19 Tumours of the Reproductive Tract

Question 1

How common are vulval cancers?

Answer 1

Uncommon (3% all female cancers)

Tend to arise in older patients

Question 2

What types of vulval cancer are there? (4)

Answer 2

Question 3

What clincal feastures might you get for a vulval cancer?

Answer 3

Lumps

Ulceration

Skin changes

Question 4

What is shown in the following histology?

Answer 4

Question 5

What is vulval intraepithelial neoplasia? (VIN)

Answer 5

In situ precursor of vulval squamous cell carcinoma

Atypical cells- no invasion through basement membrane

May or may not develop into squamous cell carcinoma

Question 6

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

Answer 6

Question 7

How does vulval cancer spread?

Answer 7

Question 8

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

Answer 8

Question 9

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

Answer 9

Question 10

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

Answer 10

Question 11

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

Answer 11

Question 12

What is cervical intraepithelial neoplasia? (analogous to VIN)

Answer 12

Question 13

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

Answer 13

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

Question 14

How is CIN staged?

Answer 14

Question 15

How is CIN treated? (screening- smear)

Answer 15

CIN 1- follow up with cervical smear- 1 year

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

Question 16

How is cervical cancer screened for?

Answer 16

Question 17

Can HPV be vaccinated against?

Answer 17

Yes gardasil- age 12-13

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

Question 18

What are the 2 types of invasive cell carcinoma?

Answer 18

Question 19

How might an invasive cell carcinoma present?

Answer 19

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

Question 20

How does invasive cervical cancer spread?

Answer 20

Pelvic side wall –> rectum / bladder

Question 21

How is invasive cervical cancer treated if advanced?

Answer 21

Question 22

Fill in the missing label:

Answer 22

Question 23

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?

Answer 23

11mm

If >11mm- suggests thickened endometrium

Presentation:

• Inter-menstrual bleeding
• Post-menopausal bleeding

Question 24

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

(think Endogenous, exogenous and irregular cycle)

Answer 24

Question 25

What is the most common gynaecological tract cancer?

Answer 25

Endometrial

Question 26

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

Answer 26

Post menopausal

Question 27

How might endometrial cancer present? (2)

Answer 27

Question 28

What are the 2 types of endometrial cancer?

Answer 28

Endometrioid adenocarcinoma Serous adenocarcinoma

Question 29

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

Answer 29

Serous adenocarcinoma

Question 30

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

Answer 30

Question 31

Outline how an endometrioid adenocarcinoma spreads.

Answer 31

Cervix --\> vagina --\> lymph nodes --\> bowel/bladder/other organs

Question 32

Outline how a serous adenocarcinoma spreads:

Answer 32

Transcoelomic spread

Question 33

How is an endometrial cancer managed?

Answer 33

Hysterectomy Bilateral salpingo-oophrectomy (ovaries and fallopian tubes) +/- lymph node dissection +/- chemo/radiotherapy

Question 34

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

Answer 34

Benign= leiomyoma (fibroids) Malignant= leiomyosarcoma

Question 35

What is the most common tumour of the myometrium?

Answer 35

leiomyoma (fibroids)

Question 36

What does a leiomyoma look like?

Answer 36

Pale Homogenous Well circumscribed mass

Question 37

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

Answer 37

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

Question 38

How does a leiomyoma appear histologically?

Answer 38

Elongated, cigar shaped nuclei Benign smooth muscle cells= whorled, intersecting, fascicles

Question 39

What is a leiomyosarcoma?

Answer 39

Malignant tumour of smooth muscle cells **doesn't arise from a leiomyoma** Can metastasise to lung

Question 40

Why does ovarian cancer often have a delayed diagnosis?

Answer 40

Early symptoms= vague and non-specific

Question 41

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

Answer 41

* Abdominal pain * Abdominal distension * Urinary symptoms * GI symptoms * Hormonal disturbances

Question 42

What 2 serum markers are tested for ovarian cancer?

Answer 42

Question 43

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

Answer 43

Question 44

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

Answer 44

Increased atypia No stromal invasion

Question 45

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

Answer 45

Question 46

Name some tumours that metastasise to the ovary

Answer 46

Question 47

What is the main risk factor for testicular cancer?

Answer 47

Cryptorchidism (undescended testicle)

Question 48

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

Answer 48

Question 49

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

Answer 49

Question 50

What are the subtypes of testicular cancer?

Answer 50

Question 51

What sort of tumour is shown here?

Answer 51

Mature teratoma

Question 52

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

Answer 52

Endometrioid adenocarcinoma

Question 53

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

Answer 53

Epithelial - Mucinous adenocarcinoma