Disease of the female genital system Flashcards
What types of neoplasias are often caused by Human papillomaviruses?
intraepithelial neoplasias
i.e. vulva, cervical, cervical glandular, vaginal, anal
What is dysplasia and how does it progress into neoplasia?
the earliest stage of change into neoplasia
shows all the signs of cancer except invasion (in situ)
still curable at the stage
What is the human papillomavirus?
double stranded DNA virus
different types invade different tissues
Genital HPV’s are categorised how?
low oncogenic risk
high oncogenic risk
What are the two most common subtypes of low HPV risk?
6
11
What are the two most common subtypes of high HPV risk?
16
18
99.7% of which type of cancer contains HPV DNA?
cervical
What do low risk HVP’s normally present as?
warts
benign
What do high risk HVP’s normally present as?
invasive carcinomas
What are the two vaccines for HPV and what subtypes do they target? Also which one is used currently?
Cervarix - HPV 16 and 18
Garasil - HPV 6, 11, 16 and 18 (Currently used)
How many and what sets of genes does HPV have?
2 - early and late sets of genes
What do late genes express for?
codes of capsid proteins
What are the 2 early genes and what do they do?
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)
What happens in the presence of HPV?
high risk HPV integrates into the host chomosomes
upregulates E6/E7 expression
How does vulval intraepithelial neoplasia (VIN) present?
warts
white patches
pigmented patches
Classical VIN is caused by what and more common in what age range?
HPV
younger people
Differetiated VIN is caused by what and more common in what age range?
not HPV related - occurs commonly in conjunction with chronic inflammatory skin conditions, esp lichens sclerosus (precursor to cancer)
older people
Why is it important that VIN is treated?
untreated = 87% of those can lead to invasive cancer
only treatment is surgical
Who is VIN invasion more likely to occur in?
postmenopausal
immunocompromised
How does vulval squamous cell carcinoma present?
eroded plaque
ulcer
What is the spread of vulval squamous cell carcinoma typically like?
very predictable
spreads to ipsilateral ingiunal lymph nodes first
Then to contralateral inguinal lymph nodes & deep iliofemoral lymph nodes
What is the staging system used for vulval squamous cell and cervical carcinomas?
FIGO staging system
What is the mean age of people with malignant melenoma of the vulva and how likely is it to spread?
50-60 years old
aggressive
spreads to urethra frequently
lymph nodes/haematogenous spread common
What is the mean age of people with extramammary Pagets disease is how does present?
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
Explain the histology of the cervix in its original state
squamous epithelium at the base
columnar epithelium further up and inside
squamocolumnar junction present at the external os
Explain the histology of the cervix during first menstrual cycle
oestrogen increases
increased sqaumous epithelium
squamocolumnar junction becomes wider
Explain the histology of the cervix during the development of the transformational zone
due to the vaginal acidic environment, metaplasia occurs
squamous epithelium turns into columnar epithelium = transformational zone
Explain the histology of the cervix during menopause
squamocolumnar junction moves up
Where does specifically cervical intraepithelial neoplasia happen?
transformational zone
What can cervical intraepithelial neoplasia lead to?
squamous cell cervical cancer
What does the cervical screening programme detect?
cervical intraepithelial neoplasia
NOT cancer
How is cervical intraepithelial neoplasia catagorised?
Low grade (CIN I) High grade (CIN II/III)
At what age do you receive your first invitation for cervical screening programmes?
25
Why can cervical screening programmes produce confusing cytology sometimes?
reactive changes, especially in younger people
i.e. inflammation/healing
What is the next step if cervical screening shows low grade/borderline changes?
HPV testing
if +ve then refer for colposcopy and biopsy
if -ve then normal recall
What is the next step if cervical screening shows high grade changes?
refer for colposcopy and biopsy
What is the treatment for CIN?
Large Loop Excision of the Transformation Zone (LLETZ)
What are risk factors for cervical squamous cell carcinoma?
high risk HPV is most important Multiple sexual partners Male partner with multiple partners Young age at first intercourse Low socioeconomic group SMOKING Immunosuppression
What is the presentation and spread like for cervical adenocarcinoma?
arises from the mucosal glands
same as cervical squamous cell cancer
What is the precursor for cervical adenocarcinoma?
Cervical Glandular Intraepithelial Neoplasia (CGIN)
Which has a worse prognosis out of adenocarcinoma and squamous cell carcinoma?
adenocarcinoma due to radioresistance
Metastasis is common from where and to where in regards to cervical carcinomas?
TO pelvic and para-aortic lymph nodes
FROM blood to lungs, bone etc
