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Kanser dan wanita
 

Kanser dan wanita

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    Kanser dan wanita Kanser dan wanita Presentation Transcript

    • UTERINE CANCER, VULVA AND VAGINA CANCER
    • Leukoplaki a Condylomata SCC
    • Stage 1B1 SCC
    • Endophytic
    • • Here is the gross appearance of a normal uterus with fundus, lower uterine segment, cervix, vaginal cuff, right fallopian tube, left fallopian tube, right ovary, and left ovary from a young woman.
    • (EPITHELIUM) MESENCHYMA (STROMA , MYOMETRIUM)
    • ENDOMETRIAL CARCINOMA 1. A. In Singapore, 3rd most common gynaecological cancer while in USA, endometrial carcinoma is 4 th most common cancer in female after breast, bowel and lung. 2. B. 25% occur in premenopausal women. 3. C. 5% in younger than 40 year old. 4. D. 20% occur in women age 40 to 50 5. E. 75% presented at early stage (confined to uterus) Li F. Lifetime risk of developing Ca endometrium is women less than 75 year old is 2-3%. Average age of on set is 60
    • Normal endometrium Endometrial hyperplasia MESENCHYMA (STROMA , MYOMETRIUM) Adenocarcinoma
    • Pathogenesis of endometrial carcinoma • • • 1. Many endometrial carcinomas appear to arise in a background of abnormal estrogen metabolism. 2. Constitutional complex of symptoms, frequently associated with women who have endometrial carcinoma. a. Obesity b. Low Parity c. Hypertension d. Diabetes mellitis e. Late menopause 3. The above complex of constitutional characteristics suggest the possibility of an underlying hormonal abnormality. Evidence suggests hyperoestrogenism. This includes: a. Chronic anovulation, resulting in unopposed estrogen stimulation of the endometrium. b. Association of endometrial carcinoma with estrogen secreting ovarian tumors, i.e. theca-granulosa cell tumors. c. Evidence that weak androgen precursors from the adrenals and ovarian stroma are aromatized to estrone, a weak estrogen, in body fat. This contributes to the overall estrogen levels in the body. d. The association of endometrial carcinoma in young women with high dose-estrogen-containing sequential oral contraceptives. (These are no longer available for use.)
    • Pathophysiology and Clinical Course 1. Presenting complaint: Abnormal vaginal bleeding (usually post menopausal) 2. Mechanisms of progression a. Myometrial invasion b. Ovarian metastasis c. Regional lymph nodes d. Distant metastases: Late occurrence with grave implications 3. Prognostic Factors a. Tumor Grade: Relative percentage of glandular and solid areas; A solid growth pattern is less differentiated than a glandular pattern and is therefore, less favorable. b. Depth of myometrial invasion c. Surgical-Pathologic stage d. New technologies are under investigation including Estrogen/Progesterone receptors DNA ploidy
    • ENDOMETRIAL (EPITHELIAL) CARCINOMA: CLASSIFICATION 1. 1. Endometroid adenocarcinoma (75-80%) 2. Mucinous carcinoma (5%):Pattern similar with ovary and endocervix, CEA, Good prognosis. 3. Serous carcinoma (<10%), 4. 5. 6. Clear cell carcinoma (4%), Squamous carcinoma (very rare), poor prognosis Undifferentiated carcinoma(glassy cell carcinoma), rare, poor prognosis Mixed types ( if each of the component represent >10% of tumour) Miscellaneous carcinoma A. Metastatic carcinoma (Genital source, ovary is most common, extragenital B. SYNCRONOUS tumours ( Ovary-Endometrium) 7. 8. 1.
    • ADENOCARCINOMA OF ENDOMETRIUM GRADE 1 Clinical summary: 60 year old female with vaginal bleeding Tumor location: Endometrial cavity. Tumor size: 2.8 x 2.4 x 1.7 cm. Tumor characteristics: Soft, pale tan, and nodula mass.
    • Clinical summary: 68 year old female with postmenopausal bleeding Tumor location: Endometrium. Tumor protrudes into the endometrial cavity. Tumor size: 7.5 x 5.2 x 1.5 cm. Tumor characteristics: Soft, fungating, polypoid, tan-red mass. Adenocarcinoma of endometrium G3
    • Well differentiated adenocarcinoma has invaded through the muscle bundles of the myometrium.
    • UTERINE PAPILLARY SEROUS ADENOCARCINOMA Tumor location: Endometrium. Tumor size: 9.5 x 8.5 x 3.0 cm. Tumor characteristics: Soft, fungating, polypoid, pale, tan to tan-red mass. Aggressive tumour, intraperitoneal spread common Resembles ovarian serous carcinoma
    • CLEAR CELL ADENOCA ENDOMETRIUM Very aggressive, occur in older women Clinical summary: 71 year old female with a history of clear cell carcinoma of the endometrium. Tumor location: Fundus of endometrium. Tumor size: 5.0 x 3.0 x 3.0 cm. Tumor characteristics: Soft, fungating and tan brown mass
    • SYNCRONOUS OVARIAN-ENDOMETRIAL CARCINOMA Occur in 15-20% of endometrioid carcinoma of ovary If disease limited to pelvis, only 16% recurs within 5 years Metastasis to ovary is unlikely from the endometrium if : 1. Ovarian tumour is bilateral b. 2. Invasion is less than middle third of endometrium c. 3. Vessel is not involved 4.Endometrial carcinoma is well differentiated
    • MESENCHYMA (STROMA, MYOMETRIUM)
