Gynaecological Pathology and Malignancy Flashcards
(33 cards)
What is cervical intra-epithelial neoplasia?
CIN is disordered growth and development of the lining of the transformation zone of the cervix and 30-80% will progress to cervical carcinoma if over grade III
What HPV subtypes are the cause?
16 and 18
What is the prerequisites for cervical screening?
25-64
Smear test every 3 years until 50 then every 5 years after that
When do you refer to colposcopy?
Colposcopy - inspection of the cervix with magnification and acetic acid applied to scan for abnormality and biopsie taken
- three inadequate samples
- three borderline squamous smears
- evidence of dyskaryosis
- suspected invasive disease
How is CIN treated?
Grade 1 - conservatively
Grade 2 and 3 - Large loop excision of the transformation zone (LLETZ)
What is the most common types of cervical cancer?
Squamous cell (80-90%) Adenocarcinoma (10%)
What are some S+S of cervical cancer?
Asymptomatic maybe
Irregular PV bleeding, postcoital bleeding
Hard, craggy, bleeding cervix
What tests would you do if cervical Ca was suspected?
Histological biopsy
MRI/CT chest, abdo and pelvis
What are the stages of cervical Ca?
1 - confined to cervix (local excision)
2 - extends to upper 2/3 of vagina (hysterectomy and radio/chemo)
3 - extended to pelvic wall, lower vagina or causing hydronephrosis (radio/chemo)
4- extended beyond pelvis (radio/chemo/palliate)
What are the risk factors for endometrial cancer
95% adenocarcinoma Early menarche/late menopause Obesity Tamoxifen HRT Lynch Syndrome
What are the S+S of endometrial cancer?
Post menopausal bleeding
pelvic pain
pain on defecation
What tests are done in endometrial cancer?
TVUSS to measure endometrial lining thickness
Biopsy
CT/MRI to stage
Stage 1 and 2 can be treated with salpingoophorectomy and TAH
What is the pathology of ovarian cancer?
Most common gynae malignancy
Majority are adenocarcinomas
What are the S and S of ovarian cancer?
Majority have non specific bowel symptoms
Bloating
Early satiety
Loss of appetite
DD - IBS
Late stage may present as a mass on palpation
What tests are used in ovarian cancer?
Pelvic MRI
CA125
CT abdo/pelvis/chest for staging
How is ovarian cancer treated?
Grade dependant
TAH and BSO
Survival related to the success of the debulking
Usually presents late
What is a molar pregnancy?
Abnormal placental development causing overgrowth of pregnancy tissue
Benign: hydatiform mole
Malignant: choriocarcinoma
Caused by disorder of fertilisation
What are the S+S of a molar pregnancy?
Early PV bleeding, hyperemesis, pelvic mass
‘Snowstorm’ on endometrial cavity
Very elevated hCG
Increasing hCG indicates active malignant disease
What is pelvic inflammatory disease?
Usually an ascending infection from the cervix causing endometritis, salpingitis and peritonitis
What are the common causes of PID
Chlamydia and gonorrhoea and unprotected sex
what are the S+S of PID?
Persistant abdominal pain Purulent discharge Pain during sex Cervical excitation Irregular PV bleeding
What are some DD of lower abominal pain on a young woman?
Ectopic pregnancy PID Appendicitis Endometriosis IBS Ovarian cyst rupture UTI
What tests would you do if PID was suspected?
FBC, ESR/CRP, high vaginal swab for STD, hCG, MSSU. pelvic USS
How is PID treated?
Ofloxacin and metronidazole orally for 14 days
Contact tracing for partners
