Tumours Of The Reproductive Tract Flashcards
What type of cancers may appear on the vulva?
Squamous cell carcinoma,
Basal cell carcinoma,
Melanoma,
Soft tissue tumours.
What does in situ mean?
Tumour has not yet breached the basement membrane. No invasion.
What percentage of vulval SS carcinomas are related to HPV?
What are others associated with?
30%.
70% associated with longstanding inflammatory conditions.
Where does vulval cancer often spread to?
Anus vagina and bladder directly.
Inguinal, iliac and paraaortic lymph nodes.
Lung and liver.
How do cervical cancers commonly develop?
Oestrogen causes the cervical columnar epithelium to evert into the vagina, exposing it to acidic conditions and inducing metaplasia. This predisposes to dysplasia, formation of cervical intraepithelial neoplasia and squamous cell carcinomas.
Which strains of HPV are linked with oral, anal, cervical and vulval cancers?
How so?
HPV 16 and 18.
Produce viral proteins E6 and E7 that inactivate p53 and Rb.
What are CIN stages 1-3?
Dysplasia beginning from the basement membrane and progressively rising to the surface layer. Will likely eventually breach the basement membrane and become squamous cell carcinoma.
What risk factors are there for CIN?
HPV exposure, Early first pregnancy, Multiple births, Smoking, Immunosuppression.
What treatment is done for CIN1, 2 and 3?
1 - regresses spontaneously
2 and 3 - colposcopy alongside large loop excision of transformation zone.
When is cervical cancer screened for?
How is it done?
In 25-49 yo - every 3 years.
In 50-64 yo - every 5 years.
A brush is used to scrape cells and these are tested for HPV. If affected, they are looked at under a microscope.
What vaccination is there for HPV?
Gardasil against HPV 6,11,16,18
What cancers may arise in the cervix?
Squamous cell carcinoma,
Adenocarcinoma.
How might invasive cervical cancer present?
Bleeding - postcoital, intermenstrual or post menopausal.
Often picked up after screening.
How is invasive cervical cancer managed?
Hysterectomy and lymph node dissection +- chemoradiotherapy.
What is endometrial hyperplasia?
Increased gland:stromatolites ratio with endometrium thickened to >7mm. Can precede endometrial cancer.
What causes endometrial hyperplasia?
Excess oestrogen.
Obesity, early menarche, late menopause, oestrogen hormone replacement therapy, tamoxifen, PCOS.
Which type of endometrial cancer arise from endometrial hyperplasia?
What does it look like on histology?
Endometrioid adenocarcinoma.
Resembles normal endometrial glands.
What type of endometrial cancer is less common, but more aggressive than other cancers?
Serous adenocarcinoma. Poorly differentiated.
Where does endometrioid adenocarcinoma spread to?
Stage 2 - into cervix, Stage 3 into ovary (a) or vagina (b), 3c - lymph nodes, 4a - bladder or bowel. 4b - other organs.
How does serous adenocarcinoma commonly spread?
Exfoliates, travels through Fallopian tubes and deposits on peritoneal surface (transcoelomic spread)
What are the collections of calcium seen in serous adenocarcinoma called?
Psammoma bodies.
How is endometrial cancer managed?
Hysterectomy or bilateral salpingoophorectomy if necessary. +- lymph node dissection and chemoradiotherapy.
What are fibroids?
Leiomyomas. Benign tumours of the myometrium. Well circumscribed, pale and homogenous.
How might leiomyoma present?
Pelvic pain, heavy periods, urinary frequency.
What description is used for leiomyomas on histology?
Whorled intersecting fascicles of smooth muscle cells.
Where do leiomyosarcomas commonly metastasise to?
Are they related to leiomyomas?
Lungs.
No.
How do ovarian cancers present?
Why is diagnosis often delayed?
Abdominal pain and distension,
Urinary and GI symptoms,
Hormonal disturbance.
Vague symptoms are hard to pinpoint so diagnosis is made late.
What cancer marker can be used to detect and monitor ovarian cancer?
Ca-125
Which gene is associated with development of ovarian cancer?
What type of cancer is it associated with?
BRCA1/2,
associated with high grade serous cancers.
What types of adenocarcinoma may arise in the ovary?
Serous,
Mucinous,
Endometrioid.
Why is the maturity of teratomas important?
The more mature the cell types are, the less likely the tumour is to be malignant.
List some types of germ cell tumour
Choriocarcinoma, Yolk sac tumour, Embryonal carcinoma, Dysgerminoma in ovary, Seminoma in testes.
What do theca and granulosa cell tumours secrete?
Oestrogen
What do sertoli and Leydig cell tumours secrete?
How might women with these tumours present?
Testosterone. Infertility, Amenorrhea, Hirsuitism, Breast atrophy
What are krukenberg tumours?
Metastatic GI tumours that grow upon the ovary. Identified by signet cell appearance on histology.
What is the largest risk factor for testicular cancer?
Cryptorchidism (undescended testicle)
Which tumour marker do choriocarcinoma secrete?
What about yolk sac tumours?
Beta HCG.
Alpha fetoprotein.
