S11) Cancers of the Reproductive Tracts Flashcards Preview

(LUSUMA) Reproductive System > S11) Cancers of the Reproductive Tracts > Flashcards

Flashcards in S11) Cancers of the Reproductive Tracts Deck (59)
Loading flashcards...
1

Where can gynaecological tumours arise?

- Vulva

- Cervix (neck of uterus)

- Endometrium (lining of uterus)

- Myometrium (body of uterus)

- Ovary 

2

What are the clinical features of vulval tumours?

- Uncommon 

- Approx. 2/3rds occur > 60 years of age

- Usually squamous cell carcinoma 

3

How many vulval squamous neoplastic lesions are related to HPV infection? 

30% HPV-related (6th decade) – risk factors the same as for cervical carcinoma

- 70% HPV-related (8th decade) – often occur in longstanding inflammatory and hyperplastic conditions of the vulva e.g. lichen sclerosis 

4

What is vulvar intraepithelial neoplasia?

- Vulvar intraepithelial neoplasia involves atypical squamous cells within the epidermis (no invasion)

- It is an in situ precursor of vulval squamous cell carcinoma 

5

How does vulval squamous cell carcinoma spread?

- Spreads initially to inguinal, pelvic, iliac and para-aortic lymph nodes

- Thereafter spreads to lungs and liver 

6

Almost all cases of CIN and cervical carcinoma are related to high risk HPVs.

How does an HPV infection lead to these conditions?

⇒ Infects immature metaplastic squamous cells in transformation zone

⇒ Produces viral proteins E6 & E7 which interfere with activity of TSGs to cause inability to repair damaged DNA and increase cell proliferation

7

What are the risk factors for CIN and cervical carcinoma?

 

- Early first sexual intercourse

- Early first marriage/pregnancy

- Multiple births

- Sexual promiscuity

- Immunosuppression (cannot clear HPV infection)

8

Why is cervical screening successful?

- Cervix accessible to visual examination (colposcopy) and sampling

- Slow progression from precursor lesions → invasive cancers (years)

- Pap test detects precursor lesions and low stage cancers

- Allows early diagnosis and curative therapy 

9

What does cervical screening involve?

- Cells from the transformation zone are scraped off

- Cells are stained with Pap stain

- Cells are examined microscopically

- Cervical cells can be tested for HPV DNA

10

In cervical screening, abnormalities are referred for colposcopy and biopsy.

What sort of abnormalities could be seen? 

- Increased nuclear:cytoplasmic

- Irregular nuclear outlines

- Hyperchromatic nuclei

11

What are the advantages of vaccinating men against HPV too?

- Reduce risk of oral and penile cancer

- Reduce risk of transmission of HPV

- Protect girls who cannot be vaccinated (herd immunity)

12

What is Cervical Intraepithelial Neoplasia?

- CIN is a dysplasia of squamous cells within the cervical epithelium, induced by infection with high risk HPVs

- Three stages: CN I mostly regresses spontaneously, some progress to CN II (in situ carcinoma) and 10% may progress to an invasive carcinoma (CN III – 2-10 years)

13

What is the treatment for CIN?

- CIN I – follow-up or cryotherapy

- CIN II & CIN III – superficial excision (LLETZ – large loop excision of transformation zone) 

14

What are the different types of invasive cervical carcinomas?

- 80% – squamous cell carcinomas

- 15% – adenocarcinomas (also caused by high risk HPVs) 

15

Which age group is usually affected by invasive cervical carcinoma?

Average age = 45 years 

16

What do invasive cervical carcinomas look like?

Exophytic (external) or infiltrative (stromal invasion through basement membrane)

17

Identify the three ways in which invasive cervical carcinomas spread

Locally to para-cervical soft tissues, bladder, ureters, rectum, vagina

- Lymphatic system to para-cervical, pelvic, para-aortic nodes

- Distally 

18

How does cervical carcinoma present?

- Screening abnormality

- Postcoital, intermenstrual or postmenopausal vaginal bleeding 

19

How are cervical carcinomas treated?

- Microinvasive carcinomas: cervical cone excision

- Invasive carcinomas: hysterectomy, lymph node dissection and radiation and chemotherapy (if advanced)

20

Describe the structure and location of the endometrium

Location: lines internal cavity of uterus

- Structure: glands are within a cellular stroma 

21

Why is endometrial hyperplasia a frequent precursor to endometrial carcinoma? 

- Increased gland:stroma ratio

- Associated with prolonged oestrogenic stimulation:

I. Annovulation

II. Increased oestrogen from endogenous sources (e.g. adipose tissue)

III. Exogenous oestrogen

22

What are the clinical features of endometrial adenocarcinoma?

Most common invasive cancer of the female genital tract

- Usual age: 55-75 years

- Presents with irregular or postmenopausal vaginal bleeding 

23

What do endometrial adenocarcinomas look like?

Polypoid or infiltrative 

24

Identify the two types of endometrial adenocarcinoma

- Endometrioid endometrial adenocarcinoma

- Serous carcinoma

25

What are the clinical features of endometrioid endometrial adenocarcinoma?

- More common

- Mimics proliferative glands

- Arises due to endometrial hyperplasia

- Spreads by myometrial invasion to local lymph nodes and distant sites

- Associated with unopposed oestrogen and obesity

26

How do endometrioid endometrial adenocarcinoma look? 

27

What are the clinical features of serous carcinoma (endometrial adenocarcinoma)?

Poorly differentiated

- Aggressive

- Exfoliates, travels through oviducts and implants on peritoneal surfaces 

28

What is the commonest tumour of the myometrium?

- Leiomyoma – benign tumour of myometrium (fibroid) 

- Probably most common tumour in women 

29

What are the clinical features of a leiomyoma?

- Often multiple

- Range from tiny → massive

- Asymptomatic or heavy/painful periods, urinary frequency, infertility 

- Malignant transformation rare

30

What does a uterine leiomyoma look like?

- Well circumscribed, round, firm and whitish in colour

- Bundles of smooth muscle (resembles normal myometrium)