L17 Genital Cancers: ovary, tube and vulval

Ca125 very high levels usually assoc with?

(>1000) disseminated peritoneal malignancy

Ovarian cancer EPITHELIAL TYPES? 1. serous look like? assoc with which gene?

(look like tube) • BRCA gene mutation associated • often disseminated at presentation • tubal and primary peritoneal cancer are almost identical to ovarian serous - may all be same

Ovarian cancer EPITHELIAL investigations?

- Ca125 - US pelvis - CT abdo/pelvis

Ovarian cancer SEX CORD/STROMAL investigations

- Ca125, (inhibin) - US pelvis - CT abdo/pelvis

Ovarian cancer GERM CELL investigations

- Ca125, LDH, AFP, βHCG (all women under 40 with suspicious ovarian mass) - US pelvis - CT abdo/pelvis

Ovarian cancer EPITHELIAL presentation

- abdominal swelling (tumour and/or ascites) - pressure symptoms; early satiety, incontinence - discomfort - GI disturbance (may mimic IBS) - PV bleeding rare

Vulval cancer other than squamous cell carcinoma, other rare types?

- basal cell carcinoma (BCC) - malignant melanoma - Bartholin's gland tumour

BRCA and ovarian cancer if BRCA1 AND BRCA2 DNA repair genes are damaged, what cancer risk inc?

- breast - ovary - prostate - leukaemia/lymphoma

Ovarian cancer EPITHELIAL treatment

- chemotherapy (carboplatin +/-paclitaxel) - surgery (TAH, BSO, omentectomy + debulking)

Ovarian cancer GERM CELL types?

- dermoid cyst (benign cystic teratoma) - dysgerminoma (associated with gonadal dysgenesis) - non-dysgerminoma (loads of subtypes!)

Vulval cancer prognosis

- early disease is curable - advanced disease has poor outlook

Ovarian cancer GERM CELL prognosis

- generally very good, most cured

Ovarian cancer SEX CORD/STROMAL types

- granulosa cell tumours (malignant) - fibromas/thecomas (often benign) - Sertoli-Leydig cell tumours (malignant) - others

Vulval cancer squamous cell carcinoma caused by?

- lichen sclerosus (autoimmune disease) - HPV 16 infection

Ovarian cancer EPITHELIAL prognosis

- most incurable once spread beyond ovary - mean survival 3 years

Ovarian cancer SEX CORD/STROMAL treatment

- surgery (TAH, BSO, omentectomy + debulking but can preserve fertility if confined to ovary) - chemotherapy - not usually sensitive, BEP sometimes

Ovarian cancer GERM CELL treatment

- surgery (unilateral oopherectomy) - chemotherapy (BEP; bleomycin, etoposide, cisplatin)

Vulval cancer treatment

- surgery (wide local excision of tumour +/- groin node dissection) - radiotherapy if local spread

Ovarian cancer SEX CORD/STROMAL prognosis

- usually good, can recur locally

Lynch syndrome

-Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC), is a type of inherited cancer syndrome associated with a genetic predisposition to different cancer types. means people with Lynch syndrome have a higher risk of certain types of cancer.

Ovarian tumours TYPES

1. Epithelial Tumors 2. Germ Cell Tumors 3. Sex cord-stromal tumors of the ovary 4. Metastasis

Ovarian cancer EPITHELIAL TYPES?

1. serous 2. mucimnous 3. endometrioids/clear cell 4. brenner

Ovarian tumours TYPES 4. Metastasis what % of all ovarian tumours?

10-15% of all ovarian tumors

Ovarian tumours TYPES 2. Germ Cell Tumors WHAT % of all ovarian tumours?

15-25% of all ovarian tumors

Ovarian tumours TYPES 3. Sex cord-stromal tumors of the ovary what % of all ovarian tumours?

5-10% of all ovarian tumors

Ca125 normal in what % of stage 1 ovarian cancer?

50%

Ovarian tumours TYPES 1. Epithelial Tumors WHAT % OF ovarian tumours? % of malignant ovarian tumours?

