- recombinant vaccine - against HPV - given to 12-13 year olds - protects from cervical, vulval, oral + anal cancers

Cancers Flashcards by Emily Stephens

Define neoplasm

An abnormal growth of cells that persist after initial stimulus is removed

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Define malignant neoplasm

An abnormal growth of cells that persists after the initial stimulus is removed
AND
Invades surrounding tissue wit potential to spread to distant sites

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Define dysplasia

A potentially pre-neoplastic alteration where cells show disordered organisation + abnormal appearances
Can be reversible

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Types of vulval cancers in order of prevalence

Squamous cell carcinoma
Basal cell carcinoma
Melanoma
Soft tissue tumours

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What is the main causative factor of vulva cancer in pre-menopausal?

HPV 16 with invasion into developing field of vulval intraepithelial neoplasia

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What is the main causative factor of vulva cancer in older women?

Unknown
Probably related to chronic inflammatory conditions e.g lichen sclerosus

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Describe the spread of vulval cancer

Spread locally
Metastasises to inguinal lymph nodes
distant metastases to lungs + liver

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Clinical features of vulval cancer

Lumps
Ulceration
Skin changes e.g. pigmentation, sensation

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Features of squamous cell carinoma in histology

Atypical squamous cell
Keratin formation

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Define vulval intraepithelial neoplasia

In situ precursor of vulval squamous cell carcinoma with no invasion through basement membrane (in situ)

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What are the different epithelial lining of the cervix?

Ectocervix: stratified squamous epithelium to withstand low pH environment of vagina
Endocervix: simple columnar epithelium

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What changes happen to the epithelium of the cervix as a woman ages?
What risk is within this?

Simple columnar epithelium becomes into contact with low vaginal pH > undergoes metaplasia > stratified squamous epithelium in transformation zone
Increased risk of dysplasia

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How does HPV cause cervical cancer?

infection transformation zone of cervix produce viral proteins
inactivate tumor suppressor genes
causing uncontrolled cellular proliferation

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What do cervical squamous cell carcinomas develop from?

Cervical intraepithelial neoplasia

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What are the types of cervical cancers?

Squamous cell carcinoma (most common)
Adenocarcinoma

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Risk factors for cervical carcinomas

increased risk of exposure to HPV: multiple sexual partners, early age of first intercourse, sexual interaction with person with HPV
early first pregnancy
multiple births
smoking
low socio-economic status
Immunosuppression

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Treatment for cervical interepithelial neoplasia

CIN1: regresses spontaneously but follow up cervical smear
CIN2/3: colposcopy +/- large loop excision of transformation zone

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Describe the cervical cancer screening programme

25-49: every 3 years
50-64: every 5 years
> 65: only if recent abnormality
.
Brush used to scrape cells from transformation zone
tested for HPV
if positive, cells looked at under microscope

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Describe the spread of cervical cancers

locally to ureters, bladder + rectum
spread to iliac then aortic lymph nodes

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What does in situ mean?

Does not break through basement membrane

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Presentation of cervical cancer

postcoital bleeding
intermenstrual bleeding
post menopausal bleeding
mass
screening

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Treatment of invasive cervical cancer

Hysterectomy
Lymph node dissection
+/- chemoradiotheraphy

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Describe HPV vaccine

recombinant vaccine
against HPV
given to 12-13 year olds
protects from cervical, vulval, oral + anal cancers

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How are gynaecological cancers screened?

Figo

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Define cervical intraepithelial neoplasia

Dysplasia of squamous cells in cervical epithelium

What is endometrial hyperplasia caused by?

Excessive oestrogen

Endogenous sources of excessive oestrogen

- obesity (androgens > oestrogen) - early menarche - late menopause - oestrogen secreting tumours - irregular cycle *e.g. PCOS*

Exogenous sources of excessive oestrogen

- unopposed oestrogen HRT - tamoxifen

What is the most common gynaecological tract cancer?

Endometrial cancer

Types of endometrial cancer

Endometrioid adenocarcinoma (most common) Serous adenocarcinoma

Describe endometrioid adenocarcinoma

- Most common type of endometrial cancer - commonly arises from endometrial hyperplasia due to excessive unopposed oestrogen - often in perimenopasual + older women

Describe endometrial serous adenocarcinoma

- Less common but more aggressive + worse prognosis - poorly differentiated cells

Where can advanced endometrial cancer spread to?

