gynae path - cervix

Question 1

what staging is used for gynae tumours

Answer 1

FIGO - international federation of obs and gynae

Question 2

what is inflammation of the vulva, vagina, cervix, endometrium, fallopian tube and ovary called

Answer 2

vulvitis
vaginitis
cervicitis
endometritis
salpingitis
oophoritis

Question 3

infections of the genital tract that cause discomfort but no serious complications

Answer 3

Candida: Diabetes mellitus, oral contraceptives and pregnancy enhance development of infection
Tichomonas vaginalis: protozoan
Gardenerella: gram negative bacillus causes vaginitis

Question 4

infections of the female genital tract that have serious complications

Answer 4

Chlamydia: infertility
Gonorrhoea: infertility
Mycoplasma: spontaneous abortion and chorioamnionitis
HPV: implicated in cancer

Question 5

definition of PID

Answer 5

infection of the upper female genital tract

Question 6

organisms that cause PID

Answer 6

Gonococci, chlamydia, enteric bacteria
* start from lower genital tract,
* spread upwards via mucosal surface

Staph, strept, coliform bacteria and clostridium perfringens
* 2ndary to abortion
* start from uterus - spread by lymphatics and blood vessels up
* deep tissue layer involvement

Question 7

complications of PID

Answer 7

Peritonitis
Bacteraemia and septicaemia
Intestinal obstruction due to adhesions
Infertility - from lesions

Question 8

summarise the sequence of events in salipingitis

Answer 8

acute, chronic or granulomatous
direct ascent from vagina (except with TB)
can resolve
complications:
* Plical fusion
* Adhesions to ovary
* Tubo-ovarian abscess - from obstruction of lumen -> abdo mass
* Peritonitis
* Hydrosalpinx
* Infertility - path of ovum disrupted
* Ectopic pregnancy

Question 9

where can you get ectopics

Answer 9

tubal - most common
ovarian
peritoneal

Question 10

Answer 10

benign endocervical polyp

Question 11

epidemiology of cervical ca

Answer 11

2nd most common cancer affecting women
mean age - 45-50yrs

viruses involved in aetiology
screening
intervention is possible at preinvasive stage
possibly prevent with vaccine

pre-malignant phase is cervical intraepithelial neoplasia

Question 12

RF for cervical cancer

Answer 12

Human Papilloma Virus -present in 95%
Many sexual partners
Sexually active early
Smoking
Immunosuppressive disorders

Question 13

what are the low risk HPVs

Answer 13

types that cause oral and genital warts
Most common types: 6, 11

Other types: 40, 42, 43, 44, 54, 61, 72, 73, 81

Low grade cervical dysplasia

Question 14

what are the high risk HPVs

Answer 14

cancer causing types - cervical, Vulval, vaginal, penile, and anal
low and high grade dysplasia
Most common types: 16, 18
Other types: 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68,82

Question 15

compare L and R

Answer 15

Transitional zone of cervix

L normal

R - high grade dysplasia - lots of mitotic activity, disorganisation of cells.

Question 16

summarise disease progression of cervical cancer

Answer 16

CIN3 - severe dysplasia

If cells breach bottom layer = ca

Question 17

what is cervical intraepithelial neoplasia

Answer 17

dysplasia
epi cells have undergone phenotypic and genetic changes -> premalignant and preinvasive
basal membrane in tact
squamous epi (CIN) involved more than glandular (CGIN)
CGIN -> adenoca
CIN -> sq ca

Question 18

define cervical ca

Answer 18

invasion through the basement membrane changes CIN to cancer

the 2 main types are
* squamous cell ca
* adenoca - HPV dependent/independent

Question 19

what does the Px of cervical cancer depend on

Answer 19

Tumour type
Tumour grade
Tumour stage: FIGO Stage I (90%) – IV (10%)
5 year survival
Lymphovascular space invasion

Question 20

summarise latent HPV infection

Answer 20

• HPV DNA resides in basal cells
• infectious virons are not produced
• Replication of viral DNA is coupled to replication of the epithelial cells with replication of the host DNA
• Complete viral particles not produced
• cellular effects of HPV infection not seen
• Infection can only be identified by molecular methods

Question 21

summarise productive viral infection

Answer 21

viral DNA replication independantly of host DNA synth
-> large number of viral DNA
-> infectious virons
cytological and histological features

Question 22

How does HPV transform cells

Answer 22

proteisn E6 and E7 encoded by virus have effect on genes
they bind and inactivate tumour suppressor genes - retinoblastoma gene (Rb) (E7), p53 (E6)

-> interfere with apoptosis
-> increase cellular proliferation
-> oncogenesis

Question 23

Px with HPV

Answer 23

most people - immune system eliminate HPV -> undetectable in 2yrs
few will have sx
persistent infection with high-risk HPV - associated with cancerous and pre-cancerous changes

Question 24

summarise the cervical screening program

Answer 24

start at 25yrs
every 3yr until 50
then every 5yr until 64

Question 25

value of cervical cytology

Answer 25

sensitivity ranging between 50% - 95% and specificity of at most 90% in detecting high grade CIN and SCC.

now screening focused on detecting high risk

Question 26

summarise HPV DNA test

Answer 26

nucleic acid solution hybridisation assay with signal amplification - uses long synthetic RNA probes complementary to DNA seq of different types of HPV
- to the most common cancer-associated HPV types

Question 27

summarise the HPV vaccine

Answer 27

protect against HPV cancers - cervical, anal, head and neck

girls and boys aged 12-13yrs offered HPV vaccine
1st dose in yr 8, 2nd dose 6-24mo after