Neoplasms of the Reproductive Tract

Question 1

Where can gynaecological tumours arise?

Answer 1

Vulva

Cervix

Endometrium

Myometrium

Ovary

Question 2

What % of vulval cancers are linked to HPV?

Answer 2

30%

Usually HPV 16

Question 3

What type of cancer usually effects the vulva?

Answer 3

Squamous cell carcinoma

Question 4

In what nature does vulval cancer spread?

Answer 4

Initially to inguinal, pelvic, iliac, para-aortic lymph nodes

Then lungs and liver

Question 5

Almost all cases of cervical carcinoma are related to what?

Answer 5

High risk HPV 16

Question 6

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

Answer 6

Sexual intercourse

Early first marriage

Early first preg

Multiple births

Many partners

Promiscuous partner

Long term use of OCP

Partner with carcinoma of the penis

Smoking

Immune suppression

Question 7

Why is cervical screening successful?

Answer 7

Cervix easily accessible

Slow progression to invasive cancer

Papanicolaou (pap) test detects precursor lesions and low stage cancers

Allows early diagnosis and curative therapy

Question 8

What is cervical intraepithelial neoplasia?

Answer 8

dysplasia of squamous cells within the cervical epithelium

induced by high risk HPVs

Dyskaryosis = abnormal nuclei

Not malignant

Progresses to invasive cervical carcinoma

Question 9

There are diff types of cervical intraepithelial neoplasia (CIN), how long does it take to progressive from T1 to T3?

Answer 9

Several years

Question 10

What is invasive cervical carcinoma?

Answer 10

Average age 45 y/o

80% squamous cell carcinoma

15% adenocarcinomas (also caused by high risk HPVs)

may be exophytic or infiltrative

Spreads – para-cervical, pelvic, para aortic and then distally

Presents: screening abnormality, post coital, intermenstrual or post menopausal vaginal bleeding

Question 11

Outline the pathophysiology of HPV

Answer 11

HPV infects immature squamous cells undergoing metaplasia in transition zone

produce viral proteins (E6 and E7)

interact with tumour suppressor proteins (p53 and retinoblastoma protein)

cells can’t repair any damaged DNA

= promote hallmarks of carcinoma

Question 12

How is cervical intraepithelial neoplasia (CIN) treated?

Answer 12

Follow up

Cryotherapy

Superficial excision of transformation zone

Question 13

How is invasive cervical carcinoma treated?

Answer 13

Cervical cone excision

Hysterectomy

Lymph node dissection

Radiation/chem

Question 14

How does endometrial adenocarcinoma present?

Answer 14

Irregular or postmenopausal vaginal bleeding

Question 15

What are the pathological features of endometrial adenocarcinoma?

Answer 15

Increased gland to stroma ratio

Prolonged oestrogenic stimulation

Exogenous oestrogen

Polyploidy

Infiltrative

Question 16

How is endometrial adenocarcinoma treated?

Answer 16

Complex/atypical = hysterectomy

Question 17

What is the most common tumour of the myometrium?

Answer 17

Leiomyoma = benign tumour of the uterine smooth muscle

Question 18

What is a leiomyosarcoma?

Answer 18

Malignant tumour of the myometrium

Mets to the lungs

Uncommon

Bad prognosis

Question 19

How does a leiomyoma present?

Answer 19

May be asymptomatic

Heavy/painful periods

Urinary frequency (due to bladder compression)

Infertility

Can be massive = filling the pelvis

Question 20

How does an ovarian tumour present?

Answer 20

Abdo pain

Abdo distension

Ascites

Urinary/GI symptoms

Menstrual disturbances = prod male/female sex hormones

Question 21

Roughly 50% of ovarian tumours spread to where?

Answer 21

The other ovary

Question 22

How are ovarian tumours diagnosed?

Answer 22

Serum CA-125

BRCA mutations

Question 23

How can ovarian tumours be classified?

Answer 23

Mullerian epithelium

Germ cells

Sex cord stromal cells

Metastases

Question 24

Describe a mullerian epithelial ovarian tumour

Answer 24

Risk factors = null/low parity, OCP, endometriosis, smoking

Serous type = bilateral, if rubbed will flake off

Mucinous type = large cystic mass, sticky fluid filled

Endometriod type = looks like endometrial tissue, can arise in endometriosis

Question 25

Describe germ cell ovarian tumours

Answer 25

Mature = hair, sebaceous material, teeth (benign) Immature (malignant) Monodermal = rare, stuma ovari: can be functional and prod thyroid hormone = hyperthyroidism

Question 26

Describe sex cord-stomal cell ovarian tumours

Answer 26

Derived from sex cord of embryonic gonads granulosa/theca cell = post-menopausal, high oestrogen leydig cell = block normal female sexual devel, defeminisation, peak incidence in teens/twenties

Question 27

Describe metastasis to the ovary

Answer 27

Most common are mullerian tumours from other areas in repro tract  Can get metastases from: GI tumours (colon, stomach, biliary tract, pancreas, appendix) and breast Krukenberg tumour = metastatic GI tumour, usually from stomach, often bilateral

Question 28

How can testicular tumours be classified?

Answer 28

Germ cell = seminomas, non-seminomatus germ cell Sex cord stromal tumours = sertoli, leydig Lymphomas

Question 29

If a mass is derived from 3 germ cell layers what is the diagnosis?

Answer 29

Teratoma

Question 30

Define cervical intraepithelial neoplasia III

Answer 30

dysplasia of squamous cell, carcinoma in situ

Question 31

From which tissue does endometrial adenocarcinoma arise?

Answer 31

endometrium

Question 32

What is the most common invasive cancer of the female genital tract?

Answer 32

endometrial adenocarcinoma

Question 33

What are the risk factors for devel endometrial cancer?

Answer 33

history of polycystic ovary syndrome increased years of menstruation

Question 34

What is the most significant risk factor for the development of germ cell tumors?

Answer 34

cryptorchidism undescended testis