Gynaecology 4 Flashcards
What are the risk factors for endometrial carcinoma?
Increasing age
Obesity
Early menarche/ Late menopause
Nulliparity
Hereditary non-polyposis carcinoma
Give some differentials for Post menopausal bleeding:
Endometrial cancer
Cervical cancer
Atrophic Vaginitis** most common cause
Ovarian cancer
*remember contamination with other blood
How can endometrial hyperplasia be differentiated from fibromas or polyp formation on histology? and what is the treatment?
Hyperplasia has a Gland> stroma ratio
May contain
- atypical cells
- Typical cells
Typical hyperplasia:
- Mirena coil - progesterone
Atypical:
- Hysterectomy
What is a total hysterectomy and what is a radical hysterectomy?
Total hysterectomy:
- uterus
- cervix
- recommended for stage 1 endometrial cancer along with oophorectomy
Radical:
- Uterus
- Cervix
- Upper vagina
- parametrium
What are the cells that are being looked for in a cervical smear?
Dyskaryotic cells
which can be graded:
- high grade
- low grade
*if low grade the HPV testing is conducted to determine need for colposcopy
Define Dyskaryotic cells and CIN:
Dyskeratosis cells is a cytological observation
CIN is a histological sample looking depth of the neoplasia
What are the two major histological types of endometrial cancer?
Adenocarcinoma
- hyperplasia
Squamous (spontaneous)
- p53 related
- elderly patients
What are the risk with multiple LETZ operations for CIN?
Cervical incompetence leading to premature labour
When should the cervical smear be taken?
day 14
- les contamination
- thicker
What is the most common type of cervical cancer?
Squamous - 80%
Adenocarcinoma - 20%
Where on the cervix is cancer most likely to develop?
Transitional Zone
What is the most useful imaging modality for local staging of gynaecological diseases?
MRI
- MRI is best for peritineum staging.
CT is used for distant metastasis
What are the risk factors for ovarian cancer?
Increasing age
Obesity
HRT
*increase oestrogen
Early menarche
Late menarche
Nulliparity
*increased ovulation
BCRA1, BCRA2
COCP is protective as it supresses ovulation
What are the tumour markers for ovarian carcinoma?
Ca125
LDH - dysgerminomas
BhCG - Choriocarcinoma
AFP - teratoma
**typically the LDH, AFP and bhCG are done in <40 years old
What is the most common type of ovarian cancer?
Serous Cystadenocarcinoma
What things on physcial examination may be seen with someone with ovarian cancer?
Ascites
Pelvic mass
Cachexia
What gynaecological pathology can cause a raise in ca125?
Endometriosis
When carrying out hystrorectomy and bilateral salpino-oopherctomy due to ovarian cancer - what other things must be sent for analysis?
Omentum
Peritoneal fluid/ Pelvic fluid
Sent away for analysis.
*remember the cyst should not be burst during the surgery as it may lead to metastatic spread
What is VIN and what two aetiologies are associated with them? and what is the other type of cancer that can occur here?
Vulva intra-epithelial Neoplasia
Aetiology:
- HPV
and
- Vulva lichen sclerosus
Other:
- Paget’s disease of the vulva
What are the risk factors for prolapse?
Pelvic floor weakened:
- parity
- Age and loss of oestrogen
- Smoking
- Connective tissue disorders
Increased pressure:
- obesity
- chronic cough
What are the management options for prolapse?
Conservative:
- loose weight
- Pelvic floor exercises
- Vaginal oestrogen
Pessaries
- 3-4months check for ulcerations
Surgical:
- Anterior/ Posterior Colporrhaphy
(tightening the vaginal fascia)
- Sacrocolpopexy
(attaching the apex of the vagina to the sacrum, used for vaginal fault prolapse) - Sacrohysteropexy
(attaching uterus to sacrum)
What are the major risk factors for cervical cancer?
HPV infection
Smoking
Lack of screening
Multiple sexual partners
COCP use
What are the symptoms of cervical cancer?
Post coital bleeding
Intermenstrual bleeding
Post - menopausal bleeding
Offensive discharge
Localised pain
What is removed in a radical hysterectomy?
Uterus
Cervix
Upper part of vagina
What is the management of cervical cancer?
MDT lead
Surgical:
- hysterectomy (either radical or total)
Radiotherapy:
- brachytherapy
or
- external
Chemotherapy
- often delivered alongside radiotherapy
If a woman with cervical cancers wants to retain her fertility and it is appropriate what surgery can be conducted to allow this?
Trachelectomy
- cervix
- upper portion of vagina
- cardinal and uterosacral ligaments
What is the risk of developing cervix cancer in a woman’s lifetime?
1 in 130
Give some differentials for menopause:
Pregnancy
PCOS
Carcinoid syndrome
Hypothyroidism
