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