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Repro > Tumours of the repro tract 2 > Flashcards

Tumours of the repro tract 2 Flashcards

1
Q

How common is endometrial cancer?

A

Most common gynaecological cancer

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1
Q

Age of peak endometrial cancer

A

65-70

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2
Q

Presentation of endometrial cancer

A

Bleeding - post menopausal, intermenstrual (common symptom for cancer of repro tract)
Palpable mass

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3
Q

Two types of endometrial

A

Endometrioid adenocarcinoma
Serous adenocarcinoma

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4
Q

Which endometrial cancer is more common?

A

Endometrioid adenomcarcinoma

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5
Q

Appearance of endometrioid adenomcarcinoma

A

Resembles normal endometrial glands
Commonly arises from hyperplasia

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6
Q

Appearance of serous adenocarcinoma

A

Less common, more aggressive
Poorly differentiated cells - DO NOT resemble normal

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7
Q

Spread of endometrioid endmometrial adenocarcinoma vs serous endometrial adenocarcinoma

A

Endometrioid - direct, lymph or blood vessel spread

Serous - exfoliates (breaks off) and travels through fallopian tubes to peritoneal cavity - TRANCOELEMIC spread

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8
Q

What are serous endometrial adenocarcinomas associated with on histology?

A

Psammoma bodies - collections of calcium which stain very dark purple blobs

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9
Q

Management of endometrial cancer

A

Hysterectomy
Bilateral salpino-oophorectomy (removal of both tubes and ovaries)
+/- lymph node dissection or chemoradiotherapy

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10
Q

What two tumours can occur in myometrium?

A

Leiomyoma
Leiomyosarcoma

(smooth muscle benign tumour and malignant)

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11
Q

What is a leiomyoma?

A

Fibroid
Most common tumour of myometrium
Benign
Pale, homogenous (same throughout) well circumscribed (borders good) mass

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12
Q

Presentation of leiomyoma

A

Asymptomatic if small
Pelvic pain
Heavy periods
Urinary frequency - bladder compression
Or GI symptoms from compression

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13
Q

Appearance of leiomyoma on histolofy

A

Whorled intersecting fascicles (streams) of benign smooth muscle cells

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14
Q

What is a leiomyosarcoma?

A

Malignant tumour of smooth muscle
Atypical cells
DOES NOT arise from leiomyoma

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15
Q

Where does leiomyosarcoma often metastasise to?

A

Lung

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16
Q

Early symptoms of ovarian cancer

A

Vague and non-specific - means its hard to diagnose and often delayed

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17
Q

Later symptoms of ovarian cancer and why

A

From the mass effect:
Abdominal pain and distension
Urinary symptoms
GI symptoms
Hormonal disturbances

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18
Q

Tumour marker for ovarian cancer

A

Ca-125 - can be used for diagnosis or monitoring recurrence post treatment

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19
Q

Genetic predispostion for ovarian cancer and what it is associated with

A

BRCA1/2 gene - tumour suppressor gene mutation
Associated with high grade SEROUS cancers

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20
Q

What do those with BRCA1/2 gene sometimes undergo?

A

Prophylactic salpingo-oophorectomy (removal of fallopian tubes and ovary)

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21
Q

Types of tumours that can occur within ovary (4)

A

Epithelial tumours - lined by this
Germ cell tumours - contains germ cells
Sex cord stromal tumours - contains these
Also a site for metastasis

22
Q

How do ovarian epithelial tumours often present?

A

cystic masses - sac lined by epithelium containing fluid

23
Q

Histological subtypes of ovarian epithelial tumour

A

Serous adenocarcinoma
Mucinous adenocarcinoma
Endometroid adenocarcinoma

24
Q

What can all the subtypes of epithlial ovarian cancer be?