65-75% of all ovarian tumors; ∼ 70% of all malignant ovarian tumors

Ovarian tumours clinical features GENERAL SYMPTOMS advances stages, size and growth of tumours can lead to?

Abdominal pain and ascites Cancer cachexia Possible disruption of menstrual cycle Dyspnea due to malignant pleural effusion Abdominal or pelvic mass

Endometrial cancer clinical features TUMOUR RELATED

Abnormal uterine bleeding is the main symptom. Postmenopausal: any amount of vaginal bleeding, including spotting or staining Perimenopausal/premenopausal: metrorrhagia, menometrorrhagia Vaginal bleeding usually does not occur in type II cancer. Later stages may present with pelvic pain, palpable abdominal mass, and/or weight loss. Pelvic exam is often normal; possible findings include an abnormal cervix, enlarged uterus, or evidence of local metastases (see below).

Ovarian tumours clinical features SPECIFIC SYMPTOMS Meigs syndrome

Ascites and pleural effusion in association with an ovarian tumor (e.g., ovarian fibroma) In 90% of cases, the ovarian tumor is unilateral. The cause is unknown. Surgical removal of the tumor leads to a complete resolution of symptoms.

Ovarian tumours risk factors GENETIC PREDISPOSITION

BRCA1/BRCA2 mutation HNPCC syndrome Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC), is a type of inherited cancer syndrome associated with a genetic predisposition to different cancer types. This means people with Lynch syndrome have a higher risk of certain types of cancer. Peutz-Jeghers syndrome

Ovarian tumours TYPES 3. Sex cord-stromal tumors of the ovary types? Ovarian fibroma

Benign, although may cause Meigs' syndrome

Ovarian tumours clinical features SPECIFIC SYMPTOMS Pseudomyxoma peritonei

Bursting of a mucinous cystadenoma/carcinoma may spread tumor cells throughout the peritoneum. Mucinous cells cause gelatinous ascites and intra-abdominal adhesions. May require several surgical treatments and, in the long term, usually leads to cachexia and death.

Endometrial cancer prognosis

Cancer stage at diagnosis determines the 5-year survival rate: Localized endometrial carcinoma: > 90 % Metastasized endometrial cancer: 16.8 % Clear cell and papillary serous carcinomas (type II) have a poor prognosis.

Ovarian tumours TYPES 1. Epithelial Tumors TYPES Borderline ovarian tumors

Characterized by increased epithelial proliferation and cellular atypia, without the invasive characteristics typical of malignant tumors About 10-15% recur, often in the form of invasive tumors Peak incidence: 35-45 years

Vulvar cancer differential diagnoses Vulvar dermatoses diagnosis

Colposcopy and biopsy of suspicious lesions are required to rule out malignancy.

Ovarian tumours TYPES 1. Epithelial Tumors TYPES

Cystadenoma and Cystadenocarcinoma Endometrioid carcinoma Borderline ovarian tumors Clear cell carcinoma Brenner tumor

BRCA and ovarian cancer BRCA 1 and BRCA 2 are?

DNA repair genes

Ovarian tumours TYPES 2. Germ Cell Tumors types Teratoma types Mature

Dermoid cysts: most common of all germ cell tumors (90% of cases) -Malignant transformation in 2% of cases -Can theoretically contain any type of tissue, e.g., hair, teeth, and sebaceous glands, but mostly include parts of ectodermal origin -Differentiated, mostly benign tumor Struma ovarii: teratoma with endodermal differentiation into thyroid tissue -Very rare: malignant transformation into a thyroid carcinoma -May produce thyroxine and cause hyperthyroidism symptoms -Differentiated, mostly benign tumor

Ovarian tumours risk factors Hormonal imbalance and menstrual cycle

Elevated number of lifetime ovulations (the contraceptive pill appears to have a protective effect) Infertility/low number of pregnancies Early menarche and late menopause PCOS

Endometrial cancer DIAGNOSIS

Endometrial biopsy with histology Imaging Laboratory tests

Endometrial cancer subtypes? SEE L16

Endometrial hyperplasia increased estrogen stimulation leads to excessive proliferation of the endometrium,

Ovarian tumours diagnosis tumour markers present in the diff tumour types? Epithelial ovarian tumor Yolk sack tumor Non-gestational choriocarcinoma Granulosa cell tumor

Epithelial ovarian tumor: CA-125 Yolk sack tumor: alpha-fetoprotein Non-gestational choriocarcinoma: beta hCG Granulosa cell tumor: inhibin B

Ovarian tumours TYPES 1. Epithelial Tumors MAY BE?