- Cervix, bladder + rectum - Through peritoneal cavity (out via fallopian tubes) or lymph nodes

What is the lymphatic drainage of the cervix?

- superior portion - **internal iliac** - inferior portion - **sacral**

Presentation of endometrial cancer

Post-menopausal bleeding Intermenstrual bleeding Mass

Management of endometrial cancer

- Hysterectomy - Bilateral salpingo-oophorectomy - +/- lymph node dissection - +/- chemo radio therapy

What are leiomyoma?

Benign tumours of the myometrium Pale, homogenous, well circumscribed mass

What is the most common tumour of the myometrium?

Leiomyoma

Symptoms of myometrial tumours

- Asymptomatic - Pelvic pain - Heavy menstrual loss - menorrhagia - infertility - urinary frequency due to bladder compression

What is a leiomyosarcoma?

Malignant tumour of myometrium

Types of myometrial tumours

**Leiomyoma** - benign **Leiomyosarcoma** - malignant

Where do leiomyosarcoma commonly spread to?

Lungs

Early symptoms of ovarian cancer

Vague + non specific causing delayed diagnosis

Late symptoms of ovarian cancer

Abdominal pain + distension Urinary + GI symptoms Hormonal disturbances

Types of ovarian tumours

- epithelial tumours (most common) - germ cell tumours - sex cord stromal tumours

Classification of epithelial ovarian tumours

- Serous - Mucinous - Endometriod . Further classificed into: - Benign - Borderline - Malignant

Why is prognosis of malignant epithelia tumours often poor?

- Do not present until late stage - metastasise to abdomen > ascites, intestinal obstruction + death

Markers for familial ovarian epithelial carcinoma

BRCA1/2

What is the most common germ cell tumour?

Mature (benign) cystic teratoma (dermoid cyst)

Three subtypes of germ cell tumours

Mature - benign Immature - malignant Monodermal - highly specialised

The presence of what in a germ cell tumour indicates malignancy?

Immature tissue *e.g. Primitive neuroepithelium*

Types of germ cell tumours

- Mature cystic teratoma - Dysgerminoma - Choriocarcinoma - Embryonal carcinoma - Yolk sac tumour (All by MCT are malignant)

Germ cell tumour markers

Alpha fetoprotein Beta human chorionic gonadotropin

Describe the development of sex cord stromal tumours

Derived from ovarian stroma (which is derived from sex cords of embryonic gonads)

Types of sex cord stromal tumours

- Theca + granuloma cell tumours - sertoli-leydig tumours

What do granuloma cell tumours produce?

Oestrogen

What can granuloma cell tumours cause?

Precocious puberty Breast cancer Endometrial hyperplasia + carcinoma

What do sertoli-leydig tumours produce?

testosterone

What do sertoli leydig tumours cause?

- Prevents normal female pubertal changes - infertility - amenorrhoea - Hirsutism - male pattern baldness - breast atrophy

What types of cancers can metastases to the ovaries?

- Breast - GI - Endometrial, fallopian tube, other ovary

What are Krukenburg tumours?

Metastatic GI tumours within the ovaries Often arise from stomach

Risk factor of testicular cancer

Cryptorchidism

Who is testicular cancer common in?

Men aged 15-34

Presentation of testicular cancer

Mass +/- pain

What is cryptorchidism?

Undescended testicles

What are the two groups of germ cell tumours

Seminomas Non-Seminomatous

What are the classes of cervical intraepithelial neoplasia?

- **CNI**: mild dysplasia in situ - most regress spontaneously - **CNII**: moderate dysplasia in situ - **CNIII**: severe dysplasia in situ - **SCC**: invasive carcinoma - has invaded through basement membrane

How often should you have a cervical cancer smear test?

- 25-49: every 3 years - 50-64: every 5 years - >65: only if recent abnormality

What is the tumour marker for ovarian cancer?

CA 125

What is the tumour marker for breast cancer?

CA 15-3

Cancers Flashcards

(70 cards)