Diseases of the Female Genital System I Flashcards
Name the different intraepithelial dysplasia that can occur?
Vulvula Cervical Cervical Glandular Vaginal Anal
What are intraepithelial neoplasia related to?
HPV infection
What is dysplasia?
The earliest manifestation of neoplasia
In situ, non-invasive, CURABLE (if l;eft, can become metastatic)
Forms the basis for the cervical screening program
What type of virus is the HPV? How are they divided?
- DNA virus
- Different types effect different tissues
- Divided into LOW and HIGH Oncogenic risk
What types of HPV are low risk? What do they cause?
Types 6, 11
Associated with GENITAL WARTS (most common) - d not produce malignancies
What types of HPV are HIGH risk? What do they cause?
Types 16 and 1, 31 and 33
Associated with CERVICAL CANCER
(99.7% cervical cancers related to HPV infection)
What are the two vaccines against HPV? What types do they vaccinate against?
Cervarix - 16, 18
Gardasil 6, 11, 16, 18** - prevents genital warts and cervical cancer
** main one used in UK
How does the HPV virus exert its action?
Early genes
E6 - deactivates P53 responsible for apoptosis with damage to DNA - accumulation of genetic damage
E7 - deactivates RB1 - tumour suppressor gene which controls G1/S checkpoint in cell cycle - dysregulated cell proliferation
How do vulvulal intraepithelial neoplasia’s present?
Warty
White patches
Pigmented patches
What is another cause of vulvula intraepithelial neoplasms?
Lichen sclerosis (older people) - can cause malignancy unrelated to HPV
What is the most common type of cancer that occurs in the vulva?
Squamous cell carcinoma
What does squamous cell carcinoma look like? Where can they spread?
- Ulcer, raised lesions
- Spreads predictably - locally to vagina/distal urethra
and inguinal lymph
If the depth of squamous cell carcinoma is less than 1mm, what is the risk of metastasis?
VERY RARE (local excision)
If more than 1mm, lymph node sampling
What staging system is used for vulval squamous cell carcinoma?
Figo staging
What other cancers other in the vulva?
- Malignant melanomas (pigmented and non pigmented)
- Pagets disease - pruritic/burning/eczematous patch - like a shotgun to the vag - adenocarcinoma of squamous mucosa
What is weird about pages disease?
No underlying tumour - in situ disease, curable!
What is the area where squamous metaplasia takes place and is highly prone to HPV infection?
Transformation zone
Why does squamous metaplasia occur?
Oestrogen - increased cervical bulk - squamocolumnar junction everts outside
Columnar epithelium of cervix cannot withstand acidic environment
Therefore, undergoes squamous metaplasia - TRANSFORMATION ZONE (squamous cels can withstand!)
What happens to the transformational zone with the menopause?
Cervical inversion - transformational zone inverts back down canal - more difficult to diagnose
What is cervical intraepithelial neoplasia? How does this relate to the cervical screening programme?
Pre-invasive stage of cervical squamous cell carcinoma
- aim of cervical screening programme is to identify CIN
If diagnosed with CIN 1, whats the standard treatment?
None - high risk of regression but low risk of progression
Is the cervical screening programme a test for cancer?
NO - its a test for cervical intraepithelial neoplasm
What characteristics call for HPV testing/colposcopy?
Dyskaryosis - abnormal squamous cells
What happens if CIN/Dyskaryosis is observed in the TZ?
Colposcopy
Long loop excision of the transformation zone
What are the risk factors for cervical squamous cell carcinoma?
Multiple sexual partners
Male partners
Young age at intercourse
Smoking
What are the treatment for squamous cell carcinoma?
Excision (LLETZ)
Chemotherapy
What is the purcurose for cervical adenocarcinoma?
Cervical glandular intraepithelial neoplasm