Epithelial ovarian tumors may be benign, malignant, or borderline!

Ovarian tumours TYPES 3. Sex cord-stromal tumors of the ovary types?

Estrogen producing: Granulosa cell tumor and Theca cell tumor Androgen producing:Sertoli-Leydig cell tumor Ovarian fibroma

what is contraindicated in ovarian cancer?

Fine needle aspiration cytology is absolutely contraindicated in ovarian tumors because it increases the risk of spreading tumor cells to the peritoneum!

Vulvar cancer treatment first line?

First-line treatment: local excision and surgical resection (radical vulvectomy) Radiotherapy and/or palliative chemotherapy: when disease metastasizes to peripheral lymph nodes or other organs

Ovarian tumours TYPES 1. Epithelial Tumors TYPES Endometrioid carcinoma

Frequently associated with endometrial cancer and endometriosis Commonly malignant

Ovarian cancer treatment surgery

Frozen section and histology positive for carcinoma: radical surgical staging -Removal of the greater omentum -Lymphadenectomy -Hysterectomy with bilateral salpingo-oophorectomy -Appendectomy if involvement is suspected during surgery -Biopsy from all noticeable locations/adhesions Frozen section negative for carcinoma: tumor resection, but no surgical staging

ovarian cancer prevention? 1. genetic predisposition 2. hormonal contraceptives

Genetic predisposition -Consider a preventive bilateral salpingo-oophorectomy if no future pregnancies are desired -If surgery is not pursued, then frequent screening (CA 125 and transvaginal ultrasound) is recommended Hormonal contraceptives, GnRH analogs, breast feeding, and tubal ligation appear to reduce the risk of ovarian carcinoma.

Ovarian tumours diagnosis histology Granulosa cell tumor Sertoli-Leydig cell tumor Ovarian fibroma

Granulosa cell tumor: Call-Exner bodies (granulosa cells arranged in clusters surrounding a central cavity with eosinophilic secretions, resembling primordial follicles) Sertoli-Leydig cell tumor: contain Reinke crystals Ovarian fibroma: clusters of spindle-shaped cells (fibroblasts)

Ovarian tumours clinical features SPECIFIC SYMPTOMS GRANULOSA CELL TUMOUR

Granulosa cells express aromatase (estrogen synthesis occurs in 25% of tumors). Menstrual irregularities such as postmenopausal bleeding and metrorrhagia Increased risk of endometrial cancer Precocious puberty

Vaginal cancer etiology HPV types?

HPV 16 and 18

Endometrial cancer treatment surgical management

Indication: women with endometrial cancer who are postmenopausal, perimenopausal, or do not intend to become pregnant Procedures 1. Total hysterectomy with bilateral salpingo-oophorectomy (TAH/BSO) with or without lymph node removal 2. Advanced radical hysterectomy and removal of the upper vagina according to Wertheim-Meigs additional

Vulvar cancer etiology risk factors

Infection with HPV 16, 18, 31, and 33 (16 and 33 account for 55% of HPV-related cases of vulvar cancer) Immunosuppression Vulvar dystrophy and vulvar or cervical intraepithelial neoplasia (VIN/CIN) Smoking Precancerous lesions

Vulvar cancer differential diagnoses Vulvar dermatoses subtypes? Lichen sclerosus

Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women.

Lynch syndrome inheritance pattern

Inheritance pattern -autosomal dominant

Vulvar cancer differential diagnoses Vulvar dermatoses subtypes? Lichen simplex chronicus

Leukoplakia with thick, leathery vulvar skin associated with chronic irritation and scratching., hyperplasia of the vulvar squamous epithelium

Vulvar cancer differential diagnoses Vulvar dermatoses subtypes?

