Week 10 - Female Genital Tract Flashcards
What are the risk factors for squamous intraepithelial lesion (SIL)?
HPV and STI
What are the risk factors for HPV infection?
Young age at first intercourse
Multiple sex partners
Unprotected intercourse
Smoking
Oral contraceptive use
Pregnancy
Diabetes
Immunosuppression
Poor hygiene
Long form of HPV
Human papillomavirus
What are prevention techniques to avoid HPV?
o Safe sex practice (ex. condom use)
o HPV vaccination
o Cervical screening: Pap test
Describe the process of a pap test
- Cervical cells are scraped from the transformation zone using a spatula or brush
- Sample is put in a fixative and sent to the pathology lab
- Cells are processed and prepared on glass slides
- Cells are examined under a microscope to detect dysplastic changes
Describe the location and zones of the cervix
- Lowermost portion of the uterus
- Connects vagina and uterus
- Ectocervix (composed of squamous epithelium)
- Transformation zone
- Endocervix (composed of glandular epithelium)
Where is the most common site for cervical neoplasia to occur?
Transformation zone (of the cervix)
Describe the transformation zone (of the cervix)
area of squamous metaplasia where there is a transition from squamous epithelium to glandular (endocervical) epithelium
Almost all cervical cancer is preceded by pre-cancerous changes in the cervical epithelial cells called
cervical dysplasia
Cervical dysplasia (pre-cancerous) can be detected by what?
A pap test
A pap test allows for what?
earlier intervention (removal) and therefore a dramatically reduced incidence of invasive cancer in the cervix
When cervical dysplasia is detected by a pap test, what happens?
- Patients with low grade lesions
o Repeat pap test in 6 months since many low-grade lesions spontaneously regress - Patients with high grade lesions
o If the pap smears are consistently abnormal
Glandular lesion or high grade SIL is detected, the patient is investigated by colposcopy - Direct examination of the cervix under magnification and biopsy confirmation
cervical squamous dysplasia high grade lesions are …
a precursor lesion to invasive cancer
cervical squamous dysplasia low grade lesions such as genital warts are…
low risk of progression to invasive cancer
What percentage of cervical cancers are squamous cell carcinomas?
90%
What are cervical cancer risk factors?
Same as SIL - HPV and STIo Co-factors such as immunodeficiency (HIV positive and transplant patients) also play a role
o A history of never having had a Pap smear is often obtained from women with cervical cancer
Describe the clinical presentation of cervical cancer
o Abnormal vaginal bleeding, especially post-coital spotting
Typically cervical cancer spread invades where?
locally into vagina, rectum, bladder, and metastasize to regional lymph nodes
Entrapment of the ureters in advanced cases of cervical cancer can result in what?
Urinary obstruction and lead to uremia and death
treatment and prognosis of cervical cancer depend on what?
the stage of the cancer
prognosis/survival for low stage cervical cancer is what?
excellent - around 90%
prognosis/survival for advanced stage cervical cancer is what?
less than 20%
Advanced cases of cervical cancer are treated with what?
radiotherapy
early invasive cases of cervical cancer are treated how?
Early invasive cases can be locally exercised (cone excision) or treated with radial surgery (hysterectomy – removal of the uterus, cervix, and paracervical connective tissues).
When should cervical cytology screening start? (Pap test)
21 years of age for women who are or have been sexually active; if normal, screening should be done every 3 years
screening (pap test) may be discontinued at what age?
70 if there is an adequate negative cytology screening history in the previous 10 years (i.e., 3 or more negative cytology tests)
What are the cell types in the ovary?
o Surface epithelium (and epithelial inclusions)
o Germ cells
Egg production
o Stroma and sex cord cells
Granulosa, theca, and Leydig cells
Support the germ cells
Produce hormones
What are the functions of the ovaries?
- Facilitates maturation of oocytes for ovulation.
- Production and secretion of sex hormones
Which type of ovarian tumour is more common in adults?
epithelial tumours are most common
Which type of ovarian tumour is most common in younger/adolescents?
germ cell tumours are more common
(Ovarian) carcinoma is more likely in who?
post-menopausal females
In general, most ovarian tumours are what?
Benign
Describe benign epithelial ovarian tumours
- Variety of microscopic subtypes (e.g., serous, mucinous, etc.)
- Often large and cystic, but lack solid growth of tumour cells and invasion
Describe malignant epithelial ovarian tumours
- Variety of microscopic subtypes
o E.g., serous, mucinous, etc. - Most common form of “ovarian cancer” = ovarian carcinoma (meaning arose from epithelial cells)
- Leading cause of death from gynecologic malignancy (even through not the most frequent gynecologic malignancy)
What is the most common form of “ovarian cancer”
Ovarian carcinoma (a malignant epithelial ovarian tumour)
Which type of FGT cancer is the leading cause of death from gynecologic malignancy?
