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S3 Reproduction > Tumours Of The Repro Tract > Flashcards

Tumours Of The Repro Tract Flashcards

1
Q

What is a tumour?

A

Clinically detectable lump or swelling

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2
Q

What is a neoplasm and malignant neoplasm?

A

An abnormal growth of cells that persists after the initial stimulus is removed

If malignant: abnormal growth of cells that persist after the initial stimulus removed and invades surrounding tissue with potential to spread to distant sites

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3
Q

Vulval cancers epidemiology, types, presentation, cause, spread

A

3% all female cancers, uncommon, older ppl
Squamous cell carcinoma, basal cell carcinoma, melanoma, soft tissue tumours

Lumps, ulceration, skin changes

30% of cases related to HPV (often 16) peak 60yrs, 70% not related HPV usually associated with long-standing inflammatory co dictions e.g. lichen sclerosis, peak age 80yrs

Spread:

  • direct extension anus/ vagina/ bladder
  • lymph nodes inguinal/ iliac/ para-aortic
  • Distant metastasis lungs/ liver

Keratin whirls SCC, no architecture, irregular borders, polymorphic nuclei, invasion into basement membrane

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4
Q

Where has the biggest risk of dysplasia in the cervix?

A

The transitional zone - columnar epithelium -> squamous cell epithelium (more able to deal with erosive acidic environment)

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5
Q

What is dysplasia?

A

Pre-neoplasticism alteration in which cells show disordered tissue organisation. Not neoplastic bc change reversible

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6
Q

What are the subtypes of HPV and what could they lead to?

A

HPV 6 & 11 -> warts

HPV 16 & 18 -> high risk at transformation zone - produce viral proteins E6 & E7 - inactivate tumour suppressor genes P53 & RBC -> cervical intraepithelial neoplasia

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7
Q

How do ppl get cervical intraepithelial neoplasia? What stages can it be divided into and how does affect management?

A

Dysplasia confined to cervical epithelium
99.5% have HIV
Caused by HPV infection

Divided into CIN 1/2/3:
-1 within epithelium, bottom 1/3 atypical cells
✅often regress spontaneously, flow up cervical smear 1yr
-3 full thickness of epithelium
✅2/3 needs treatment, large loop excision of transformation zone
-Invasive carcinoma SCC

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8
Q

Risk factors for cervical intraepithelial neoplasia and cervical carcinoma and pathological features on histology

A

Increased risk exposure HPV:

  • sexual partner HPV
  • multiple partners
  • early age of first intercourse
  • early first pregnancy
  • smoking
  • multiple births
  • low social- economic status
  • immunosuppression

Pathological features:
Irregular nuclear membrane
Big nuclei
Polymorphism

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9
Q

How do we vaccinate against HPV, who gets them and what does it help protect against?

A

Gardasil - recombinant vaccination, against HPV 6/11/16/18

12-13yrs boys and girls

Cervical/ vulval/ oral/ anal cancers

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10
Q

Presentation of invasive (squamous cell carcinoma) cervical cancer and treatment

A

Bleeding
Post coital
Inter menstrual
Post menopausal

✅if advanced:
Hysterectomy
LN dissection
+/- chemoradiotherapy

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11
Q

What is endometrial hyperplasia, what might this lead to? Signs, causes

A

Thickened endometrium >11mm

Can be a precursor to endometrial cancer

Inter-menstrual/ post-menopausal bleeding

Causes:
XS oestrogen

Endogenous

  • obesity (androgens)
  • Early menarche/ late menopause
  • Oestrogen secreting tumours

Exogenous

  • unopposed oestrogen HRT
  • tamoxifen

Irregular cycle
- polycystic ovary Syndrome

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12
Q

How common is endometrial cancer? Presentation, types and how different types look histologically and spread

A

Most common gynalogical cancer - most common 65-70yrs

80% survival 20yrs

Bleeding
Post menopausal
Intermenstrual
Mass

Types:

  • endometrioid adenocarcinoma most common resembles normal endometrial glands, starts in uterus moves down to cervix then surrounding organs and beyond
  • serous adenocarcinoma less common, more aggressive, poorly differentiated, exfoliates travels through Fallopian tubes, deposits on peritoneal surface (transcoelomic spread) associated collections of calcium (psammoma bodies)
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13
Q

Management of endometrial cancer

A

Hysterectomy

Bilateral salpingo-oophorectomy

+/- LN dissection

+/- chemoradiotherapy

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14
Q

How do we screen for cervical cancer, who gets screened?