A

Benign
Borderline - increased atypia but no stromal invasion
Malignant - BM invasion

25
Q

Ovarian serous adenocarcinoma on histology

A

Highly atypical cells

Exfoliating cells - spread the same way as endometrial serous adenocarcinoma, can spread to peritoneal surface

Often show psammoma bodies - like endometrial serous adenocarcinoma

26
Q

Ovarian mucinous adenocarcinoma appearance histology

A

atypical epithelial cells
Secreting mucin - white filled blobs, look like goblet cells

27
Q

Ovarian endometrioid adenocarcinoma appearance

A

Glands resembling endometrium
Can have syncronous endometrial endometrioid adenocarcinoma at same time

28
Q

When can ovarian endometrioid adenocarcinomas arise?

A

In endometriosis

29
Q

What is the most common germ cell tumour?

A

Teratoma

30
Q

Three subtypes of teratoma

A

Mature - benign (more scary looking)
Immature - malignant
Monodermal - highly specialised

31
Q

What is a mature teratoma?

A

Dermoid cyst
Fully mature, differentiated tissue from all germ layers
Can be bilateral and often contains skin + hair structures

32
Q

Other types of germ cell tumours

A

Dysgerminoma (same as seminoma in testes)
Choriocarcinoma
Embryonal carcinoma
Yolk sac tumour

(these are ALL malignant)

33
Q

Where do sex cord stromal tumours arise from in female?

A

Ovarian stroma

34
Q

Sex cords in male vs female which can cause sex cord stromal tumours

A

Male - testes sertoli cells or leydig cells

Female - ovaries granulosa cells or theca cells

Tumours resembling any of these can arise in ovary

35
Q

What do theca and granulosa cell tumours do?

A

Produce oestrogen so cause symptoms associated with this
If patient is pre-puberty - precocious puberty (early)
If post puberty - breast canceer, endometrial hyperplasia –> endometrial carcinoma

36
Q

What do sertoli-leydig tumours produce?

A

Testosterone so get symptoms associated with this
If pre-pubertal - prevents normal female pubertal changes
If post puberty - infertility, amenoorhoea, hirsuitism, male pattern baldness, breast atrophy

37
Q

What cancers often metastasise to ovary?

A

Breast
GI
Krukenberg tumour - from GI, often gastric, causes signet cells
Other gynae eg endometrial, other ovary, fallopian tube

38
Q

Risk factor for testicular cancer

A

Cryptorchidism - undescended testicle
Need to ask about surgical history of orchidopexy

39
Q

Presentation of testicular cancer

A

Mass palpable in teste +/- pain

40
Q

Investigations for testicular cancer

A

US scan
Tumour markers - BhCG and alpha fetoprotein

41
Q

When are testicular cancer tumour markers useful?

A

In germ cell tumours

42
Q

When is BhCG raised?

A

In choriocarcinoma

43
Q

When is alpha fetoprotein raised?

A

Yolk sac tumours (+liver cancer)

44
Q

Two types of malignant testicular neoplasm

A

Germ cell and non-germ cell

45
Q

Two types of germ cell tumour

A

Seminomatous and non-seminomatous

46
Q

Two types of seminomatous tumours

A

Seminoma
Spermatocytic seminoma

47
Q

4 types of non-seminomatous germ cell tumour

A

Teratoma
Yolk sac tumour (AFP)
Choriocarcinoma (BhCG)
Embryonal carcinoma

48
Q

Two types of non-germ cell tumours

A

Sex cord stromal tumours or other

49
Q

Types of sex cord stromal tumours

A

Leydig or sertoli cell tumour

50
Q

Other non germ cell tumours

A

Lymphoma/mets

51
Q

Causes of excessive oestrogen (which can cause endometrial hyperplasia and then cancer)

A

Endogenous:
Obesity - fat cells convert androgens to oestrogen
Early menarche/late menopause - more ovulations so more oestrogen exposure over life
Oestrogen secreting hormones

Exogenous:
Unapposed HRT oestrogen - need progesterone usually to appose
Tamoxifen - used to treat oestrogen receptor +ve breast cancer, inhibits receptor in breast but activates in endometrium

Irregular cycle - PCOS

52
Q

What type are testicular cancers often?

A

Mixed of different subtypes within same tumour

Repro (22 decks)

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