Tumors Of The Reproductive System Flashcards
List the common breast diseases
Infection/Inflammation (Mastitis)
Benign lesions
Adenocarcinoma
Describe the clinical presentation of breast conditions
Pain - diffuse cyclic pain is non-pathologic, non-cyclic tends to be localised
Palpable mass
Nipple discharge
Skin changes
Lumpy tissue
What is the relationship between age and breast tumours?
Benign tumours tend to be in younger women (pre-menopausal) whereas older women tend to have malignant changes.
The majority of breast lumps are due to fibrocystic changes or have no underlying pathology. 10% are actually cancer
How are breast lesions investigated and diagnosed?
Triple approach
Clinical - history and examination
Radiological - mammography, ultrasound
Pathology - cytology, cor biopsy
Describe the features of benign breast changes
Benign changes in ducts and lobules classified as:
non-proliferative - fibrocystic changes, dense breast with cysts or fibrosis from chronic inflammation
proliferative: epithelial hyperplasia, papillomas,
atypical hyperplasia. cell hyperplasia however lack defining features of DCIS/LCIS e.g. do not fully distend the duct or lobule.
Describe the features of benign breast tumours
Fibroademona:
Occurs in young women, multiple and bilateral
Spherical nodules, clearly circumscribed and freely moveable. Bulge into the surrounding tissue Proliferation of interlobular stroma distorts epithelium.
What are the risk factors for breast cancer
Increasing age Family history Hormonal factors - early menarche, late menopause Proliferative breast disease Diet - High levels of fat, moderate to heavy alcohol consumption Obesity Ethnicity Radiation
Patterns of metastasis for breast cancer
Local: skin/muscle
Lymph nodes: axilla
Blood:bone, brain, liver, lung
Trans coelomic: pleura, peritoneal
Briefly describe the epidemiology of breast cancer
Commonest tumor in women
More common in developed world (lifestyle factors)
More common in women over 50 (post menopause
Describe the pathobiology of breast cancer
Earliest detectable change - loss of normal regulation of cell number resulting in epithelial hyperplasia, sclerosing adenosis and proliferative changes
Genetic instability in multiple small clonal populations (atypical hyperplasia)
Carcinoma in situ: Multiple other changes in malignancy - increased expression of oncogenes; decreased expression of tumor suppressors; alteration in cell structure
Invasive carcinoma:loss of cell-adhesion; increase in cell cycle proteins; increased angiogenesis
Mammographic screening
used to detect small non-palpable asymptomatic breast cancers, effectiveness increases with age as there is atrophy of the breast tissue, ulrasound tends to be used in younger women
Significance of the presence of oestrogen receptors in breast carcinomas?
Differences in patient characteristics, pathology, treatment and outcome.
Difference betwen invasive carcinoma and carcinoma in situ (breast)
Carcinoma in situ refers to a neoplastic proliferation that is limited to ducts and lobules by the basement membrane.
Invasive carcinoma has penetrated through the basement membrane into the stroma
Types of malignant breast tumours
Adenocarcinoma
Ductal carcinoma - hard, irregular border (spiculate mass), tubule formation, solid clusters of infiltrating cells
Lobular carcinoma - diffusely infiltrates the tissue causing a stromal reaction. Difficult to detect by palpation. Cells ararnged in single file/sheets. No tubule formation. Metastasis to GIT and peritoneumaa
Axillary node clearance in breast cancer
70% of breast cancer have no metastasis
Assess the sentinel node - the first node in the tumour drainage path. If clear it is unlikely the cancer has metastasised.
Remove sentinel node it metastasis and then treat with chemotherapy.
Management of invasive breast cancer
Surgery - mastectomy, breast conservation
Hormonal
Radiotherapy
Chemotherapy
Paget’s disease of the nipple
Rare manifestation of breast cancer
Unilateral erythematous eruption with a scale crust. Pruritis is common, may be mistaken for eczema.
Malignant cells extend from DCIS in the ductal system into tthe nipple. Disrput epithelial barrier and fluid seeps out onto nipple surface.
Prognostic factors for breast cancer
Hormone receptor status (HER-2/oestrogen receptor)
TNM staging
Grade of tumour
Histological type
Cervical cancer
Presents in women aged 45-65 (bleeding or aymptomatic). 90% squamous cell at transformation zone between ecto and endocervix, 10% adenocarcinoma.
Affected by age of first sex, HPV infection, smoking.
Key prognostic factors: size, depth of invasion, node involvement
Preinvasive cancer detected by cytology (25-64).
Endometrial cancer
Mean age of presentation 55 years (most postmenopausal)
Adenocarcinoma that spreads to myometrium. Caused by excessive oestrogen stimulation (obesity, PCOS, HRT, tamoxifen) or endometrial atrophy
Present with abnormal bleeding
Older patients have a worse prognosis
Uterine fibroids
Benign smooth muscle leiomyoma
Causes infertility, abnormal bleeding, ectopic pregnancy, abdominal mass, urinary frequency
Sharply circumscribed, discrete, firm white tumours
Ovarian neoplasms
Epithelial - arise from the surface mesothelium. Serous tumour, cystadenofibroma
Germ cell - teratoma, choriocarcinoma
Stromal - fibroma
Ovarian cancers are usually solid or papillary adenocarciomas. Spreads to peritoneum and adjacent organs, late presentation.
Testicular neoplasms
Rare, 90% germ cell tumours
Occur in young-middle aged men.
Present as painlessly enlarged tetis
Seminoma - resemble primordial germ cells. prognosis related to differentiation
Teratoma - tissues of the three germ layers represented, more aggressive, prognosis related to differentiation
Fibroadenoma
Benign, localised proliferation of the breast ducts and stroma
Firm, rubbery, well circumscribed
Presents as mobile lump of the breast in young women (25-30)
Grading of breast cancer
Describes cytological changes
Grade 1 - tubular structure
Grade 2: disorganised glandular structure, mitoses
Grade 3: no glands, mitoses, poorly differentiated tissue, pleimorphic nuclei
Presentation of breast tumours on examination
Malignant cancer - hard, irregular surface and diffuse edges
Benign - soft and flat
Depressed nipple
Eczematic change in the nipple (Pagets)
Dimple (if cancer is tethered to skin)
Oedema and orange peel appearance
Benign breast diseases
Fibrocystic disease Papilloma Sclerosing lesions Epithelial hyperplasia Inflammation Benign tumours Developmental
Breast carcinoma in situ
Ductal CIS - duct lined by large tumour cells and fibrosis, distorted acini (appear like ducts), necrosis and calcification. 1/3 become malignant
Lobular CIS - normal lobular architecture, increased size, packed with atypical cells. Risk of invasive cancer in both breasts
