Tumours Of The Reproductive Tract

Question 1

What type of cancers may appear on the vulva?

Answer 1

Squamous cell carcinoma,
Basal cell carcinoma,
Melanoma,
Soft tissue tumours.

Question 2

What does in situ mean?

Answer 2

Tumour has not yet breached the basement membrane. No invasion.

Question 3

What percentage of vulval SS carcinomas are related to HPV?

What are others associated with?

Answer 3

30%.

70% associated with longstanding inflammatory conditions.

Question 4

Where does vulval cancer often spread to?

Answer 4

Anus vagina and bladder directly.
Inguinal, iliac and paraaortic lymph nodes.
Lung and liver.

Question 5

How do cervical cancers commonly develop?

Answer 5

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.

Question 6

Which strains of HPV are linked with oral, anal, cervical and vulval cancers?
How so?

Answer 6

HPV 16 and 18.

Produce viral proteins E6 and E7 that inactivate p53 and Rb.

Question 7

What are CIN stages 1-3?

Answer 7

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.

Question 8

What risk factors are there for CIN?

Answer 8

HPV exposure,
Early first pregnancy,
Multiple births,
Smoking,
Immunosuppression.

Question 9

What treatment is done for CIN1, 2 and 3?

Answer 9

1 - regresses spontaneously

2 and 3 - colposcopy alongside large loop excision of transformation zone.

Question 10

When is cervical cancer screened for?

How is it done?

Answer 10

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.

Question 11

What vaccination is there for HPV?

Answer 11

Gardasil against HPV 6,11,16,18

Question 12

What cancers may arise in the cervix?

Answer 12

Squamous cell carcinoma,

Adenocarcinoma.

Question 13

How might invasive cervical cancer present?

Answer 13

Bleeding - postcoital, intermenstrual or post menopausal.

Often picked up after screening.

Question 14

How is invasive cervical cancer managed?

Answer 14

Hysterectomy and lymph node dissection +- chemoradiotherapy.

Question 15

What is endometrial hyperplasia?

Answer 15

Increased gland:stromatolites ratio with endometrium thickened to >7mm. Can precede endometrial cancer.

Question 16

What causes endometrial hyperplasia?

Answer 16

Excess oestrogen.

Obesity, early menarche, late menopause, oestrogen hormone replacement therapy, tamoxifen, PCOS.

Question 17

Which type of endometrial cancer arise from endometrial hyperplasia?
What does it look like on histology?

Answer 17

Endometrioid adenocarcinoma.

Resembles normal endometrial glands.

Question 18

What type of endometrial cancer is less common, but more aggressive than other cancers?

Answer 18

Serous adenocarcinoma. Poorly differentiated.

Question 19

Where does endometrioid adenocarcinoma spread to?

Answer 19

Stage 2 - into cervix,
Stage 3 into ovary (a) or vagina (b),
3c - lymph nodes,
4a - bladder or bowel.
4b - other organs.

Question 20

How does serous adenocarcinoma commonly spread?

Answer 20

Exfoliates, travels through Fallopian tubes and deposits on peritoneal surface (transcoelomic spread)

Question 21

What are the collections of calcium seen in serous adenocarcinoma called?

Answer 21

Psammoma bodies.

Question 22

How is endometrial cancer managed?

Answer 22

Hysterectomy or bilateral salpingoophorectomy if necessary. +- lymph node dissection and chemoradiotherapy.

Question 23

What are fibroids?

Answer 23

Leiomyomas. Benign tumours of the myometrium. Well circumscribed, pale and homogenous.

Question 24

How might leiomyoma present?

Answer 24

Pelvic pain, heavy periods, urinary frequency.

Question 25

What description is used for leiomyomas on histology?

Answer 25

Whorled intersecting fascicles of smooth muscle cells.

Question 26

Where do leiomyosarcomas commonly metastasise to?

Are they related to leiomyomas?

Answer 26

Lungs.

No.

Question 27

How do ovarian cancers present?

Why is diagnosis often delayed?

Answer 27

Abdominal pain and distension,
Urinary and GI symptoms,
Hormonal disturbance.
Vague symptoms are hard to pinpoint so diagnosis is made late.

Question 28

What cancer marker can be used to detect and monitor ovarian cancer?

Answer 28

Ca-125

Question 29

Which gene is associated with development of ovarian cancer?

What type of cancer is it associated with?

Answer 29

BRCA1/2,

associated with high grade serous cancers.

Question 30

What types of adenocarcinoma may arise in the ovary?

Answer 30

Serous,
Mucinous,
Endometrioid.

Question 31

Why is the maturity of teratomas important?

Answer 31

The more mature the cell types are, the less likely the tumour is to be malignant.

Question 32

List some types of germ cell tumour

Answer 32

Choriocarcinoma,
Yolk sac tumour,
Embryonal carcinoma,
Dysgerminoma in ovary,
Seminoma in testes.

Question 33

What do theca and granulosa cell tumours secrete?

Answer 33

Oestrogen

Question 34

What do sertoli and Leydig cell tumours secrete?

How might women with these tumours present?

Answer 34

Testosterone.
Infertility,
Amenorrhea,
Hirsuitism,
Breast atrophy

Question 35

What are krukenberg tumours?

Answer 35

Metastatic GI tumours that grow upon the ovary. Identified by signet cell appearance on histology.

Question 36

What is the largest risk factor for testicular cancer?

Answer 36

Cryptorchidism (undescended testicle)

Question 37

Which tumour marker do choriocarcinoma secrete?

What about yolk sac tumours?

Answer 37

Beta HCG.

Alpha fetoprotein.