Lichen sclerosus: epidermal atrophy and loss of vulvar architecture Lichen simplex chronicus: squamous cell hyperplasia Other dermatoses, e.g., genital lichen planus (hypertrophied skin with purple lesions)

Ovarian tumours epidemiology

Lifetime prevalence of malignant ovarian cancer: 1-2% Peak incidence: 60-70 years Genetic predisposition may play a role in familial incidence and in younger patients (< 30 years) developing tumors. Epithelial ovarian carcinomas account for 70% of all ovarian malignancies.

Endometrial cancer clinical features metastases TYPES + WILL SEE?

Localized metastasis: contiguous spread to the cervix and vagina, fallopian tubes, and ovaries (25% of cases) Lymphogenic metastasis: seen in late stage cases; retroperitoneal spread, or involvement of the pelvic and/or para-aortic lymph nodes Hematogenic metastasis: rare; occurs at a very late stage and usually in the lungs

Endometrial cancer Etiology protective factors

Low estrogen and high progestin or progesterone levels have a protective effect. Multiparity Combination oral contraceptive pills Tobacco consumption Regular physical exercise Lifelong soy-rich diet

Ovarian tumours TYPES 2. Germ Cell Tumors types Teratoma types

Mature Immature

Vulvar cancer clinical features

May initially be asymptomatic Local pruritus, possibly with burning sensation and pain Reddish, blackish, and/or whitish patches of discoloration Lumps or growths of various shapes, often wart-like lesions or ulcers Vulvar bleeding or discharge Dysuria, dyspareunia Lymphadenopathy in the groin area

Vulvar cancer differential diagnoses Vulvar intraepithelial neoplasia (VIN) prognosis

May progress to vulvar carcinoma despite treatment (in < 10% of cases)

Ovarian tumours TYPES 2. Germ Cell Tumors types Dysgerminoma:

Most common malignant ovarian tumor in young women (20-30 years); histologic, female equivalent to the male seminoma

Ovarian tumours TYPES 3. Sex cord-stromal tumors of the ovary types? Estrogen producing: Granulosa cell tumor and Theca cell tumor

Mostly benign ∼ 75% of cases affect postmenopausal women

Ca125

Non specific marker of peritoneal irritation

Ca125 elevated by?

Non specific marker of peritoneal irritation - Elevated by, eg. menstruation, pregnancy, endometriosis, heart failure, pneumonia and any peritoneal malignancy

Endometrial cancer Etiology Risk factors for estrogen-dependent tumors

Nulliparity Early menarche and late menopause PCOS (polycystic ovary syndrome) Unopposed estrogen replacement therapy (e.g., for menopausal symptoms) Breast cancer: history of breast cancer, tamoxifen treatment Metabolic syndrome (esp. obesity and diabetes mellitus type 2 ) Lynch syndrome (hereditary nonpolyposis colorectal cancer)

Ovarian tumours TYPES 3. Sex cord-stromal tumors of the ovary types? Androgen producing:Sertoli-Leydig cell tumor

Occurs very rarely; ∼ 20% malignant transformation Production of androgens → virilization Primarily affects women aged 30-40 years

Ovarian tumours TYPES 2. Germ Cell Tumors types Yolk sac tumor of the ovary

Often malignant; occurs mainly in childhood and adolescence

Ovarian cancer differentials

Ovarian cysts Endometriosis Tubo-ovarian abscess Ectopic pregnancy Pelvic inflammatory disease

Vulvar cancer differential diagnoses Vulvar dermatoses clinical features?

Parchment-like, thin, shiny vulvar skin Narrow, atrophic vaginal introitus resulting in dyspareunia Burning pain, pruritus, bleeding vulvar ulcers Lichen simplex chronicus is characterized by chronic itching, which provokes persistent scratching of the vulva and so causes lichenification of the skin.

Vaginal cancer diagnosis

Pelvic exam Colposcopy: if abnormal cytology results without a clearly visible lesion during pelvic exam Biopsy of mass to determine histopathology: spindle-shaped cells, desmin positive

Vulvar cancer diagnosis

Pelvic exam and colposcopy Biopsy -All suspicious lesions must be biopsied for histological analysis.

