Tumours Of The Reproductive Tract Flashcards
Vulval cancers are relatively uncommon.
What type are most of them?
Who’s affected mostly?
Squamous cell carcinomas (produce keratin)
Older women
What causes Vulval Cancer in Older women?
Undone cause, but suspected to be due to chronic irritation and long-standing dermatoses
(Lichen Sclerosus and Squamous Hyperplasia)
What causes Vulval Cancer in Pre-menopausal women?
Main factor appears to be HPV, with invasion developing from precursor- VIN
(Vulval Intraepithelial Neoplasia, doesn’t invade through BM)
Vulval cancer spreads locally.
Where does it metastasise to primarily?
What does definitive surgery include?
Inguinal lymph nodes
Includes removing primary tumour and lymph nodes
In what percentage of cases does HPV cause VIN and Vulval Cancer?
30%
What classification is used to classify Cervical Cancer?
FIGO system
Compare the epithelia of the Endocervix and Ectocervix
Endo;
- Glandular (Simple columnar) epithelium
Ecto;
- Stratified squamous (as in contact with acidic vagina)
What are 2 significant things about the Transformation Zone of the Endocervix?
- This is the part removed for histology in a Loop Excision
- This is where metaplasia occurs between the 2 types of cervical epithelium (can lead to dysplasia and neoplasia)
What percentage of Cervical carcinomas are Adenocarcinomas and Squamous Cell Carcinomas?
Adenocarcinoma- 15%
Squamous cell- 80%
Describe the common aetiology of Cervical Adenocarcinomas and Squamous Cell carcinomas?
- Infection by HPV, which produces E6 and E7
- These proteins inactivate TS genes p53(E6) and pRB(E7)-> Unregulated cell proliferation-> Neoplasia
What is CIN (Cervical Intraepithelial Neoplasia)?
What can CIN lead to?
What is a common cause of CIN?
- Confined Neoplasia of cervical epithelia, without invasion of BM (In Situ)
- Can lead to Squamous Cervical Cell carcinoma
- Commonly due to HPV Infection (99%)
There are 3 classes of CIN.
Explain them
CIN 3: Full thickness of cervical epithelia is displaying abnormal cellular features
CIN 2: Bottom 2/3 “”
CIN 1: Bottom 1/3 ”” (Resolves spontaneously, smear 1 year later)
Since 2008, girls aged 12-13 have been offered HPV vaccine.
How long this vaccine protect against?
Up to 10 years
Suggest some risk factors for CIN-> Cervical cancer
- Multiple partners or one with confirmed HPV
- Early age of 1st intercourse
- Smoking
- Early 1st pregnancy
- Low socioeconomic status
- Immunosuppression
Anything that could increase HPV exposure
Cervical screening is done to detect a pre-invasive lesion and excise the involved area completely
(Colposcopy to look for, Diathermy to remove)
What does cervical screening look for?
Cells with abnormally enlarged nuclei and abnormal chromatin (dyskaryotic cells)
Where can cervical cancer spread to?
What structures can be affected locally?
How does this present?
- Initially to the Iliac lymph nodes, then to Aortic nodes, before systemic spread
- Ureters, Bladder, Rectum
- Pain and fistula formation
What can HPV cause in men?
Oral and Anal cancers
Hence vaccinated, but also to achieve herd immunity
How can Invasive Cervical cancer present?
Bleeding;
- Inter menstrual
- Post menopausal
- Post coital
- Possible palpable abdominal mass
Define Endometrial Hyperplasia
What is it caused by?
How is it investigated?
What can it lead to?
- Increased Gland to Stroma ratio of endometrium
- Excessive Oestrogen (Obesity)
- USS to look at thickness
- Biopsy if thickness> 7mm
- Can progress to Invasive Endometrial Endrometroid Carcinoma
How can Obesity causes excessive endogenous oestrogen
List 5 other causes of excessive oestrogen
Adipocytes can convert androgens to oestrogen
- Oestrogen secreting tumour
- Early Menarche or Late Menopause (More oestrogen made over lifetime)
- Oestrogen administration (Pill, HRT)
- Tamoxifen (Used to treat breast cancer)
- Irregular menstrual cycles (PCOS)
Endometrial Adenocarcinoma occurs in Peri-menopausal and Older women.
What are 2 types of Endometrial Adenocarcinoma?
How do they differ in incidence and outcome?
- Endometroid (More common)
- Serous (More aggressive, with worse prognosis)
When can advanced endometrial carcinoma spread to?
Compare the method of spread of Serous and Endometroid carcinoma
(Direct invasion, Via blood, via lymph, Transcoelomic)
Cervix, Bladder, Rectum
- Endometroid: Lymphatics and Direct Invasion
- Serous: Transcoelomic
What sign of Serous Carcinoma may you see on histology?
Psammoma Bodies: Spherical collections of Ca
Dark purple in colour
How can Endometrial cancer be treated
- Surgery (Removal of Cervix, Uterus, Fallopian tubes, possibly lymph nodes)
- Possibly Radio and Chemo
