Gynaecological malignancies Flashcards
What ligament connects the ovaries and the lateral pelvic wall?
Suspensory ligament
What ligament connects the ovaries and the uterus?
Utero-ovarian ligament
The ovaries are located behind which ligament?
Broad ligament
What hormones do the corpus luteum secrete and for what physiological processes?
Oestrogen and progesterone.
Oestrogen for menstruation; progesterone for menstruation and pregnancy.
What is the lymphatic drainage of ovaries (for spread of ovarian cancer)?
- Para-aortic LNs (mainly)
- Iliac LNs (common, internal, external iliac)
- Sacral and obturator LNs
- Pelvic and retroperitoneal LNs
- Inguinal LNs
What is the lymphatic drainage of endometrium of the uterus?
- Parametrial LNs
- Paracervical LNs
- Iliac LNs (common, external, internal iliac)
- Paraaortic LNs
- Inguinal LNs
Why does swapping the ectocervix for pap smear cells in a post-menopausal woman be not accurate?
Because the ectocervix cells would have become atrophic and have high N:C ratio that resembles dysplasia.
Where to swap for Pap smear to detect early cancerous cells in the cervix?
Squamocolumnar junction where columnar, glandular cells of the endocervix meets the stratified squamous cells of the ectocervix (transitional epithelium)
Because this is the place where metaplastic/dysplastic/cancerous cells are most likely to reside.
What is the lymphatic drainage of the cervix?
- Parametrial
2. Uterosacral and cardinal ligament routes
What are the most common type of ovarian tumour?
Epithelial ovarian tumour
Which subtype of epithelial ovarian tumour is the most prone to malignancy?
- Endometrioid
2. Serous
Ulceration lesion on cervix - differentials?
- Polyp (endometrial or cervical)
- Carcinoma (endometrial or cervical)
- Cervical ectropion
- Cervicitis, endometritis
- Leiomyoma
What history & exam to do on a woman who presents with abnormal vaginal bleeding?
History: - Bleeding: anticoagulants, anaemia - Past Hx: previous uterine disorders, pap smear results - Sexual Hx: contraceptive Hx, STDs Exam: - Abdominal exam - Pelvic exam For tenderness and mass
What is the ligament that connects the uterus and sacruum? Where are the attachments?
Sides of cervix to anterior aspect of the sacruum
Uterosacral ligament
On PR exam this ligament can be palpated
What is the ligament that extends from the lateral vagina and cervix to the lateral pelvic walls?
Cardinal ligament
Why is cancer so easily spread from the uterus and cervix to the bladder?
Because there is no intervening peritoneum between the cervix/uterus and the bladder anteriorly, they are in direct contact with each other.
What is the arterial supply of the cervix?
Uterine and ovarian arteries
What is the venous drainage of the cervix?
Uterine veins entering the broad ligament
Form uterine venous plexuses on either side
Drain into internal iliac veins
