Tumours Of The Repro Tract Flashcards
Descrb ethe epidemiology of Vivaldi cancer
Uncommon
• 3% of all female cancers
• 1,339 new cases in 2015
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What types of cancers usually arise in he vulva and wha are the clinical features
• Usually squamous cell carcinoma (90%)
– Others
• Melanoma
• Basal Cell Carcinoma
• SCC clinical features
– Lumps/ulcers/skin changes
Describe the hisptoly of vulval cancer
Sheets of atypical cells. No basement membrane. We know its acc bc of areas of ketatinasiauon - keratin pearls
What is VIN and describ ethe histology
Vulval Intraepithelial Neoplasia (VIN) • In situ precursor of vulval squamous cell carcinoma – May or may not develop into SCC • Atypical squamous cells • Confined to epidermis – No invasion bast basement memo (SS)
Are vin and vulval acc related to Hpv
Ss
How does vulval cancer spread?
• Direct extension – Anus – Vagina – Bladder • Lymph nodes that supply the vulva – Inguinal – Iliac – Para-aortic • Distant Metastases – Lungs – Liver
What is the cervix transformation zone
Before menstruation Ectocervix is exposed acidic environment of vagina. Stratid squmaous to Thea with it. Ectocervix - simple Columbia
After menstruatio - estroge - cervix everts outside - columnar - exposed to Lowe pH. Area or inflammation - ectropian
Simple columnar epithelium undergoes metaplasia into stratified squamous to adapt to low pH - metaplasia
What is hpv
• DNA virus - can be sexually transmitted
• Many subtypes
– HPV 6 & 11 = anogenital warts
– HPV 16 & 18 = high risk subtypes
• Infects transformation zone
• Produce viral proteins E6 & E7
• These inactivate tumour suppressor
genes (p53 and Retinoblastoma )
• Results in uncontrolled cell growth and proliferationWhat is CIN
• Cervical Intraepithelial Neoplasia – Dysplasia – Confined to cervical epithelium (in situ - doesnt break through bm ) – Caused by HPV infection – Divided into CIN 1, 2, 3 • Increasing thickness of dysplasia • Increasing risk of progression to invasive squamous cell carcinoma
What ae teh risk factors for cin
• Increased risk of exposure to HPV: – Sexual partner with HPV – Multiple partners – Early age of first intercourse • Early first pregnancy • Multiple births • Smoking • Low socio-economic class • Immunosuppression
What are the treatments from cin
• CIN1 – Often regresses spontaneously – Follow up cervical smear in 1 year • CIN2 & 3 – Needs treatment: – Large Loop Excision of Transformation Zone (LLETZ) - Excised - sent to lab - check if vin is there and if it had ben completely excised
What is the cervical cancer screening programme
Brush used to scrape cells from transformation zone – sent for cytological assessment
Significant reduction in rates of cervical cancer
• Aged 25 – 49 = every 3 years
• Aged 50 – 64 = every 5 years
• Over 65 – only if recent
abnormality
Describe the hpv vaccine
• Gardasil – Vaccination against high risk HPV subtypes (6,11,16,18) – Given aged 12-13 – Protection from • Cervical, vulval, oral, anal cancer – Not given to men… • HPV -> penile cancer • Men are carriers for HPV
Describe teh presentation of invasive cervical cancer
• Presentation
– Post-coital, inter menstrual, post-menopausal bleeding
– Mass
• exophytic and infiltrative – Screening
What is figo staging
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Describe teh treatment of invasive cervical cancer
If advanced: • Hysterectomy • Lymph node
dissection • Chemoradiotherapy
Describe the histology of the endometrium
The fact that there are glands an stroke doesn’t hinge. In endometrium, gland lining tends to be columnar. Intervening stroma cells support and architecture
Describe endometrial hyperplasia
Thickened endometrium
>11mm
Can be a precursor to endometrial cancer
Inter- menstrual/post- menopausal bleeding
What is endometrial hyperplasia caused by
• Caused by excessive oestrogen
– Endogenous
• Obesity (androgens -> oestrogens — More peripheral fat, more of this conversion within it, more oestrogen)
• Early menarche/late menopause (More mentruamtion, more oestrogen exposure)
• Oestrogen secreting tumours (e.g. Granulosa cell tumour)
– Exogenous
• Unopposed oestrogen HRT (Estrogen not given if they have a uterus - need progesterone too)
• Tamoxifen (Er receptor positive breast cancer. It blocks receptors in breast but activates oestrogen receptors in the endometrium - agonist)
– Irregular cycles
• PCOS (Polycystic Ovary Syndrome)
Describe the epidemiology f endometrial cancer
Most common gynaecological tract cancer
Describe the presentation of endometrial cenacle
Presentation • Intermenstrual bleeding • Postmenopausal bleeding •if it progresses, palpable Mass
What are the types of endometrial cancer
Endometrioid Adenocarcinoma
- Most common
• Resembles normal endometrial glands
• Commonly arises from endometrial hyperplasia
Subtypes into endometrioid and serous .
Endometrioid - still glands , but glands ar fusing together, cels piling up, and no stroma.
Decsribe the sprea of endometrioid cancer
Ss
Describe serous carcinoma
Serous • Less common • More aggressive • Poorly differentiated cells Massive nuclei that look different from ach other. Irregular chromatin. Mitotic bodies.
