Gynaecology 4

Question 1

What are the risk factors for endometrial carcinoma?

Answer 1

Increasing age

Obesity

Early menarche/ Late menopause

Nulliparity

Hereditary non-polyposis carcinoma

Question 2

Give some differentials for Post menopausal bleeding:

Answer 2

Endometrial cancer
Cervical cancer
Atrophic Vaginitis** most common cause
Ovarian cancer

*remember contamination with other blood

Question 3

How can endometrial hyperplasia be differentiated from fibromas or polyp formation on histology? and what is the treatment?

Answer 3

Hyperplasia has a Gland> stroma ratio

May contain

• atypical cells
• Typical cells

Typical hyperplasia:
- Mirena coil - progesterone

Atypical:
- Hysterectomy

Question 4

What is a total hysterectomy and what is a radical hysterectomy?

Answer 4

Total hysterectomy:

• uterus
• cervix
• recommended for stage 1 endometrial cancer along with oophorectomy

Radical:

• Uterus
• Cervix
• Upper vagina
• parametrium

Question 5

What are the cells that are being looked for in a cervical smear?

Answer 5

Dyskaryotic cells

which can be graded:

• high grade
• low grade

*if low grade the HPV testing is conducted to determine need for colposcopy

Question 6

Define Dyskaryotic cells and CIN:

Answer 6

Dyskeratosis cells is a cytological observation

CIN is a histological sample looking depth of the neoplasia

Question 7

What are the two major histological types of endometrial cancer?

Answer 7

Adenocarcinoma
- hyperplasia

Squamous (spontaneous)

• p53 related
• elderly patients

Question 8

What are the risk with multiple LETZ operations for CIN?

Answer 8

Cervical incompetence leading to premature labour

Question 9

When should the cervical smear be taken?

Answer 9

day 14

• les contamination
• thicker

Question 10

What is the most common type of cervical cancer?

Answer 10

Squamous - 80%

Adenocarcinoma - 20%

Question 11

Where on the cervix is cancer most likely to develop?

Answer 11

Transitional Zone

Question 12

What is the most useful imaging modality for local staging of gynaecological diseases?

Answer 12

MRI
- MRI is best for peritineum staging.

CT is used for distant metastasis

Question 13

What are the risk factors for ovarian cancer?

Answer 13

Increasing age
Obesity
HRT
*increase oestrogen

Early menarche
Late menarche
Nulliparity
*increased ovulation

BCRA1, BCRA2

COCP is protective as it supresses ovulation

Question 14

What are the tumour markers for ovarian carcinoma?

Answer 14

Ca125
LDH - dysgerminomas
BhCG - Choriocarcinoma
AFP - teratoma

**typically the LDH, AFP and bhCG are done in <40 years old

Question 15

What is the most common type of ovarian cancer?

Answer 15

Serous Cystadenocarcinoma

Question 16

What things on physcial examination may be seen with someone with ovarian cancer?

Answer 16

Ascites

Pelvic mass

Cachexia

Question 17

What gynaecological pathology can cause a raise in ca125?

Answer 17

Endometriosis

Question 18

When carrying out hystrorectomy and bilateral salpino-oopherctomy due to ovarian cancer - what other things must be sent for analysis?

Answer 18

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

Question 19

What is VIN and what two aetiologies are associated with them? and what is the other type of cancer that can occur here?

Answer 19

Vulva intra-epithelial Neoplasia

Aetiology:
- HPV
and
- Vulva lichen sclerosus

Other:
- Paget’s disease of the vulva

Question 20

What are the risk factors for prolapse?

Answer 20

Pelvic floor weakened:

• parity
• Age and loss of oestrogen
• Smoking
• Connective tissue disorders

Increased pressure:

• obesity
• chronic cough

Question 21

What are the management options for prolapse?

Answer 21

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)

Question 22

What are the major risk factors for cervical cancer?

Answer 22

HPV infection

Smoking

Lack of screening

Multiple sexual partners

COCP use

Question 23

What are the symptoms of cervical cancer?

Answer 23

Post coital bleeding

Intermenstrual bleeding

Post - menopausal bleeding

Offensive discharge

Localised pain

Question 24

What is removed in a radical hysterectomy?

Answer 24

Uterus
Cervix
Upper part of vagina

Question 25

What is the management of cervical cancer?

Answer 25

MDT lead

Surgical:
- hysterectomy (either radical or total)

Radiotherapy:
- brachytherapy
or
- external

Chemotherapy
- often delivered alongside radiotherapy

Question 26

If a woman with cervical cancers wants to retain her fertility and it is appropriate what surgery can be conducted to allow this?

Answer 26

Trachelectomy

• cervix
• upper portion of vagina
• cardinal and uterosacral ligaments

Question 27

What is the risk of developing cervix cancer in a woman’s lifetime?

Answer 27

1 in 130

Question 28

Give some differentials for menopause:

Answer 28

Pregnancy

PCOS

Carcinoid syndrome

Hypothyroidism