Diseases of female genital system 1

Question 1

What are the Low risk Human papillomavirus subtypes

Answer 1

6 and 11

Question 2

What are the High risk Human papillomavirus subtypes?

Answer 2

16 and 18

Question 3

What do these acronyms stand for?:
VIN
CIN
CGIN
VaIN
AIN

Answer 3

Vulval intraepithelial neoplasia. 
Cervical intraepithelial neoplasia. 
Cervical glandular intraepithelial neoplasia. 
Vaginal intraepithelial neoplasia. 
Anal intraepithelial neoplasia.

Question 4

What is the action of the protein E6 expressed by the early genes of high risk HPV

Answer 4

E6 binds to and inactivates p53.

p53 mediates apoptosis in response to DNA damage (Guardian of the genome)

Question 5

What is the action of the protein E7 expressed by the early genes of high risk HPV

Answer 5

E7 binds to the RB1 gene product.

RB1 is a tumour suppressor gene which controls G1/S checkpoint in cell cycles

Question 6

Which Vulval Intraepithelial neoplasia is:

• Graded VIN 1-3
• Related to HPV infection
• Younger people

Answer 6

Classical / warty / baseloid

Question 7

Which Vulval Intraepithelial neoplasia is:

• Not graded
• Not HPV related
• Occurs in chronic dermatosesesp. lichen sclerosus
• Older people

Answer 7

Differentiated VIN

Question 8

Vulval tumour characterised by:

• Usually dark pigmentation
• 5% of vulval cancers
• Mean age 50-60
• Local recurrence in 1/3, spread to urethra frequent
• Lymph node/haematogenous spread common
• Depth of invasion correlates with LN involvement

Answer 8

Malignant melanoma

Question 9

Vulval tumour characterised by:

• Pruritic/burning/eczematous patch
• 5% Vulval cancers
• mean age 80
• In-situ adenocarcinoma of squamous mucosa
• Tend to recur following excision
• Can develop invasive adenocarcinoma

Answer 9

Paget’s disease

• Usually no underlying tumour

Question 10

What is the name of the physiological area of squamous metaplasia at the cervix post menarche?

Answer 10

Transformational zone

Question 11

What are you looking for in a cervical smear?

Answer 11

Cervical intraepithelial neoplasia

Question 12

Why is it more difficult to diagnose and excise CIN in post menopausal women?

Answer 12

The Transformation Zone retracts up the canal as the cervix atrophys post menopause

Question 13

What is the name of the procedure to excise CIN?

Answer 13

Large Loop Excision of the Transformation Zone (LLETZ)

Question 14

What are the age groups offered cervical screening and how often?

Answer 14

25 First invitation
25 – 49 3 yearly
50 – 64 5 yearly
65+ Only screen those who have not been screened since age 50 or have had recent abnormal tests

Question 15

Risk factors of Cervical squamous cell carcinoma

Answer 15

High risk HPV (most important causative factor)
Multiple sexual partners
Male partner with multiple partners
Young age at first intercourse
High parity
Low socioeconomic group
SMOKING
Immunosuppression

Question 16

What is the precursor of Cervical squamous cell carcinoma?

Answer 16

Cervical intraepithelial neoplasia - CIN

Question 17

What is the precursor of Cervical adenocarcinoma?

Answer 17

Cervical Glandular Intraepithelial Neoplasia (CGIN)

Question 18

Cervical carcinoma FIGO staging:
I ?
II ?
III ?
IV ?

Answer 18

I Confined to cervix
II Invades beyond uterus, not to pelvic side wall
III Extends to pelvic wall, lower 1/3 vagina, hydronephrosis
IV Invades bladder or rectum or outside pelvis

Question 19

Cervical carcinoma metastasis locations:

Answer 19

Pelvic and para-aortic lymph nodes

Via blood to lungs, bone etc