Tumours of Reproductive Tract

Question 1

What is the most common type of vulval cancer?

Answer 1

Squamous cell carcinoma

Question 2

What are the clinical features of vulval cancer?

Answer 2

Lumps
Skin changes
Ulvers

Question 3

What is VIN?

Answer 3

Vulval intraepithelial neoplasia

In situ precursor to vulval SCC - atypical cells confined to epidermis

Question 4

Where can vulval cancer spread?

Answer 4

Direct

• anus
• vagina
• bladder

Lymph nodes

• inguinal
• iliac
• para-aortic

Mets

• lungs
• liver

Question 5

What is the cervical transformation zone?

Answer 5

During puberty - oestrogen increases
Cervix exerts - simple columnar epithelium is exposed to low vaginal pH
Metaplasia (stratified squamous) occurs = transformation zone

Question 6

What HPV subtypes are a risk for cervical cancer?

Answer 6

HPV 16

HPV 18

Question 7

How does HPV increase risk of cervical cancer?

Answer 7

Infects transformation zone
Produces viral proteins E6 + E7
E6/7 inactivate tumour suppressor genes
Results in uncontrolled cell growth

Question 8

What is CIN?

Answer 8

Cervical intraepithelial neoplasia

Dysplasia caused by HPV confined to cervical epithelium

Question 9

What are the stages of CIN?

Answer 9

CIN 1 - mild
CIN 2 - moderate
CIN 3 - severe

Question 10

What are risk factors for CIN/cervical cancer?

Answer 10

Increased risk of HPV 
Early pregnancy 
Multiple births
Smoking 
Immunosuppression

Question 11

What is the management for CIN1?

Answer 11

Often regresses spontaneously

Follow up smear in 1 year

Question 12

What is the management for CIN2/3?

Answer 12

Large loop excision of transformation zone

Question 13

When should you receive a cervical smear?

Answer 13

25-49 = every 3 years
50-64 = every 5 years
65 + = only if recent abnormality

Question 14

What are the common types of cervical cancer?

Answer 14

SCC

Adenocarcinoma

Question 15

How does cervical cancer present?

Answer 15

Bleeding

• post-coital
• intermenstrual
• post menopausal

Mass

Question 16

How is cervical cancer staged?

Answer 16

Stage 1 = confined to cervix
Stage 2 = disease beyond cervix
Stage 3 = disease to pelvic wall or lower 1/3 of vagina
Stage 4 = invades bladder, rectum or metastases

Question 17

How is cervical cancer managed?

Answer 17

Hysterectomy
Lymph node dissection
Chemoradiotherapy

Question 18

What is endometrial hyperplasia?

Answer 18

Thickened endometrium >11mm

Precursor to endometrial cancer

Question 19

What causes endometrial hyperplasia?

Answer 19

Excessive oestrogen

Question 20

How does endometrial cancer present?

Answer 20

Intermenstrual bleeding
Postmenopausal bleeding
Mass

Question 21

What are the types of endometrial cancer?

Answer 21

Endometrioid adenocarcinoma

Serous

Question 22

What is endometrioid adenocarcinoma?

Answer 22

Most common endometrial cancer

Resembles normal endometrial glands

Question 23

How is endometrioid adenocarcinoma staged?

Answer 23

Stage 1 = in endometrium 
Stage 2 = cancer grown into cervix
Stage 3a = cancer spread into ovary 
Stage 3b = cancer spread into vagina 
Stage 3c = cancer spread into lymph nodes
Stage 4a = cancer in bladder/bowel 
Stage 4b = cancer in distant organ

Question 24

What is serous endometrial cancer?

Answer 24

More aggressive cancer with poorly differentiated cells

Question 25

How does serous carcinoma spread

Answer 25

Exfoliates Travels through fallopian tubes Deposits on peritoneal surface Associated with psammoma bodies - calcium collections

Question 26

How is endometrial cancer managed?

Answer 26

Hysterectomy Bilateral sapingo-oophrectomy +/- lymph node dissection +/- chemoradiotherapy

Question 27

What tumours can affect the myometrium?

Answer 27

Leiomyoma | Leiomyosarcoma

Question 28

What is leiomyoma?

Answer 28

Benign, well circumcised tumour in myometrium

Question 29

How does a leiomyoma present?

Answer 29

Asymptomatic Pelvic pain Heavy periods Urinary frequency - bladder compression

Question 30

What is leiomyosarcoma?

Answer 30

Malignant tumour of smooth muscle

Question 31

How does ovarian cancer present?

Answer 31

Early symptoms = vague Late symptoms - abdo pain - abdo distension - urinary symptoms - hormonal disturbances

Question 32

What is a serum marker for ovarian cancer?

Answer 32

Ca-125

Question 33

What are the subtypes of ovarian tumours?

Answer 33

Epithelial Germ cell Sex cord stromal

Question 34

What types of epithelial ovarian tumours are there?

Answer 34

Serous Mucinous Endometrioid

Question 35

What is the appearance of ovarian serous tumours?

Answer 35

Highly atypical pleomorphic cells Often show psammoma bodies

Question 36

Where can ovarian serous tumours spread?

Answer 36

Peritoneal surface

Question 37

What is the appearance of ovarian mucinous tumours?

Answer 37

Atypical epithelial cells Secrete mucin

Question 38

What is the appearance of ovarian endometrioid tumours?

Answer 38

Glands resembling endometrium

Question 39

What types of germ cell ovarian tumours are there?

Answer 39

``` Teratoma Dysgerminoma Choriocarcinoma Embryonal carcinoma Yolk sac tumour ```

Question 40

What are the types of teratoma?

Answer 40

Mature - benign Immature - malignant Monodermal

Question 41

What is a mature teratoma?

Answer 41

Also known as a dermoid cyst Contains fully mature differentiated tissue

Question 42

What is an immature teratoma?

Answer 42

Contains immature embryonal tissue

Question 43

What is a monodermal teratoma?

Answer 43

Teratoma comprised almost entirely of one cell type Benign

Question 44

What is the most common tissue in a monodermal teratoma?

Answer 44

Thyroid tissue

Question 45

What are the sex cord stromal ovarian tumours?

Answer 45

Tumours resembling - Sertoli-Leydig cells - granulosa-theca cells

Question 46

What is the effect of granulosa/theca cell ovarian tumours?

Answer 46

Produce oestrogen Precocious puberty Endometrial hyperplasia

Question 47

What is the effect of Sertoli/Leydig cell ovarian tumours?

Answer 47

Produce testosterone Sterility Amenorrhea Hirsuitism

Question 48

What cancers commonly metastasise to the ovary?

Answer 48

Breast GI Other gynae tumours

Question 49

What is a risk factor for testicular cancer?

Answer 49

Cryptorchidism

Question 50

What is the presentation of testicular cancer?

Answer 50

Mass /- pain

Question 51

What are the subtypes of testicular cancer?

Answer 51

Germ cell - seminomatous - seminoma - non-seminomatous - teratoma Non-germ cell - sex cord stromal - Leydig/Sertoli

Question 52

What are testicular cancer markers?

Answer 52

B hCG - choriocarcinoma Alpha fetoprotein - yolk sac tumours