S11 Neoplasms Of The Reproductive Tract Flashcards by Ayyaz Butt

What are the main sites of gynaecological tumours?

Vulva (outside vagina)
Cervix
Endometrium
Myometrium 
Ovary

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What type of tumour affects the vulva, and what causes this?

Usually squamous cell carcinoma
Around 30% related to HPV 16
Around 70% unrelated to HPV, often occur in longstanding inflammatory and hyperplastic conditions of the vulva e.g. lichen sclerosis

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Around what age do vuvlar cancers occur?

Oven 60’s

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What are some risk factors of cancer of the vulva?

Frequent sex, many partners, multiple births, smoking

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What is vulvar intraepithelial neoplasia?

Atypical squamous cells within epidermis, in situ precursor of vulvar squamous cc.
Polyploid appearance

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What is the treatment of vulvar cancers?

Usually need vulva and lymph nodes removed.

Otherwise can spread to inguinal, iliac and para-aortic LN’s. Then to lung and liver

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Describe the cervical canal and the metaplasia which occurs in cervical cancer

In the cervical canal, we have the endocervix (glandular epithelia) and ectocervix (squamous. Epithelia).
The transformation zone is the most common site for cervical cancers.
Here we get metaplasia of glandular to squamous epithelia.

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What are the causes of CIN or cervical carcinoma?

HPV 16 in 60% of cases and HPV 18 in 10% of cases.

Infect immature metaplastic squamous cells in the transformation zone.

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How do viral proteins E6 and E7 causes cervical carcinoma?

Viral proteins E6 and E7 interfere with tumour suppressor proteins (e.g. p53) and cause inability to repair damaged DNA and increased cell proliferation

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What are the risk factors for cervical carcinoma?

Frequent sex, many partners, multiple births, smoking

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How do we screen for cervical cancers?

Precursors and low stage cancers detected by Papanicolaou (Pap) test

Cells are scraped off from transformation zone, stained with Papanicolaou stain and examined microscopically.

Abnormal test has dyskaryosis (abnormal nuclei), increased nuclear:cytoplasmic ratio, pleomorphism

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What is cervical intraepithelial neoplasia?

Dysplasia of squamous cells in the cervical epithelium induced by HPV

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What are the different stages of CIN?

CIN I: most regress spontaneously, only a small percentage progress to-
CIN II: proportion of which progress to-
CIN III: carcinoma in situ (not breached BM), 10% progress to invasive carcinoma.

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What is the treatment for CIN?

CIN I: treat with follow up or cytology

CIN II and III: superficial excision (cone, large loop excision of the transformation zone)

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Around what ages does invasive cervical carcinoma occurs and what type of cancer is it?

45 years

80% are squamous cell carcinomas, 15% adenocarcinomas (also caused by HPV)

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How does CIN appear on histology?

Large nuclei

Hyperchromatic

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Describe the spread of invasive cervical cancers

Local: bladder, ureters, rectum, vagina
LNs: pelvic, para-aortic

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What is the treatment for invasive cervical carcinoma?

Micro invasive: cervical cone excision

Invasive carcinomas: hysterectomy, LN dissection, if advanced need radiation and chemotherapy

What causes endometrial cancer?

Prolonged oestrogen exposure (eg exogenous oestrogen sources, obesity) which causes endometrial hyperplasia.

Get increased gland:stroma ratio
May be polyploid or infiltrative

What type of cancer is endometrial cancer?

Endometrial adenocarcinoma

What age does endometrial adenocarcinoma occur?

55-75 years old

How is endometrial adenocarcinoma treated?

Hysterectomy

What are the features of Endometrioid endometrial adenocarcinoma?

Well-differentiated
Mimics proliferation glands
Arises with endometrial hyperplasia and can spread to myometrium and lymph nodes

What are the features of serous endometrial adenocarcinoma?

Poorly differentiated
Aggressive and worse prognosis
Cells exfoliate (drop off), travel through fallopian tubes and implant in peritoneum

What type of cancer affects the myometrium and what are the symptoms?

Leiomyoma (benign) Leiomyosarcoma (malignant, 40-60yr, metastasise to lungs). Can be asymptomatic or cause heavy periods, urinary frequency, infertility

Describe the appearance of myometrium cancer

Well circumscribed, round, firm, whitish colour

Describe the incidence of ovarian tumours?

80% benign (younger), malignant in older, have often metastasised by presentation so poor prognosis. Often bilateral

Describe the presentation of ovarian tumours

None-functional: produce symptoms when are large and metastasise e.g ascites, abdominal pain, urinary and GI symptoms) Some produce hormones so can get menstrual disturbances and inappropriate sex hormones (e.g. precocious puberty)

Describe the clinical features of ovarian tumours

Spread: to other ovary, regional LNs Serum CA-125 marker used in diagnosis and monitoring Some associated with BRCA mutations

How do we classify ovarian tumours?

``` This is dependent on the tissues which they arise from: Müllerian epithelium Germ cells Sex cord-stromal cells Metastases ```

How can mullerian epithelium tumours be classified?

Histological types: serous, mucinous, endometrioid ovarian tumours These can be further classified as benign, borderline or malignant

Describe serous ovarian tumours

Often spread to peritoneum and omentum so associated with ascites.

Describe mucinous ovarian tumours

Large cystic masses filled with sticky fluid. | One example is pseudomyxoma peritonei, where you get extensive mucinous ascites

Describe endometrioid ovarian tumours

Contain tubular glands resembling endometrial glands

What are the risk factors for mullerian ovarian tumours?

``` Low parity (not having children) Not taking the pill (OCP is protective as prevents ovulation so less healing of endometrium so fewer mutations) Heritable mutations (BRCA1/2) Smoking Endometriosis ```

Why do nuns tend to get ovarian cancer?

They have the maximum number of follicle ruptures (due to no pregnancies) and so get repeated scarring which predisposes them to cancer.

What type of cancers are germ cell ovarian tumours?

Teratomas

Describe the appearance of the different teratomas

Mature teratomas - usually cystic, contain hair, teeth and sebaceous material Immature teratomas - malignant, composed of tissues resembling foetal tissue Monodermal - most common is stroma ovarii which is made up of thyroid tissue

Describe ovarian tumours of sex cord stromal cells

Derived from ovarian stroma (from sex cords of embryonic gonad). Sex cord produces Sertoli and Leydig cells in testes, and granulosa and theca cells in ovaries – can get tumour from any of these in ovary

Describe the features of granulosa cell tumours

Produce large amounts of oestrogen - feminising So in adult women (common) can get endometrial cancer or breast cancer. In young girls can cause precocious puberty

Describe the features of sertoli-leydig cell tumours

Usually in teenagers In young girls can block normal female sexual development. In women can cause masculinisation (breast atrophy, hair loss).

Describe the different types of metastases to ovaries

Müllerian tumours: Most common, from uterus, Fallopian Tubes GI tumours: from colon, stomach, pancreas Krukenberg tumour: metastatic GI tumour within ovaries (transcoloemic spread), usually from stomach

What tumours occur at the testes?

Get germ cell tumours - seminomas and non-seminonas Can also get lymphomas, or sex cord-stromal tumours: sertoli and leydig tumours