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3 Reproduction Unit > 19 Tumours of the Reproductive Tract > Flashcards

19 Tumours of the Reproductive Tract Flashcards

1
Q

How common are vulval cancers?

A

Uncommon (3% all female cancers)

Tend to arise in older patients

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2
Q

What types of vulval cancer are there? (4)

A
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3
Q

What clincal feastures might you get for a vulval cancer?

A

Lumps

Ulceration

Skin changes

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4
Q

What is shown in the following histology?

A
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5
Q

What is vulval intraepithelial neoplasia? (VIN)

A

In situ precursor of vulval squamous cell carcinoma

Atypical cells- no invasion through basement membrane

May or may not develop into squamous cell carcinoma

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6
Q

Are vulval squamous cell carcinomas (and VIN) linked to HPV?

A
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7
Q

How does vulval cancer spread?

A
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8
Q

Fill in the missing labels for a pre-menarchal cervix:

A
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9
Q

What happens to the cells around the external os as a woman enter reproductive age?

A
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10
Q

Give 2 high risk subtypes for HPV (human papilloma virus) and 2 low risk subtypes:

A
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11
Q

How does HPV (16 and 17) increase someones risk of neoplasia? (think viral proteins and tumour supressor genes)

A
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12
Q

What is cervical intraepithelial neoplasia? (analogous to VIN)

A
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13
Q

What are the risk factors for cervical intraepithelial neoplasia and cervical carcinoma?

A
  1. HPV exposure
    1. Eg early first age sexual intercourse, multiple partners
  2. Early first pregnancy
  3. Multile births
  4. Smoking
  5. Low socioeconomic status
  6. Immunosuppression
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14
Q

How is CIN staged?

A
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15
Q

How is CIN treated? (screening- smear)

A

CIN 1- follow up with cervical smear- 1 year

CIN 2 & 3- treatment- large loop excision of transformation zone

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16
Q

How is cervical cancer screened for?

A
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17
Q

Can HPV be vaccinated against?

A

Yes gardasil- age 12-13

(protects from cervical, vulval, oral, anal cancers)

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18
Q

What are the 2 types of invasive cell carcinoma?

A
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19
Q

How might an invasive cell carcinoma present?

A
  • Bleeding:
    • post coital
    • inter menstrual
    • post menopausal
  • Mass
  • (seen on screening)
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20
Q

How does invasive cervical cancer spread?

A

Pelvic side wall –> rectum / bladder

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21
Q

How is invasive cervical cancer treated if advanced?

A
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22
Q

Fill in the missing label:

A
23
Q

A thickened endometrium can be a precursor to endometrial cancer. What thickness is the cut off for normal thickness of the endometrium? What might a woman present with?

A

11mm

If >11mm- suggests thickened endometrium

Presentation:

  • Inter-menstrual bleeding
  • Post-menopausal bleeding
24
Q

Endometrial hyperplasia is caused by excessive oestrogen (exposure). Give some causes of excessive oestrogen. (6)

(think Endogenous, exogenous and irregular cycle)

A
25
Q

What is the most common gynaecological tract cancer?

A

Endometrial

26
Q

When are women at the highest risk of contracting endometrial carcinoma?

A

Post menopausal

27
Q

How might endometrial cancer present? (2)

A
28
Q

What are the 2 types of endometrial cancer?

A

Endometrioid adenocarcinoma

Serous adenocarcinoma

29
Q

Which is the more aggresive of the 2 types of endometrial cancer?

A

Serous adenocarcinoma

30
Q

Which of the following histologies is endometroid adenocarcinoma and which is serous adenocarcinoma?

A
31
Q

Outline how an endometrioid adenocarcinoma spreads.

A

Cervix –> vagina –> lymph nodes –> bowel/bladder/other organs

32
Q

Outline how a serous adenocarcinoma spreads:

A

Transcoelomic spread

33
Q

How is an endometrial cancer managed?

A

Hysterectomy

Bilateral salpingo-oophrectomy (ovaries and fallopian tubes)

+/- lymph node dissection

+/- chemo/radiotherapy

34
Q

What are the 2 types of tumours of the myometrium (1 benign, 1 malignant)

A

Benign= leiomyoma (fibroids)

Malignant= leiomyosarcoma

35
Q

What is the most common tumour of the myometrium?

A

leiomyoma (fibroids)

36
Q

What does a leiomyoma look like?

A

Pale

Homogenous

Well circumscribed mass

37
Q

How might a patient with fibroids (leiomyoma) present? (4)

A
  1. Asymptomatic
  2. Pelvic pain
  3. Heavy periods
  4. Urinary frequency (bladder compression)
38
Q

How does a leiomyoma appear histologically?

A

Elongated, cigar shaped nuclei

Benign smooth muscle cells= whorled, intersecting, fascicles

39
Q

What is a leiomyosarcoma?

A

Malignant tumour of smooth muscle cells

doesn’t arise from a leiomyoma

Can metastasise to lung

40
Q

Why does ovarian cancer often have a delayed diagnosis?

A

Early symptoms= vague and non-specific

41
Q

What are the later symptoms that someone with ovarian cancer would present with?

A
  • Abdominal pain
  • Abdominal distension
  • Urinary symptoms
  • GI symptoms
  • Hormonal disturbances
42
Q

What 2 serum markers are tested for ovarian cancer?

A
43
Q

What 3 categories of tumours can be found in the ovary?

A
44
Q

A tumour can be benign, malignant or borderline. What does borderline mean? (ie what is the tumour like)

A

Increased atypia

No stromal invasion

45
Q

What are the different types of ovarian tumours? How do the sex cord stromal tumours present?

A
46
Q

Name some tumours that metastasise to the ovary

A
47
Q

What is the main risk factor for testicular cancer?

A

Cryptorchidism (undescended testicle)

48
Q

How does testicular cancer usually present and how is it investigated?

A
49
Q

Testicular cancer tumour markers can be useful in diagnosis/monitoring treatment. Give 2 examples of cancer tumour markers.

A
50
Q

What are the subtypes of testicular cancer?

A
51
Q

What sort of tumour is shown here?

A

Mature teratoma

52
Q

The following image shows an ovarian tumour. What type of tumour is it?

A

Endometrioid adenocarcinoma

53
Q

The following image shows an ovarian tumour. What type of tumour is it?

A

Epithelial - Mucinous adenocarcinoma

3 Reproduction Unit (21 decks)

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