Describe the spread of serous carcinoma
Exfoliates
Travels through Fallopian tubes
Deposits on peritoneal surface
Associated with collections of calcium (Psammoma bodies)
How is endometrial cancer manages
- Hysterectomy
- Bilateral salpingo-oophrectomy
- +/- lymph node node dissection
- +/-chemo radiotherapy
What is a leiomyoma
Tumour of the myometrium Leiomyoma (fibroid) • Most common tumour of myometrium • Benign • Pale, homogenous, well circumscribed mass
Scribe the presentation of leiomyoma
Vast range of sizes Presentation • Asymptomatic • Pelvic pain • Heavy periods • Urinary frequency (bladder compression)
Describe teh histology of leiomyoma
Whorled, intersecting fascicles of benign smooth muscle cells
Not much variation. Slightly unusually arrangement. - streaming. These are called fascia=cels. They ae intersecting. Some have spindle nuclei and some are rounder - but this is due to the blame of the section. Benign.
Describe teh histology. Of meiomyosarcoma
Malignant tumour of smooth muscle Cells are bizarre and atypical Doesn’t arise from a leiomyoma Metastases to lung common Mitotic figures. No fascicles.
Desribe the presentation of ovarian cancer
• Presentation
– Early symptoms – vague and non specific
- Delayed diagnosis
– Later symptoms • Abdominal pain • Abdominal distension • Urinary symptoms • Gastrointestinal symptoms • Hormonal disturbances
What are Ca-125 and brca1/2
• Ca-125
– Serum marker
– used in diagnosis and monitoring for recurrence
• Some cancers associated with BRCA1/2 mutations
– High grade serous cancers
– Prophylactic salpingo-oophrectomy
Where can tumours arise from in the ovaries
Lined by
epithelium
• Epithelial tumours
Contains germ cells
• Germ cell tumours
Contains stromal
cells
• Sex cord stromal. tumours Is also a site for metastatic spread
Descrbe ovarian epithelial tumours
• Often present as cystic masses • Histological subtypes: – Serous – Mucinous – Endometrioid • Can all be: – Benign – Borderline (Increased atypia, no stromal invasion) – Malignant
Describe ovarian serous tumours
Highly atypical, pleomorphic cells
Bizarre atypical cells - clumps and sheets
Often show Psammoma Bodies
Often spreads to peritoneal surface
Transcoelomic spread - into serous cavities - biopsies from onetime, peritoneum, - impact on staging and prognosis
What are ovarian mutinous tumours
Atypical epithelial cells
Secreting mucin
Nuclei are piled up - some mitotic bodies. - may b e malignant
Descrbe varian endometrioid tumours
Glands resembling endometrium
May arise in endometriosis
May have synchronous endometrial endometrioid adenocarcinoma
Cells piling up, mitotic bodies. May arise in endometriosis.
What is a teratoma
Most common germ cell tumour Three subtypes: • Mature (benign) - hair and teeth can be in them • Immature (malignant) • Monodermal (highly specialised)
What is a mature teratoma
Aka dermis cyst Contain fully mature, Skin differentiated tissue from all germ cell layers Can haeve g, resp, neural, skin tissue, etc Can be bilateral Cartilage Often contains skin + hair GI epithelium structures
What are immature teratomas
• Contains immature, embryonal tissue
• Malignant
- Tissue thats not able to differentiate - indicated malignancy
What is a monodetmal teratoma
Teratoma comprised almost entirely of one fully differentiated tissue type
Most common = thyroid tissue (Struma Ovarii)
Benign
Can cause hypo/hyperthyroid -ism
Whar are some other germ cell tumours
- Dysgerminoma (equivalent of Seminoma in testes)
- Choriocarcinoma
- Embryonal Carcinoma
- Yolk Sac Tumour
- All are malignant
Whar are sex cord stromal tumours
• From ovarian stroma
– Stroma derived from sex cord of embryonic gonad
– Sex cord produces
• Sertoli and Leydig cells in the testes
• Granulosa and Theca cells in the ovaries
– Tumours resembling all these cell types can arise in the ovary
What are theca and granulosa cell tumours
• Produce oestrogen – Patient pre-puberty? • Precocious puberty – Adult patient? • Breast cancer • Endometrial hyperplasia • Endometrial carcinoma
Describe sertoli and leydig cell umours
• Produce testosterone – Patient pre-puberty? • Prevents normal female pubertal changes – Adult patient? • Sterility • Amenorrhoea • Hirsuitism • Male pattern baldness • Breast atrophy
Describe metastases to ovary
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Give an overview of testicular cancer
• Risk factor: – Cryptorchidism (undescended testicle) • Presentation: – Mass +/- pain • Investigations: – Scans (Ultrasound) – Tumour markers
What are subtypes of testicular cancer
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Describe testicular cancer tumour markers
• Used in germ cell tumour diagnosis/assessing response to treatment
• β hCG
– Choriocarcinoma
• Alpha fetoprotein (AFP)
– Yolk Sac tumours
• Tumours may be benign/malignant depending on age of patient
Tumours that arise in adults tend to be mixed. - more than one subtype - more than 1 marker elevated