Endometrial cancer clinical features TUMOUR RELATED abnormal uterine bleeding 1. postmenopausal

Postmenopausal: any amount of vaginal bleeding, including spotting or staining

Vulvar cancer differential diagnoses Vulvar intraepithelial neoplasia (VIN)

Precancerous lesion caused by dysplasia of squamous cells

Ovarian tumours TYPES 4. Metastasis types?

Primary tumors are commonly from the gastrointestinal tract or breast; endometrial cancer, malignant lymphoma Krukenberg tumor: bilateral ovarian metastases from an undifferentiated gastric carcinoma (mucin-secreting signet ring cell carcinoma)

Endometrial cancer treatment medical management

Progestins: Indicated for women with early stage endometrial carcinoma (well-differentiated and progesterone and estrogen receptor positive) , who would prefer to avoid TAH-BSO and preserve fertility, or as adjuvant therapy. Radiotherapy and/or chemotherapy (adjuvant or palliative)

Endometrial cancer complications

Pyometra Purulent infection of the endometrium Caused by obstruction of the cervical opening by the tumor and secondary blood stasis (hematometra) Treated with drainage and dilation of the cervical lumen

Vaginal cancer treatment

Radiotherapy: Indicated in squamous cell carcinomas. Preserves external genitalia. Surgical therapy

Ovarian tumours TYPES 2. Germ Cell Tumors types Non-gestational choriocarcinoma

Rare and extremely malignant; normally accompanied by beta hCG production

Vaginal cancer SUBTYPES Sarcoma botryoides

Rare, highly malignant rhabdomyosarcoma that arises most commonly, but not exclusively in the genitourinary system Polypoid mass that resembles a bunch of grapes protruding through the vagina Peak incidence before the age of 8

Ovarian tumours TYPES 2. Germ Cell Tumors types Teratoma types Immature

Rare, undifferentiated May contain tissue of embryonic/fetal period High risk of malignancy

Cervical cancer

SEE L16

Ovarian tumours TYPES 1. Epithelial Tumors TYPES Cystadenoma and Cystadenocarcinoma 1. SEROUS 2. MUCINOUS

Serous (papillary serous) -Most common ovarian tumor -Serous cystadenocarcinoma is the most aggressive ovarian cancer -Frequently bilateral (65% of cases) Histology: -Tumor cells with papillary structures and small cytoplasm -Psammoma bodies are a typical feature Mucinous -Second most common ovarian tumor. -Up to 75% of cases are benign

Vaginal cancer SUBTYPES MOST COMMON?

Squamous cell carcinoma

Vulvar cancer classifications?

Squamous cell carcinoma (> 80% of cases) Basal cell carcinoma Melanoma Adenocarcinoma (Paget disease of the vulva)

Vaginal cancer SUBTYPES?

Squamous cell carcinoma (most common) Clear cell adenocarcinoma Sarcoma botryoides

Ovarian tumours TYPES 2. Germ Cell Tumors types

Teratoma Dysgerminoma Yolk sac tumor of the ovary Non-gestational choriocarcinoma

Vulvar cancer prognosis

The average 5-year survival rates range from 30-50%. However, survival rates vary greatly depending on the stage of the disease.

Endometrial cancer epidemiology

The most common cancer of the female genital tract in the US Fourth most common cancer in women (after breast, lung, and colorectal cancer) Age: primarily postmenopausal women affected; peak incidence at 65-74 years Onset of type I cancer is usually nearer to menopause; type II cancer typically occurs in women who are much older, with the mean age of diagnosis being 67 years.

Endometrial cancer Etiology Type II what gene is present in 90% of these cancers?

The p53 mutation is present in 90 % of type II endometrial cancers.

Vaginal cancer localisation

The upper third of the posterior vaginal wall is the most common site of vaginal carcinoma.

lynch syndrome cause

These types of mutations are called inherited, or germline, mutations. Alterations in several genes involved in DNA mismatch repair that have been linked to Lynch syndrome. They include the genes of MLH1, MSH2, MSH6, PMS2, and EPCAM. A mutation (alteration) in any of these genes gives a person an increased lifetime risk of developing colorectal cancer and other related cancers

Ovarian tumours diagnosis imaging

Transvaginal ultrasound is the gold standard, but abdominal or rectal ultrasound may also be conducted.

