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CP > Disease of the female genital system > Flashcards

Disease of the female genital system Flashcards

1
Q

What types of neoplasias are often caused by Human papillomaviruses?

A

intraepithelial neoplasias

i.e. vulva, cervical, cervical glandular, vaginal, anal

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2
Q

What is dysplasia and how does it progress into neoplasia?

A

the earliest stage of change into neoplasia
shows all the signs of cancer except invasion (in situ)
still curable at the stage

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3
Q

What is the human papillomavirus?

A

double stranded DNA virus

different types invade different tissues

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4
Q

Genital HPV’s are categorised how?

A

low oncogenic risk

high oncogenic risk

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5
Q

What are the two most common subtypes of low HPV risk?

A

6

11

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6
Q

What are the two most common subtypes of high HPV risk?

A

16

18

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7
Q

99.7% of which type of cancer contains HPV DNA?

A

cervical

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8
Q

What do low risk HVP’s normally present as?

A

warts

benign

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9
Q

What do high risk HVP’s normally present as?

A

invasive carcinomas

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10
Q

What are the two vaccines for HPV and what subtypes do they target? Also which one is used currently?

A

Cervarix - HPV 16 and 18

Garasil - HPV 6, 11, 16 and 18 (Currently used)

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11
Q

How many and what sets of genes does HPV have?

A

2 - early and late sets of genes

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12
Q

What do late genes express for?

A

codes of capsid proteins

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13
Q

What are the 2 early genes and what do they do?

A

E6 - binds to and inactivates p53 (mediates apoptosis when DNA damage has occured)
E7 - binds to RB1 gene product (tumour supressor gene that controls G1/S checkpoint in cell cycle)

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14
Q

What happens in the presence of HPV?

A

high risk HPV integrates into the host chomosomes

upregulates E6/E7 expression

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15
Q

How does vulval intraepithelial neoplasia (VIN) present?

A

warts
white patches
pigmented patches

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16
Q

Classical VIN is caused by what and more common in what age range?

A

HPV

younger people

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17
Q

Differetiated VIN is caused by what and more common in what age range?

A

not HPV related - occurs commonly in conjunction with chronic inflammatory skin conditions, esp lichens sclerosus (precursor to cancer)
older people

18
Q

Why is it important that VIN is treated?

A

untreated = 87% of those can lead to invasive cancer

only treatment is surgical

19
Q

Who is VIN invasion more likely to occur in?

A

postmenopausal

immunocompromised

20
Q

How does vulval squamous cell carcinoma present?

A

eroded plaque

ulcer

21
Q

What is the spread of vulval squamous cell carcinoma typically like?

A

very predictable
spreads to ipsilateral ingiunal lymph nodes first
Then to contralateral inguinal lymph nodes & deep iliofemoral lymph nodes

22
Q

What is the staging system used for vulval squamous cell and cervical carcinomas?

A

FIGO staging system

23
Q

What is the mean age of people with malignant melenoma of the vulva and how likely is it to spread?

A

50-60 years old
aggressive
spreads to urethra frequently
lymph nodes/haematogenous spread common

24
Q

What is the mean age of people with extramammary Pagets disease is how does present?

A

80 years old
burning/eczema like patches - should be diagnoised via biopsy
arise in the intraepidermal portion of sweat ducts
in situ adenocarcinoma of squamous mucosa
can develop into invasive adenocarcinoma

25
Q

Explain the histology of the cervix in its original state

A

squamous epithelium at the base
columnar epithelium further up and inside
squamocolumnar junction present at the external os

26
Q

Explain the histology of the cervix during first menstrual cycle

A

oestrogen increases
increased sqaumous epithelium
squamocolumnar junction becomes wider

27
Q

Explain the histology of the cervix during the development of the transformational zone

A

due to the vaginal acidic environment, metaplasia occurs

squamous epithelium turns into columnar epithelium = transformational zone

28
Q

Explain the histology of the cervix during menopause

A

squamocolumnar junction moves up

29
Q

Where does specifically cervical intraepithelial neoplasia happen?

A

transformational zone

30
Q

What can cervical intraepithelial neoplasia lead to?

A

squamous cell cervical cancer

31
Q

What does the cervical screening programme detect?

A

cervical intraepithelial neoplasia

NOT cancer

32
Q

How is cervical intraepithelial neoplasia catagorised?

A 
Low grade (CIN I)
High grade (CIN II/III)
33
Q

At what age do you receive your first invitation for cervical screening programmes?

A

25

34
Q

Why can cervical screening programmes produce confusing cytology sometimes?

A

reactive changes, especially in younger people

i.e. inflammation/healing

35
Q

What is the next step if cervical screening shows low grade/borderline changes?

A

HPV testing
if +ve then refer for colposcopy and biopsy
if -ve then normal recall

36
Q

What is the next step if cervical screening shows high grade changes?

A

refer for colposcopy and biopsy

37
Q

What is the treatment for CIN?

A

Large Loop Excision of the Transformation Zone (LLETZ)

38
Q

What are risk factors for cervical squamous cell carcinoma?

A 
high risk HPV is most important
Multiple sexual partners
Male partner with multiple partners
Young age at first intercourse
Low socioeconomic group
SMOKING
Immunosuppression
39
Q

What is the presentation and spread like for cervical adenocarcinoma?

A

arises from the mucosal glands

same as cervical squamous cell cancer

40
Q

What is the precursor for cervical adenocarcinoma?

A

Cervical Glandular Intraepithelial Neoplasia (CGIN)

41
Q

Which has a worse prognosis out of adenocarcinoma and squamous cell carcinoma?

A

adenocarcinoma due to radioresistance

42
Q

Metastasis is common from where and to where in regards to cervical carcinomas?

A

TO pelvic and para-aortic lymph nodes

FROM blood to lungs, bone etc

CP (50 decks)

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