16. Pathology of the Female Reproductive Tract Flashcards
Presenting Complaints
Vaginal Bleeding:
post-coital, inter-menstrual, post-menopausal, heavy periods, irregular periods
Pain:
pelvic, abdominal, painful sex, painful periods
Discharge:
heavy, bloody, offensive, itchy.
Infertility:
primary, secondary
Cervical Pathology
Cervical Screening – Smear Test
Cervical Intra-epithelial Neoplasia (CIN)
Cervical Carcinoma
Endocervical Polyps
Cervical Screening-Smear Test
View cervix and take sample of cells
Every 3 years from age 25 to 49 years.
Every 5 years from age 49 to 64.
After age 64, screening only if no previous smears or abnormal smears.
Aims to detect early disease stages before becomes invasive.
Human Papilloma Virus
Transmitted by sexual contact
Risk increases with increased numbers of sexual partners
No symptoms
Thought to be main cause of CIN and therefore cervical cancer
HPV
Many different types
Low risk types- wart/verrucas
High risk types- cervical cancer
Girls aged 12 -13 offered HPV vaccination
offers protection against infection for strains associated with 70% of cervical cancers
Screening programme
Cervical cancer screening programme
“Smear” test carried out in GP surgery
Cytology Screening
Normal- routine 3/5 year re-smear
Abnormal- referred to colposcopy
May have biopsies taken
Cervical Cancer
2nd most common female malignancy Risk factors HPV, smoking, non attendance to CSP Symptoms Abnormal discharge and bleeding On examination the cervix appears abnormal
Cervical Carcinoma
Abnormal cells and invasion
Can present with inter-menstrual or post-coital bleeding
Treatment
Depends on stage either local excision or radical hysterectomy +/- chemoradiotherapy
Endocervical Polyps
Usually present with irregular vaginal bleeding ‘spotting’
Benign lesions
Can remove at hysteroscopy
Uterine Pathology
Menorrhagia Fibroids Endometritis and Pelvic Inflammatory Disease Endometriosis Endometrial Polyps Endometrial Cancer
Menorrhagia
“Heavy periods” >80ml blood loss Very common 1 in 20 women consult their GP a year Costing the NHS £7 million in prescriptions Causes DUB in 50% Fibroids, endometriosis, polyps......
Treatment
Mirena coil Mefanamic and tranexamic acid COCP Depo provera Endometrial ablation Hysterectomy
Fibroids (Leiomyomas)
Very common benign tumours
Arise from myometrium (uterine muscular wall)
Can present with heavy or painful periods, pelvic pain or distension
Treatment depends on symptoms and wishes for pregnancy
Endometritis and Pelvic Inflammatory Disease
Caused by Infections, usually sexually transmitted.
Can present with abnormal discharge, pain or bleeding.
Can be asymptomatic
Major cause of infertility
Endometriosis
Endometrial tissue in the wrong location i.e outside the endometrium
Very common benign condition
Can present with heavy or painful periods, pelvic pain, painful sex
Treatment depends on symptoms and often difficult
Endometriosis Treatment
COCP
Mirena
Zoladex
Surgery
Endometrial Polyps
Benign growths from endometrial cavity
Can be removed at hysteroscopy
Endometrial Cancer
Cancer of the lining of the uterus
Often presents as post menopausal bleeding and so is detected early
Risk factors are nulliparity, high BMI, HRT and late menopause
Diagnosed on biopsy
Either pipelle or hysteroscopy
Usually undergo TAH and BSO
Overall 20 year survival rate is 80%
Endometrial Carcinoma
Usually presents as post-menopausal bleeding- early stage
Risk factors include obesity and oestrogen exposure
Diagnosed by endometrial biopsy (pipelle or hysteroscopy)
Treatment usually hysterectomy
Ovarian Cysts
Follicular cysts
Benign, very common
Usually less than 6cm
Often asymptomatic, no treatment needed
Cystadenomas
Can be very large fluid filled cysts
Symptoms caused by pressure effect
Benign Mature Teratomas
Large cysts filled with solid substance
Polycystic Ovarian Syndrome (1)
Common condition
Multiple cysts on ovaries
Usually presents as irregular periods, no periods, infertility, other symptoms
Major cause of infertility
Polycystic Ovarian Syndrome (2)
Treatments
COCP
Metformin
Clomifene
Complications
Increased CV risk
Increased risk of T2DM
Increased problems in pregnancy
Ovarian Cysts
Can be benign or malignant
Can be HUGE!!!
Can occur in young women- usually benign (20-45)
Can occur in older women- usually malignant (>45)
Usually need ovary to be removed with the cyst if large
Ovarian cancer
Often asymptomatic especially if small
Usually present late when already spread
Poorer prognosis than endometrial cancer
Pregnancy Associated Diseases
Miscarriage
Ectopic Pregnancies
Gestational Trophoblastic disease
Miscarriage
Loss of pregnancy before 24 weeks Occurs in approx 15% of pregnancies Usually first trimester Classification Threatened, Inevitable, Incomplete and Missed Often no cause found Risk factors Increasing age, multiple pregnancies, smoking, alcohol, connective tissue disorders in mother and diabetes Presentation is usually with pv bleeding
Treatment options
Conservative
Medical with misoprostol
Surgical usually by vacuum suction under GA
Ectopic Pregnancy (1)
Think about in any ‘young woman’ with abdominal or pelvic pain- always test!!!!!
Risk factors are PID, coil, IVF, previous ectopic, pelvic surgery.
Ectopic pregnancy (2)
An extra uterine pregnancy usually occurring in the Fallopian tubes
Occurs in 1% of pregnancies
Can occur very early before a period has been missed
Can be a gynaecological emergency as rupture of the pregnancy carries a high mortality
Risk factors for ectopics
Fertility treatments, PID, previous ectopics, smokers
Presentation pain and unilateral lower abdominal pain
Ectopic pregnancy (3)
Raised beta-HCG levels on blood testing
Treatment almost always surgical
