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Obstetrics and Gynaecology > Gynaecological Pathology and Malignancy > Flashcards

Gynaecological Pathology and Malignancy Flashcards

1
Q

What is cervical intra-epithelial neoplasia?

A

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

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2
Q

What HPV subtypes are the cause?

A

16 and 18

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3
Q

What is the prerequisites for cervical screening?

A

25-64

Smear test every 3 years until 50 then every 5 years after that

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4
Q

When do you refer to colposcopy?

A

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
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5
Q

How is CIN treated?

A

Grade 1 - conservatively

Grade 2 and 3 - Large loop excision of the transformation zone (LLETZ)

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6
Q

What is the most common types of cervical cancer?

A 
Squamous cell (80-90%) 
Adenocarcinoma (10%)
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7
Q

What are some S+S of cervical cancer?

A

Asymptomatic maybe
Irregular PV bleeding, postcoital bleeding
Hard, craggy, bleeding cervix

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8
Q

What tests would you do if cervical Ca was suspected?

A

Histological biopsy

MRI/CT chest, abdo and pelvis

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9
Q

What are the stages of cervical Ca?

A

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)

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10
Q

What are the risk factors for endometrial cancer

A 
95% adenocarcinoma 
Early menarche/late menopause
Obesity
Tamoxifen 
HRT
Lynch Syndrome
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11
Q

What are the S+S of endometrial cancer?

A

Post menopausal bleeding
pelvic pain
pain on defecation

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12
Q

What tests are done in endometrial cancer?

A

TVUSS to measure endometrial lining thickness
Biopsy
CT/MRI to stage
Stage 1 and 2 can be treated with salpingoophorectomy and TAH

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13
Q

What is the pathology of ovarian cancer?

A

Most common gynae malignancy

Majority are adenocarcinomas

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14
Q

What are the S and S of ovarian cancer?

A

Majority have non specific bowel symptoms
Bloating
Early satiety
Loss of appetite
DD - IBS
Late stage may present as a mass on palpation

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15
Q

What tests are used in ovarian cancer?

A

Pelvic MRI
CA125
CT abdo/pelvis/chest for staging

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16
Q

How is ovarian cancer treated?

A

Grade dependant
TAH and BSO
Survival related to the success of the debulking
Usually presents late

17
Q

What is a molar pregnancy?

A

Abnormal placental development causing overgrowth of pregnancy tissue
Benign: hydatiform mole
Malignant: choriocarcinoma
Caused by disorder of fertilisation

18
Q

What are the S+S of a molar pregnancy?

A

Early PV bleeding, hyperemesis, pelvic mass
‘Snowstorm’ on endometrial cavity
Very elevated hCG
Increasing hCG indicates active malignant disease

19
Q

What is pelvic inflammatory disease?

A

Usually an ascending infection from the cervix causing endometritis, salpingitis and peritonitis

20
Q

What are the common causes of PID

A

Chlamydia and gonorrhoea and unprotected sex

21
Q

what are the S+S of PID?

A 
Persistant abdominal pain
Purulent discharge
Pain during sex
Cervical excitation 
Irregular PV bleeding
22
Q

What are some DD of lower abominal pain on a young woman?

A 
Ectopic pregnancy
PID 
Appendicitis 
Endometriosis
IBS
Ovarian cyst rupture 
UTI
23
Q

What tests would you do if PID was suspected?

A

FBC, ESR/CRP, high vaginal swab for STD, hCG, MSSU. pelvic USS

24
Q

How is PID treated?

A

Ofloxacin and metronidazole orally for 14 days

Contact tracing for partners

25
Q

What are some consequences of PID?

A

Ectopic pregnancy
Infertility
Chronic pain

26
Q

What is endometriosis?

A

The presence of endometrial tissue outside the uterus which induces a chronic inflammatory reaction
usually pelvic and peritoneal deposits

27
Q

What are the S+S of endometriosis?

A

Dyspareunia, painful heavy periods, chronic pelvic pain, ovulation pain, pain on defecation, tender bimanual examination

28
Q

What are common causes of dysmenorrhoea?

A 
Endometriosis
Ovarian cysts 
Pelvic adhesions
PID
Fibroids
29
Q

How is endometriosis diagnoses?

A

Pelvic USS

Diagnostic Laparoscopy is standard

30
Q

How is endometriosis treated?

A 
NSAIDS/paracetamol
COCP
IUS
GnRH agonist 
Surgical removal of endometriosis - range from laparotomy to TAH and BSO
31
Q

What is a bartholins abscess?

A

This is the commonest cause of vaginal swelling
Common in diabetics
Dilation of the bartholins gland due to blockage

32
Q

What are the S+S of a bartholins abscess?

A

Pain, swelling, dyspareunia

33
Q

How are bartholins abscesses treated?

A

Incision and drainage of the abscess

Obstetrics and Gynaecology (7 decks)

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