GUM 204 & 220 Gynae & Gynae Cancer Flashcards
What happen in the late luteal/early follicular phase of the menstrual cycle? (Days 25-5)
The corpus luteum is regressing and dying
Decreased steroids esp. progesterone = -ve feedback to increase LH/FSH
intercyle rise in FSH = follicular selection
What does LH stimulate? (Menstrual Cycle)
Theca cells in the developing follicles to stimulate testosterone production
What converts testosterone to oestrogen and where from? (Menstrual cycle)
Aromatase enzyme from follicular granulosa cells
What happens in the mid follicular phase? (days 5-10)
Oestrogen is increasing
-ve feedback = less FSH and there is inhibin production = no more follicular development
Dominant follicle has to have LH receptors to survive
What happens in the mid cycle phase? (days 10-20)
2 days of high oestrogen switches the negative feedback to positive
= LH (and smaller FSH) surge
= follicle rupture from ovum and atresia of other follicles
What happens to theca cells after the follicle has ruptured?
Undergo atrophy
What happens to the granulosa cells after the follicle has ruptured?
Undergo hypertrophy
Describe the mid luteal phase? (days 20-25)
Corpus luteum is formed by ruptured follicle
Oestrogen levels dropped so feedback is -ve again
Progesterone levels increase to maintain CL and endometrium
What has happened if there is menstruation?
No fertilisation so corpus luteum regresses
When does the primary oocyte finish the 1st meiotic division?
Ovulation - LH surge
What feature of seminal fluid protects against the vaginas acidity?
It is slightly alkaline
What two changes to sperm undergo once in the vagina/fertilisation?
Capacitation and the acrosome reaction
Describe capacitation?
Biochemical removal of the surface glycoprotein on spermatozoa initiating whiplash movement of tail = hyperactive sperm
What is the acrosome reaction?
Allows sperm to make a slit in the zona pellucida and stimulates the cortical reaction - prevents polyspermy
What hormone maintains the corpus luteum after implantation and is responsible for maternal recognition?
Beta-HCG
What do testes mostly consist of?
Seminiferous tubules
What are the walls of the seminiferous tubules made up of?
Sertoli cells
What lie on the basement membrane of the seminiferous tubules? What are they capable of?
Spermatogonia - germ cells
Can divide by mitosis or meiosis
What happens to spermatogonia next on the pathway to becoming mature sperm?
They undergo mitosis to produce diploid cells committed to differentiative pathway - 46XY
Primary spermatocytes
What happens to primary spermatocytes next?
Undergo 1st meiotic division to become 23X and 23Y = secondary spermatocytes
What happens to secondary spermatocytes?
They undergo second round of meiosis to give 4 mature spermatozoa
As sperm mature where do they travel from and to?
Away from basement membrane –> lumen where they then travel into rete/epidiymus and along route they undergo spermiogenesis - final maturation for motility and acrosomal cap
Once the sperm fuses with the oocyte what happens to the oocyte?
It undergoes its second meiotic division
What is mennorhagia?
Excessive blood loss during menstruation
What is primary dysmenorrhoea?
Painful menstrual bleeding usually starts 1-2 years after menarche and has no underlying pathology
What is secondary dysmenorrhoea?
Painful menstrual bleeding, occurs 3-4 days before menstruation and later in life - indicates pathology
What is DUB - dysfunctional uterine bleeding?
Menorrhagia not associated with any disease - diagnosis of exclusion
What are other causes of menorrhagia?
Fibroids
Endometriosis
PCOS
What is a uterine fibroid? What are the risk factors?
Benign tumour of the myometrium
Risk factors tamoxifen, null-parity, obesity and family hx
What are the 3 classifications of fibroids?
Intramural - within uterine wall, most common
Sub-serosal - under serosal surface, can become pedunculated
Sub mucosal - most likely to produce mennorhagia
What are some general treatments for menorrhagia?
Mirena Coil/OCP Tranexamic acid Mefenamic Acid Progestogens GnRH analogues Surgical - endometrial ablation/hysterectomy
What is endometriosis?
When endometrial tissue is found outside of the uterus
What are chocolate cysts?
Ovarian cysts caused by bleeding of endometrial tissue into cysts at menstruation
What is fecundity?
The ability to reproduce
What is subfertility?
An involuntary failure to conceive
What are the major reasons of subfertility?
Sperm dysfunction
Ovulation disorder
Tubal disease
Endometriosis
What is azospermia? What can it be due to?
No sperm in ejaculate
Primary - failure of production e.g. congenital or iatrogenic
Secondary - failure of sperm to reach urethra e.g. infection, absent vas deferens
What are some ovulatory disorders responsible for subfertility?
Hypothalamic - anorexia/low BMI
Pituitary - adenoma, prolactinomas or drugs
Ovarian - PCOS
What is PCOS?
Several tiny cysts on ovaries associated with increased androgens and anovulation
Symptoms: hair growth, acne, weight gain
What can cause tubal disease? How does it affect fertility?
Infections: mainly gonorrhoea and chlamydia
Endometriosis
Prevent a patent lumen or scars may prevent tube from moving ovary
Who does vulval cancer normally present in? Is it common?
70 year olds - rare
How may vulval cancer present?
Itching, irritation, pain, lumps, discharge and bleeding
What are some risk factors for vulval cancer?
age, smoking, HPV and lichen sclerosis
What is the most common type of vulval cancer?
Squamous cell carcinoma
How do you treat vulval cancer?
Surgically - if > 1mm invasion then wide local incision with 15mm margin
Total vulvectomy if wider - may use radiotherapy to reduce size or in inguinal lymph node involvement
What is the most common gynae cancer worldwide?
Cervical cancer
What is the 3 rd most common gynae cancer in the UK?
cervical cancer
What is the next step if dyskariosis is found on a cervical smear?
Colposcopy
What is the most common type of cervical cancer?
Squamous cell
Name risk factors for cervical cancer
Sexual behaviours - Increased risk of HOV
smoking, OCP and immunosuppressants
What is stage 1 of cervical cancer and how is it treated?
confined to cervix and treated with local excision
What is stage 2 of cervical cancer and how is it treated?
confined to uterus - total abdominal hysterectomy
What is stage 3 of cervical cancer and how is it treated?
involves pelvic side wall/lower vagina
treat with radical radio/chemo
What is stage 4 of cervical cancer and how is it treated?
beyond pelvis, bladder and rectal mucosa
radical radio/chemo
What is endometrial cancer?
A malignant adenocarcinoma
What is the second most common gynae malignancy?
Endometrial cancer
What are the risk factors for endometrial cancer?
Obesity, unopposed oestrogen, long fertile period, null parity, family history, PCOS
How does endometrial cancer often present?
Older women with PMB
What is the most common gynae malignancy?
Ovarian cancer
What type of cancer is ovarian cancer usually?
epithelial cancer - serous ovarian cancer
How does ovarian cancer often present?
Late but can also have non-specific symptoms, bloating and abdominal pain
What are risk factors for ovarian cancer?
nullparity, BRCA1 gene mutation, long fertile period
