Gynaecological malignancies

Question 1

What ligament connects the ovaries and the lateral pelvic wall?

Answer 1

Suspensory ligament

Question 2

What ligament connects the ovaries and the uterus?

Answer 2

Utero-ovarian ligament

Question 3

The ovaries are located behind which ligament?

Answer 3

Broad ligament

Question 4

What hormones do the corpus luteum secrete and for what physiological processes?

Answer 4

Oestrogen and progesterone.

Oestrogen for menstruation; progesterone for menstruation and pregnancy.

Question 5

What is the lymphatic drainage of ovaries (for spread of ovarian cancer)?

Answer 5

1. Para-aortic LNs (mainly)
2. Iliac LNs (common, internal, external iliac)
3. Sacral and obturator LNs
4. Pelvic and retroperitoneal LNs
5. Inguinal LNs

Question 6

What is the lymphatic drainage of endometrium of the uterus?

Answer 6

1. Parametrial LNs
2. Paracervical LNs
3. Iliac LNs (common, external, internal iliac)
4. Paraaortic LNs
5. Inguinal LNs

Question 7

Why does swapping the ectocervix for pap smear cells in a post-menopausal woman be not accurate?

Answer 7

Because the ectocervix cells would have become atrophic and have high N:C ratio that resembles dysplasia.

Question 8

Where to swap for Pap smear to detect early cancerous cells in the cervix?

Answer 8

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.

Question 9

What is the lymphatic drainage of the cervix?

Answer 9

1. Parametrial

2. Uterosacral and cardinal ligament routes

Question 10

What are the most common type of ovarian tumour?

Answer 10

Epithelial ovarian tumour

Question 11

Which subtype of epithelial ovarian tumour is the most prone to malignancy?

Answer 11

1. Endometrioid

2. Serous

Question 12

Ulceration lesion on cervix - differentials?

Answer 12

1. Polyp (endometrial or cervical)
2. Carcinoma (endometrial or cervical)
3. Cervical ectropion
4. Cervicitis, endometritis
5. Leiomyoma

Question 13

What history & exam to do on a woman who presents with abnormal vaginal bleeding?

Answer 13

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

Question 14

What is the ligament that connects the uterus and sacruum? Where are the attachments?

Answer 14

Sides of cervix to anterior aspect of the sacruum
Uterosacral ligament
On PR exam this ligament can be palpated

Question 15

What is the ligament that extends from the lateral vagina and cervix to the lateral pelvic walls?

Answer 15

Cardinal ligament

Question 16

Why is cancer so easily spread from the uterus and cervix to the bladder?

Answer 16

Because there is no intervening peritoneum between the cervix/uterus and the bladder anteriorly, they are in direct contact with each other.

Question 17

What is the arterial supply of the cervix?

Answer 17

Uterine and ovarian arteries

Question 18

What is the venous drainage of the cervix?

Answer 18

Uterine veins entering the broad ligament
Form uterine venous plexuses on either side
Drain into internal iliac veins