A

Brush used to scrape cells from transformation zone

Tested for HPV

If positive - cells looked at under microscope

Aged 25-49 every 3 yrs
50-64 5 yrs
>65 only if recent abnormality

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15
Q

What’s the most common tumour of the myometrium, what does it look like macro and micro, presentation. What’s the other type of tumour?

A

Leiomyoma ( fibroid) - most common tumour, smooth muscle, benign tumour, pale, homogenous, well circumcised mass
- asymptomatic, pelvic pain, heavy periods, urinary frequency, whorled intersecting fascicles of benign smooth muscle cells

Leiomyosarcoma - malignant tumour smooth muscle, atypical cells, metastasis to lungs

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16
Q

Ovarian cancer - presentation, diagnosis

A

Early symptoms:

  • vague and non-specific
  • delayed diagnosis

Late:

  • abdo pain
  • abdo distension
  • urinary symptoms
  • GI symptoms
  • hormonal disturbances

Diagnosis:
Ca-125 serum marker (monitoring recurrence)

BRCA1/2 tumour suppressor genes associated high grade serous cancers, prophylactic salpingo- oophrectomy

17
Q

Types of ovarian cancer.

A

Lined by epithelium - epithelial tumours (serous/ mutinous/ endometriod/ clear cells/ transitional cell)

Germ cell tumours (teratoma, dysgerminoma, choriocarcinoma, embryonic carcinoma, yolk sac tumour)

Sex cord stromal tumours

Metastatic spread

18
Q

Presentation, histological subtypes, features of ovarian endometrial tumours

A

Epithelial tumours:
Serous/ mucinous/ endometrioid all adenocarcinomas

Can all be: benign, borderline (increased atypia, no stromal invasion) or malignant

Ovarian serous adenocarcinoma: highly atypical cells, often show psammoma bodies, often spreads to peritoneal surfaces

Ovarian mucinous adenocarcinoma: atypical epithelial cells secreting mucin

Ovarian endometrioid adenocarcinoma: glands resembling endometrium, may arise in endometriosis

19
Q

features of ovarian germ cell tumours

A
  • teratoma most common, fully differentiated: mature (benign), immature (malignant) Or Monodermal (highly specialised)

Mature teratoma/ dermoid cyst - fully mature, differentiated tissue from all germ cell layers can be bilateral, often contains skin/ hair structures

Immature teratoma - immature, embryonal tissue, malignant

20
Q

Which cell types can cause sex cord stroma tumours of the ovary? how do the different types present In women?

A

Sex cord forms testes = sertoli and leydig cells
And ovaries= granulosa and theca cells
All the above cells can
form ovarian tumours

Theca/ granulosa cells -> oestrogen

  • Pre- puberty precocious puberty
  • Post-puberty breast cancer/ endometrial hyperplasia/ endometrial carcinoma

Sertoli- Leydig cells -> testosterone

  • pre- puberty prevents normal female pubertal changes
  • post- puberty sterility, amenorrhoea, hirsuitism, Male pattern baldness, breast atrophy
21
Q

What are common metastases to the ovary?

A

Breast cancer

GI cancers

Other gynae tumours (endometrial, other ovary, Fallopian tube)

Krukenberg tumour (metastatic GI tumour, often gastric, signet cells)

22
Q

Testicular cancer - risk factors, presentation, investigations

A

Risks factor:
Cryptorchidism (undescended testicle is childhood)

Presentation:
Mass usually unilateral
+/- pain

Investigations:
Scans
Tumour markers - useful, germ cell tumours (betahCG choriocarcinoma, alpha fetoprotein yolk sac tumours)

23
Q

Subtypes of testicular cancer

A

Malignant testicular neoplasm either:
~germ cell either:
- seminomatous (seminoma common young/ spermatocytic seminoma)
OR - non- seminomatous (teratoma, yolk sac tumour, choriocarcinoma, embryonal carcinoma)

OR ~ non germ cell either:
- sec cord stromal (leydig cell tumour/ Sertoli cell tumour) OR - other (lymphoma, metastases)

Different histological subtypes often mixed in same tumour

24
Q

Risk factors for CIN

A 
Smoking 
<18 commencing sexual activity 
Giving birth <16 
Multiple sexual partners
Immunosuppressants 
25-35 yrs

S3 Reproduction (20 decks)

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