Endometrial cancer TYPES

Type I endometrial cancer: endometrioid adenocarcinomas derived from atypical endometrial hyperplasia Type II endometrial cancer: tumors of nonendometrioid histology

Ovarian tumours TYPES 1. Epithelial Tumors TYPES Brenner tumor

Typically benign Similar to transitional cells of the bladder (urothelium) Encapsulated, pale yellow solid tumor with circular patches of cells with coffee bean nuclei

Ca125 used together with? to give?

Used together with US features and menopausal status to give risk of malignancy index (RMI)

Vaginal cancer SYMPTOMS

Vaginal bleeding Leukoplakia, vaginal ulceration with contact bleeding Malodorous discharge Possibly urinary frequency

Vulvar cancer differential diagnoses?

Vulvar dermatoses Vulvar intraepithelial neoplasia (VIN) Vaginal cancer

Vulvar cancer differential diagnoses Vulvar dermatoses

Vulvar dermatoses are not inherently precancerous, but they do increase the risk of squamous cell carcinoma.

Vulvar cancer differential diagnoses Vulvar dermatoses therapy

Without atypical cellular morphology: local therapy with glucocorticoid-containing creams In the event of malignancy: surgical resection of the lesion

Ovarian cancer SEX CORD/STROMAL presentation

abdominal swelling, pain and/or hormonal effects

Endometrial cancer clinical features TUMOUR RELATED MAIN SYMPTOM

abnormal uterine bleeding

Ovarian cancer EPITHELIAL TYPES all?

all adenocarcinomas

BRCA and ovarian cancer BRCA1 AND BRCA 2 inheritance pattern?

autosomal dominant inheritance

Ovarian cancer GERM CELL CAN BE?

benign or malignant

Vulval cancer investigations

biopsy from edge of lesion if doubt over diagnosis

Ovarian cancer EPITHELIAL can be?

can be benign, borderline or malignant

Ovarian tumours clinical features SPECIFIC SYMPTOMS Sertoli-Leydig cell tumour

can produce either estrogen or testosterone Virilization due to tumor-induced testosterone production: 1. Symptoms in females: Amenorrhea, hirsutism, decreased fertility, and acne 2. Symptoms in males: Precocious puberty in boys and gynecomastia in men, feminization in males if estrogen is produced

Vulvar cancer differential diagnoses Vulvar intraepithelial neoplasia (VIN) treatment

depending on severity, excision or ablation may become necessary

Endometrial cancer Etiology Type I

directly related to long-term exposure to increased estrogen levels.

Endometrial cancer TYPE I

endometrioid adenocarcinomas derived from atypical endometrial hyperplasia

MOST COMMON OVARIAN CANCER?

epithelial

Ovarian tumours types of tissues in ovaries (+ so what tumours can get here?)

epithelial germ cells sex cord tissue

Ovarian tumours clinical features GENERAL SYMPTOMS first symptom often?

increasing abdominal girth (clothes no longer fit at the waist)!

Ovarian cancer EPITHELIAL TYPES? 2. mucinous look like?

look like bowel

Ovarian cancer EPITHELIAL TYPES? 3. endometrioid/clear cell look like? assoc with?

look like endometrium • associated with endometriosis

Ovarian cancer EPITHELIAL TYPES? 4. brenner look like?

look like urinary tract epithelium

Vulvar cancer

malignancy of the outer female genitalia that predominantly occurs in postmenopausal women

Endometrial cancer

malignant tumor of the endometrium

Endometrial cancer clinical features TUMOUR RELATED abnormal uterine bleeding 2. Perimenopausal /premenopausal:

metrorrhagia, menometrorrhagia

Vaginal cancer most assoc with?

most are SCC and HPV associated

Vulval cancer age?

mostly elderly women but can occur as young as mid 30s

Endometrial cancer Etiology Type II

mostly estrogen-independent and is strongly associated with a genetic predisposition. The p53 mutation is present in 90 % of type II endometrial cancers.

