Gynaecology Flashcards
Gynae cancers in order of most to least common
1st: Endometrial
2nd: Ovarian
3rd: Cervical
4th: Vulval
Endometrial cancer
- Pathophys, presentation, investigation, risks, PF
Endometrial hyperplasia
Presents with PMB
USS: more than 4mm, hysteroscopy and biopsy
Risks: Unopposed oestrogen: PCOS, obesity, HRT, tamoxifen
Protective: COCP, smoking
Ovarian cancer
- cause, investigations, rf, pf
Cysts
CA125 + US - surgery
RF: ovulations, BRACA1/2, NHNPCC, endometriosis, obesity
PF: COCP
Lifetime risk of ovarian cancer
1/60 lifetime risk
usually 60yrs old
Cervical cancer
- Pathophys, RF
Cervical intraepithelial neoplasia CIN
RF: HPV, COCP, smoking
Incidence of cervical cancer
30/80
common under 35 yrs
Vulval cancer
- Pathophys, RF
Vulval intraepithelial neoplasia (VIN) causes multifocal appearance
RF: HPV, Lichen sclerosis, Immunosupression, Pagets
% of genital tract cancers caused by vulval cancer
5%
What strains of HPV is the vaccination for?
16 and 18
What age are children immunised?
12-13 years
Cervical screening programme timelines
25-49 years: Every 3 years
50-64 years: Every 5 years
When would you screen an over 65 year old
If abnormal screens or no screening since age 50
% of cervical cancers that screening prevents?
75%
When would you screen if pregnant?
12 weeks after birth
What happens to the cells?
Cervical cytology > liquid-based cytology and PCR to detect common HPV
What would you do with …
- Normal smear
Repeat in 3 years
What would you do with …
- Inflammatory
Repeat in 6 months
If CN III then colopscopy
What would you do with …
Borderline/mild dyskaryosis
High risk HPV test
- Negative: Repeat after 3 years
- Positive: Colposcopy
What would you do with …
Moderate or severe dyskaryosis
Urgent colopscopy (2ww)
What would you do with …
- Inadequate sample
Repeat
3 inadequate –> colposcopy
Epidemiology of chlamydia
Most common in ages 15-24 years
48% of new STI diagnosis
Epidemiology of gonorrhoea
Most common in 15-30 years
Common with chlamydia
Epidemiology of trichomoniasis
3-5% of females in north america
co-factor for HIV transmission
Epidemiology of syphilis
Common in MSM, black
Associated with HIV
Most common in 20-30 years
Most common type of HSV
HSV1
Epidemiology of HIV
70% in SSA
Usually through heterosexuals, then MSM then IVDU
Epidemiology of HPV
Common in 16-25 years
Prevalence around 42%
4 methods of sexual health promotion
Contraception
Programs
Peer educators
Abstinence/ condom use
What must the local CCG have for the community
Comprehensive sexual health services including HIV testing
Aim of sexual health services
Target homosexuals and black people, IVDU, sex workers, prisoners.
Reduce stigma
Unintended vertical transmission (unintended pregnancy rates)
7 methods to prevent HIV
- media campaigns
- education in school
- testing HIV and counselling
- ART
- condom use
- contraception reduces the risk man to woman by 50%.
- treat chlamydia and gonorrhea as these facilitate HIV transmission during sex.
