Session 12 - Cancers of the Reproductive System Flashcards
Name six places gynaecological tumours can effect
- Vulva
- Cervix (neck of uterus)
- Endometrium (lining of uterus)
- Myometrium (body of uterus)
- Ovary
- Tumours of gestation (pregnancy)
What are the most common type of cervical carcinomas?
Squamous carcinoma
Adenocarcinoma
Give five risk factors for cervical carcinoma
Sexual intercourse, multiple partners
Immunosuppression
Cigarette smoking
Long term use of the oral contraceptive
pill (OCP)
Early first pregnancy and increasing risk
with each subsequent pregnancy
What is one of the viral causative agents of cervical carcinoma?
Human papilloma virus
Give three macroscopic features of squamous carcinoma cervix
Cervical expansion
Ulceration
Nodules
Give a main symptom of squamous cervix carcinoma
Post coital, intermenstrual or postmenopausal bleeding
Give three histological features of a squamous cervix carcinoma
Inflitrating tongues of squamous epithelium
Cytological geatures of malignancy (pleomorphism etc)
Variable differntitation
Where is the local spread of cervical cancer?
Ureters, rectum
Forms fistula
Lymphatic (paraortic)
How does cervical screening work?
Exfoliation of epidermal layer of cervix
Cervical cancer is full thickness abnormal dysplasia
What is cervical cancer graded on?
Mitotic activity
Nuclear pleomorphism, hyper chromasia (dark nucleus)
Nuclear/cytoplasmic ratio
Outline cerivcal screening, epidemiological
Start age 25th birthday
Every 3 years until 50
What if someone is HPV positive?
Followed up in usual way with calposcopy
What if someone is HPV negative?
Returned to screening programme
What are the two types of endometrial adenocarcinoma?
Type 1 - Unopposed oestrogen tumour
Type 2 - Clear cell and uterine serous papillary
Why does type 1 endometrial adenocarcinoma happen?
Continued exposure to oestrogen
Give five main people who develop type 1 endometrial adenocarcinoma?
Obesity !! (responsible for recent increase, due to increasingly unhealthy lifestyle factors) Nulliparous Early menarche Late menopause HRT
Why do obese ladies
Androgens produced in adrenal cortex
Aromatised in fat to oestrogen
What happens in type 2 endometrial adenocarcinoma?
Arises spontaneously in post-menopausal wp,em
What is the danger of type 2 endometrial carcinoma?
Occurs in women with shruncken uteri, easily becomes malignant
Give some of the macroscopic features of endometrial adenocarcinoma
Glands present
Malignant epithelium
Invades adnexa (structures closely related to uterus)
What is the precursor for endometrial cancer?
• simple
o cystic glands, abundant stroma
• complex
o crowded, branched or budded glands
• complex with atypia
o cytological features of malignancy of
varying degrees (EIN)Name two different types of endometrial carcinoma, other than 1 and 2
Carcinosarcoma
Endometrial stromal sarcoma
What is a leiyomyoma?
Smooth muscle cancer (fibroids!)
What are the sy,ptoms of smooth muscle leiomyoma (fibroids)
Heavy/painful periods
Infertility
Benign
Give histological features of leiomyoma (3)
Interlacing bundles of smooth muscle • rounded ends to nuclei • fibrotic or myxoid stroma
Is leiomyoma benign or malignant?
Benign
Is leiomyosarcoma benign or malignant?
Malignant
Where does leiomyosarcoma metastasise?
Lungs
Give four cells from which ovarian neoplasms can arise?
o surface epithelium o stroma o sex cord components o germ cells o metastases
What is confusing about ovarian neoplasm?
Everything
But symptoms are common with IBS, a common bowel condition
What are the most common ovarian cancers?
Serous
Mucinous
Endometrioid
Brenner (transitional cell)
Is ovarian carcinoma benign or malignant?
Can be both
What do mucinous ovarian tumours look like?
- intestinal or
(rarely)
endocervical
mucin secreting
epithelium
Is often caused by spread from intestines/pancreas
What is endometrioid carcinoma related to?
Endometriosois, often develops secondary in those with past endometriosis who go on HRT
What do ovarian epithelial neoplasms develop as a result of? (talking ‘bout secretion from somewhere)
1) Fallopian tube secretions from STIC (serous tubal intraepithelial carcinoma)
Give four causes of ovarian epithelial neoplasms
Smoking
HRT
Obesity
TAYLCUM POWDEER
Give three kinds of sex cord stromal tumours
Granulosa cell tumour
• Fibroma/thecoma
• Sertoli Leydig cell tumour
What can a granulosa cell tumour cause in young people?
Iso-sexual precocious puberty as a result of oestrogen secretion
What is a key feature of granulosa cell tumour histologically?
Call-Exner Bodies (little white balls in the blue)
What do leydig cell tumours cause in mails?
Androgen production and virilisation
What do you see histologically in leydig cell tumours?
Crystals of Reinke (
What is a mature cystic teratoma?
An ovarian germ cell tumour
What is odd and disgusting about mature cystic teratoma
Skin Hair Teeth Bone ALL INSIDE THE OVARY
What is a good marker for an endodermal sinus tumour?
AFP BHCG
Give three types of vulval tumour (IMPORTANT(
Squamous carcinoma
Adenocarcinoma
Basal cell carcinoma
Where is vulval carcinoma found?
Mainly labia
Give three macroscopic features of vulval carcinoma
Keratotic, watey or ulcerated
How is vulval carcinoma caused?
HPV
Give four features of a vulval rash which is indicatve of vulvular carcinoma
Scaly red patch
• sore
• itchy
• white
What is the histology of a vulval carcinoma?
Abnormal maturation
Mitotic activity above basal layer
Basloid cells above basal layer
What is vuval basal cell carcinoma?
Pearly white or pigmented nodule
Ulcerated
Labium majora effected
Describe key features of gestational tumours
a
What is a hydatiform mole? (IMPORTANT)
An abnormal form of pregancy in which a non-viable fertilised egg implants in uterus.
When does hydatiform mole form?
Dispermic (complete 46 XX or 46 XY
One egg nuclei and two sperm (69 XXY)
What is the danger of a hydatidiform mole?
10% risk of malignancy
What occurs in a placental site trophoblastic tumour?
Intermediate trophoblastic cells colonis the blood vessels, widening them. If that does not happen eclampsia.
hese can cause tumooouuursss.
What are the most common types of vulval carcinoma?
Squamous carcinoma
What is the major causative factor of vulval cancer in pre-menopausal women?
HPV
What is the focal point for the development of vulval cancer?
VIN (vulval intraepithelial neoplasia) from HPV invasion into intraepithelial cells
What is an early cure for precursor to vulval cancer?
VIN excision
What are the causative agents of vulval carcinoma in older women?
Chronic irritation and longstanding dermatoses such as lichen sclerosus and squamous hyperplasia