Ovarian cancer specialised cell types + types of tumour? others

non-specialised cells (not specific to ovary)

Ovarian cancer EPITHELIAL predom in what age women?

older

Ovarian cancer specialised cell types + types of tumour? epithelial

outer layer of ovary

Ovarian tumours

ovaries consist of different kinds of tissue (epithelial, germ cells, and sex cord tissue), which may give rise to benign or malignant tumors.

Ovarian tumours diagnosis hypercalcemia due to?

paraneoplastic synthesis of PTHrP

Vulvar cancer differential diagnoses Vulvar dermatoses epidemiology

postmenopausal women and, less commonly, prepubescent girls

Vulval cancer predom what type of cancer?

predominantly squamous cell carcinoma (SCC)

Vulval cancer presentation

present with vulval lump/ulcer, usually painful

Ca125?

protein marker elevated in ovarian cancer

Endometrial cancer complications Pyometra

pus filled uterus

Vaginal cancer norm treated with?

radiotherapy

Ovarian tumours clinical features SPECIFIC SYMPTOMS Yolk sac tumour, dysgerminoma

rapid growth acute onset of symptoms (pelvic mass and pain)

Vaginal cancer etiology

same as vulvar neoplasia (e.g., HPV 16 and 18)

Ovarian cancer SEX CORD/STROMAL some sec?

secrete hormones (oestrogen or testosterone)

Vaginal cancer SUBTYPES Clear cell adenocarcinoma SEEN IN?

seen in daughters of women who received diethylstilbestrol during pregnancy

BRCA and ovarian cancer women with? offered BRCA mutation testing

serous ovarian cancer

Ovarian cancer screening

several trials done - All so far say it doesn't work awaiting final reports of UKCTOCS (no family history) and UKFOCSS (>10% genetic risk) combination of transvaginal US and Ca125 probably never going to be good enough for population screen in current form

Ovarian cancer specialised cell types + types of tumour? stromal (sex cord/stromal)

support germ cells, hormone secreting

Ovarian tumours clinical features SPECIFIC SYMPTOMS Struma ovarii

symptoms of hyperthyroidism

Vulvar cancer differential diagnoses Vulvar intraepithelial neoplasia (VIN) diagnosis

tissue biopsy

Ovarian cancer specialised cell types + types of tumour? germ cell

totipotent cells forming oocytes (eggs)

Ovarian tumours clinical features GENERAL SYMPTOMS complication, tumour can cause?

tumor can cause ovarian torsion→ tissue infarction → surgical emergency

Endometrial cancer TYPE II

tumors of nonendometrioid histology Histology includes serous, clear, mucinous, squamous, transitional, mesonephric, and undifferentiated cells.

Vaginal cancer rare?

v rare

Colposcopy

visual examination of the vagina and cervix using a colposcope

Ovarian cancer GERM CELL presentation

with abdominal swelling and pain

Ovarian cancer GERM CELL age of women?

younger women - predominantly under 30

ovarian cancer tumurs types?

• benign • borderline - can spread locally, rarely invade, do not metastasise • malignant - primary - secondary breast, endometrium, bowel, stomach

Ovarian cancer specialised cell types + types of tumour?

• epithelial - outer layer of ovary • germ cell - totipotent cells forming oocytes (eggs) • stromal (aka sex cord/stromal) - support germ cells, hormone secreting • others - non-specialised cells (not specific to ovary)

Ovarian cancer SEX CORD/STROMAL rare?

• rare occur throughout life

Tubal cancer

• see serous ovarian cancer - most high grade serous ovarian cancer is probably tubal in origin - treatment is the same

Ovarian tumours clinical features GENERAL SYMPTOMS in most cases, symptoms?

In most cases, there are no early symptoms.

Ovarian cancer treatment chemo

Indicated for all patients as adjuvant therapy First-line therapy: carboplatin polychemotherapy and antimitotics (e.g., paclitaxel) Radiation therapy: rarely used due to the intraperitoneal location and low radiosensitivity of the tumor