Session 11 Malignancies

• Post-coital bleeding - cervical cancer
• Post-menopausal bleeding - endometrial cancer
• Cervical screening?

  • Start after 24th birthday
  • every 3 years till 49 years
  • every 5 years from 50-64 years.
• HPV vaccine?

  Gardasil

  • Vaccination age 12 - 13 yrs (boys and girls)
• Myometrial tumours - smooth muscle fibroids - leiomyoma
• Ovarian Cancer is the cause of cancer death more than any other gynaecological malignancy - why?

  • Found at advanced stage (Lack of early symptoms)
  • Disguised presentation of IBS
  • Rapid progression
  • No national screening programmes (no test that reliably picks up)
• Ovarian cancer investigations?

  • Transvaginal ultrasound
  • CA125 blood test
• Meigs's syndrome?

  • Pleural effusion
  • Benign ovarian tumor (thecoma)
  • Ascites
• Sex cord stromal tumours

  • Granulosa cell tumour
  • Leydig cell tumour
  • Thecoma
• Types of ovarian tumours?

  • Epithelial
  • Endometrioid
  • Mucinous
  • Serous
  • clear
  • Brenner (transitional)
• Krukenberg tumours - A Krukenberg tumor refers to a malignancy in the ovary that metastasized from a primary site (usually gastro).
• Lichen sclerosus is a chronic, inflammatory skin disease of unknown cause which can affect any body part of any person but has a strong preference for the genitals.
• Placental tumors?

  • Gestational trophoblastic disease
  • Hydatidiform mole - molar pregnancy
  • Choriocarcinoma
• Ovarian germ cell tumors?

  • Immature teratoma (malignant)
  • Dysgerminoma (malignant)
  • Monodermal - struma ovarii (thyroid like) (benign)
• Anatomical zones of Prostate and malignancies (if any)?

  • Central zone
  • Transitional zone - BPH (squeezes urethra)
  • Peripheral zone - Cancer
• What histological change is seen in prostatic cancer?

  • Double layer of epithelium is absent
  • The basal layer is breeched by invading cells
• Risk factors of BPH?

  • Age above 50 years
  • Black > white > Asian ethnicity
  • Family history
  • changing hormone levels
• Complication of BPH?

  • Hydronephrosis
  • Diverticulum (bladder pouch) formation
  • Urinary retention
• Management of BPH?

  • Resection of prostate
  • Transurethral resection of prostate (TURP)
• What does bone pain in prostatic cancer indicate?

  Metastasis
• Prostate adenocarcinoma spread?

  • Lymphatics
  • Blood
  • Localised - seminal vesicles, bladder
  • Bones - axial skeleton
• Prostate adenocarcinoma - diagnosis?

  • Multiple core biopsies
  • Trans-rectal biopsy
• Prostate cancer staging – TNM system?

  • T = tumour
  • T1 = incidental finding
  • T2 = confined to prostate
  • T3 = extension outside
  • T4 = direct invasion of contiguous organs
  • N0 = no node invasion
  • N1 = nodal invasion
  • M = metastasis
• Management of prostatic cancer?

  • Prostectomy - laparoscopic procedure
  • Radiotherapy
  • Chemotherapy (advanced)
  • Hormonal therapy - castration, estrogens
• Why isn't PSA test/ screening for prostatic cancer a national screening programme?

  Large CRUK survey found that men offered a PSA screen had the same likelihood of dying from prostate cancer over 10 year follow up compared with unscreened men.
• Penile condyloma – benign viral warts – HPV 6
• Bowen’s disease of the penis – HPV 16- a proportion transform into infiltrating cancer
• Carcinoma of penis – risk factors?

  • Not circumcised
  • smoking
  • HIV infection
  • HPV 16 infection
• Management of penis carcinoma?

  Surgery
• Leydig cell carcinoma (testis) - golden brown to yellow cut surface
• Seminoma - white fleshy mass on testis
• have parts that are foreign to the organ of origin - teratoma
• Management of seminoma?

  • Orchiectomy
  • Radiation therapy
  • Chemotherapy
• Pathogenesis of testis tumours?

  • Cryptorchidism
  • Dysgenesis of the testis
  • Inherited genetic factors
• Cryptorchidism - undescended testis
• Testicular tumors staging?

  AJCC staging
• Spread of testis tumour

  • Stage 2 - Nodal spread - Retroperitoneal nodes, and under the diaphragm
  • Stage 3 - Metastasizes outside the RP nodes or above the diaphragm.