    • Uterine Mesenchymal Tumour • • A. • • • ∀ •   • • Pure non-epithelial malignant tumour (only mesenchymal component) a. b. c. d. B. Endometrial stromal sarcoma (formed by cells resemble endometrial stroma during proliferative phase) Leiomyosarcoma Mixed endometrial stromal and leiomyosarcoma Soft tissue malignant tumour Mixed epithelial-nonepithelial malignant tumour (Mesenchymal plus epithelial component) • • a. Adenosarcoma (epithelial component is benign, low grade malignancy and rarely metastasize) • • • • • b. Malignant Mixed Mullerian tumour (Carcinosarcoma, metasplastic carcinoma and sarcoma) Carcinofibroma (epithelial component malignant while mesenchymal component is benign) • c. C. Undifferentiated or Unclassifiable sarcoma (poor prognosis)
    • UTERINE STROMAL SARCOMA Clinical summary: 40 year old female with an enlarged uterus Operative procedure: TAHBSO Tumor location: Myometrium. Tumor characteristics: Pale, tan and nodular mass. The small nodules are leiomyomas.
    • Leiomyosarcoma: Malignant smooth muscle tumors that originate from myometrium. Peak incidence 40-60 years of age. Gross Appearance Bulky, fleshy tumors with a gray-tan fish flesh appearance. Focal necrosis and hemorrhage are common. a. May be a bulky tumor invading into the myometrium. b. Polypoid lesion projecting into the endometrial cavity Microscopic Appearance Variable. Elongated spindle cells that variably grow in a fascicular pattern, mimicking a benign leiomyoma. However, the nuclei are generally pleomorphic with increased mitotic activity (greater than 10 mitoses/10 high power fields). Clinical Course: Variable with strong tendency to recur and metastasize; blood borne metastases to lungs are common, although direct extension into the peritoneal cavity also occurs.
    • Histology : Spindle cells. Several mitoses are seen here • Leiomyosarcoma: Gross natural color nicely shown large neoplasm with fish flesh cerebriform appearance • Second most common uterine sarcoma
    • Multiple small nodules are scattered throughout the lung. These are nodules of metastatic leiomyosarcoma
    • LEIOMYOMA • Interlacing fascicles of smooth muscle cells arranged in a whorled pattern. Varying amounts of fibrous connective tissue are also present.
    • Rare (0.2-0.7%) sarcomatous transformation in leiomyoma Tan area at the lower edge of this tumor is softer with a fish flesh consistency and focal necrosis. This is an area of leiomyosarcoma in what appeared to be an ordinary leiomyoma.
    • MALIGNANT MIXED MULLERIAN TUMOUR Most common uterine sarcoma Aggressive and early lymphatic/haematogenous spread
    • VULVA CANCER
    • What is the vulva? The vulva is the external portion of the female genital organs. It includes: • labia majora - two large, fleshy lips, or folds of skin • labia minora - small lips that lie inside the labia majora and surround the openings to the urethra and vagina • vestibule - space where the vagina opens • prepuce - a fold of skin formed by the labia minora • clitoris - a small protrusion sensitive to stimulation • fourchette - area beneath the vaginal opening where the labia minora meet • perineum - area between the vagina and the anus • anus - opening at the end of the anal canal
    • What is vulvar cancer? Vulvar cancer is a malignancy that can occur on any part of the external organs, but most often affects the labia majora or labia minora. Cancer of the vulva is a rare disease, which accounts for half of one percent of all cancers in women, and may form slowly over many years. Nearly 90 percent of vulvar cancers are squamous cell carcinomas. Melanoma is the second most common type of vulvar cancer, usually found in the labia minora or clitoris. Other types of vulvar cancer include: • adenocarcinoma • Paget's disease • sarcomas • verrucous carcinoma • basal cell carcinoma
    • What are risk factors for vulvar cancer? • age - of the women who develop vulvar cancer, three-fourths are over age 50, and two-thirds are over age 70. • infection with the human papillomavirus (HPV) • smoking • human immunodeficiency virus (HIV) infection • low socioeconomic status • vulvar intraepithelial neoplasia (VIN) - there is an increased risk for vulvar cancer in women with VIN, although most cases do not progress to cancer. • lichen sclerosus - can cause the vulval skin to become very itchy and may slightly increase the possibility of vulvar cancer. • chronic vulvar inflammation • other genital cancers • melanoma or atypical moles on non-vulvar skin - a family history of melanoma and dysplastic nevi anywhere on the body may increase the risk of vulvar cancer.
    • • VULVA: ERYTHROPLASIA, CARCINOMA IN SITU
    • CLINICAL APPEARANCE OF VULVAR INTRAEPITHELIAL NEOPLASIA There are numerous pigmented macules on the vulva, some of which have a central depigmented area. Nonpigmented red areas are present on the labia minora which are also VIN. On the perineal body, anterior to the rectum, red and pigmented VIN lesions are seen
    • • Dysplasias may also involve the vulvar epithelium, seen here at the right with overlying hyperkeratosis (producing an area of leukoplakia), with more normal (but atrophic) keratinizing squamous epithelium at the left. Most cases of vulvar intraepithelial neoplasia (VIN) do not progress to invasive cancer. Many are multicentric, and some occur in association with cervical or vaginal carcinoma.