrium and the two histological types?

A

Adenocarcinoma

2 main histological types: endometroid and serous

27
Q

What are the causes of endometrial hyperplasia?

A

Caused by excessive oestrogen

  • Endogenous
    • Obesity (androgens → oestrogens)
    • Early menarche/ late menopause
    • Oestrogen secreting tumours
  • Exogenous
    • Unopposed oestrogen hormone replacement therapy
    • Tamoxifen (breast cancer treatment)
  • Irregular Cycles
    • PCOS
28
Q

What is the most common type of endometrial cancer?

A

Endometrioid Adenocaricoma

Resembles normal endometrial glands just very close together with no stroma

Commonly arises from hyperplasia

29
Q

What is the less common form of endometrial cancer?

A

Serous Adenocarcinoma

Less common but more aggressive

Poorly differentiated cells, look nothing like normal endometrium

30
Q

Where can serous adenocarcinoma spread to?

A
  • Cervix
  • Bladder
  • Rectum
  • Desposits in the peritoneal cavity by transcolaemic spread
31
Q

What histological feature is associated with exfoliates of serous adenocarcinoma?

A

Collections of Calcium - Psammoma bodies

32
Q

How do you manage endometrial cancer?

A
  • Hysterectomy
  • Bilateral salpingo-oophorectomy
  • +/- lymph node dissection
  • +/- chemo radiotherapy
33
Q

What are fibroids?

A

Benign tumours of uterine smooth muscle

Proper name = leiomyomas

Pale, homogenous and well circimscribed mass

34
Q

How may leiomyoma present?

A
  • asymptomatic
  • pelvic pain
  • heavy periods
  • urinary frequency (if bladder compressed)
35
Q

How does leiomyoma look histologically?

A

Whorled intersecting fasciles of beign smooth muscle cells

36
Q

What is leiomyosarcoma?

A
  • Malignant tumour of smooth muscle
  • Atypical cells
  • Doesn’t arise from leiomyoma
  • Can metastsise to lung
37
Q

What 3 types of tumour can develop in the ovary?

A
  • epithelial tumours
  • germ cell tumours
  • sex cord stromal tumours
38
Q

What are the histological subtypes of ovarian epithelial tumours?

A
  • Serous
  • Mucinous
  • Endometrioid
  • All are types of adenocarcinoma

Can all be further classified as benign, borderline or malignant

39
Q

How do ovarian serous adenocarcinomas look histologically?

A
  • highly atypical cells
  • Often show Psammoma bodies
40
Q

How does ovarian mucinous adenocarcinoma look histologically?

A
41
Q

How does ovarian endometroid adenocarinoma look histologically?

A
  • glands resembling endometrium
  • may arise from endometriosis
42
Q

Which markers exist for ovarian cancer?

A

Ca-125

  • Serum marker
  • For diagnosis / monitoring

BRCA 1/2

  • tumour suppressor genes
  • assoicated with high grade serous cancers
  • would do a prophylactic salpingo-oophrectomy
43
Q

What is a teratoma?

A

Most common germ cell tumour in women, also called a dermoid cyst. Can contai tissue from any of the 3 germ layers; skin, hair, teeth, muscle, cartilage etc

3 subtypes

  1. mature (benign)
  2. immature (malignant)
  3. monodermal (highly specialised)
44
Q

Other than teratoma, name some other germ cell tumours

A
  • Dysgerminoma (seminoma of the testes)
  • Choriocarcinoma
  • Embryonal Carcinoma
  • Yolk Sac Tumour
  • All are malignant
45
Q

What are the 2 types of sex cord stromal tumours that can arise in the ovary?

A
  1. Granulosa Cell Tumours - resemble lining of ovary follicle, commonly produce oestrogen, from granulosa and theca cells
  2. Sertoli-Leydig cell tumours- rare sex cord tumours that may produce androgen and cause defeminisation, masculation and amenorrhoea or infertility
46
Q

What is a Krukenberg Tumour?

A

Metastatic spead of GI tumour

Often gastric origin with signet cell sign

47
Q

Which tumours commonly metastasise to the ovary?

A
  • Breast cancer
  • Other gynae tumours
  • GI cancers
48
Q

What is a key risk factor for testicular cancer?

A

Cryptorchidism

i.e. maldescended testicle

49
Q

What are some useful tumour markers for testicular cancer?

A
  • Beta hCG - choriocarcinoma a type of germ cell tumour
  • Alpha fetoprotein (AFP) yolk sac tumours
50
Q

What is a seminoma?

A
  • Approx 50% of germ cell tumours are seminomas
  • Common in young men
  • Fried egg appearance on histology
  • Cancer confined to the testis for a long period
  • Common metastasis to iliac and paraortic lymph nodes
51
Q

In which age group do yolk sac tumours usually present?

A

In young children

Have good prognosis

Reproductive System (18 decks)

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