Ovarian carcinoma
What is the most common malignancy in the female genital tract?
Endometrial cancer
What is the most common neoplasm of the female genital tract?
Leiomyoma (benign)
What is the prognosis of ovarian carcinoma and why?
has a poor prognosis because:
o Often asymptomatic, or mild, non-specific symptoms until cancer is advanced
o No specific screening tests
o Therefore, more likely to present at an advanced stage
What is the clinical presentation of ovarian carcinoma?
Ovarian mass in a post-menopausal woman causing pelvic pain or discomfort, increased abdominal girth
What is the treatment of ovarian carcinoma?
Surgical excision +/- chemotherapy for distant spread
What are the risk factors for ovarian carcinoma?
- Non-modifiable:
a. Increased aged
i. Cancer is rare in patients < 40 years
ii. 50% of ovarian cancers are found in females greater than or equal to 63 years
b. Having children later or never having children
c. Family history of ovarian, breast, or colon cancer
i. Family cancer syndromes
ii. Caused by an inherited mutation - Modifiable:
a. Obesity
b. Taking hormone therapy after menopause
c. Smoking
What is the most common ovarian neoplasm in young females <30 years?
mature cystic teratoma
Mature cystic teratomas are derived from what?
ovarian germ cells
What is the treatment for a mature cystic teratoma?
surgical removal
A mature cystic teratoma is benign as long as what?
All tissues are mature (there is no “immature” neural tissue
What is the most common malignant germ cell tumour?
Dysgerminoma
Describe dysgerminoma
- Most common malignant germ cell tumour
- Female equivalent of a testicular seminoma in males
Don’t need to know more than this
Germ cell tumours (mature cystic teratoma and dysgerminoma) have the capacity to differentiate into a wide variety of mature tissues from all 3 embryonic cell lines/layers that include …
o Ectoderm (skin and skin appendages such as hair and sweat glands)
o Endoderm (respiratory and intestinal epithelium)
o Mesoderm (cartilage, bone, fat)
Ovaries are a site of metastatic cancer spread, most commonly from where?
-GI tract
-breast
-endometrium
metastatic tumours typically involve one or both ovaries?
bilateral (both)
Benign and malignant tumours can arise from what cell types of the ovary?
All cell types
Epithelial tumours (ovary) are generally ______ in younger females, and are more likely ______ in post menopausal women
Benign and malignant, respectively
Describe the uterus
- A hollow muscular organ located in pelvis
- Upper part of the uterus (fundus) is attached to the fallopian tubes
- Lower part of the uterus connected to vagina through the uterine cervix
What is the function of the uterus?
Nurture a developing fetus
What are the 3 layers of the uterus wall?
Mucosa: endometrium (glands, stroma)
o Muscular wall: myometrium
o Peritoneal surface: serosa
endometrial hyperplasia is a precursor to what?
endometrial carcinoma;
- Non-atypical hyperplasia (low risk of progression to carcinoma)
- Atypical hyperplasia (higher risk of concurrent carcinoma or progression to carcinoma 20-50%)
85% of endometrial carcinoma is associated with what?
unopposed estrogen stimulation (low stage tumours and good prognosis)
15% of endometrial carcinoma is what?
estrogen independent (aggressive, more likely to metastasize, worse prognosis)
List the risk factors for endometrial carcinoma (developed by unopposed estrogen)
- Failure to ovulate
- Obesity (increased estrogen produced by fat cells)
- Hormone replacement therapy for menopausal symptoms
- Functional tumours: some ovarian tumours can produce estrogen
What are the common presenting symptoms of endometrial carcinoma?
- Abnormal uterine bleeding
- Post-menopausal vaginal bleeding (need to exclude cancer – must perform an endometrial biopsy)
What is the treatment for endometrial carcinoma?
- Surgery – removal of uterus, fallopian tubes, and ovaries
- Radiation and chemotherapy for higher stage
Leiomyomas are commonly referred to as?
fibroids
What are leiomyomas?
benign tumours of smooth muscle
How common are leiomyomas?
They present in 30-50% of females over 30 years and in 75% of hysterectomy specimens
The growth of leiomyomas is affected by what?
hormonal alterations
Describe the microscopic appearance of leiomyomas
well circumscribed, bundles of smooth muscle cells
What is the clinical presentation of leiomyoma?
- Depends on the size, location, and number of tumours
o Ex. submucosal lesions that impinge on the endometrium are more likely to cause bleeding
o Can be asymptomatic
o Others include:
Pelvic pain
Dysmenorrhea (painful menstruation)
Infertility
