Gynecology - Cervical cancer + Congenital Uterine abnormalities

Question 1

What are the “low risk” HPV-strains? And what do they usually cause?

Answer 1

HPV 6 and 11 are “low risk”. More likely to cause genital warts.

Question 2

What are the “high risk” HPV strains?

Answer 2

HPV 16, 18, 31 and 45

Question 3

What is the name of the vaccine against HPV? and what does it consist of?

Answer 3

Gardasil. Its a vaccine consisting of recombinant VLPs.

Question 4

Risk factors of cervical cancer?

Answer 4

• Early intercourse
• Early childbearing
• “High-risk” partners
• Low socioeconomic s.
• STD’s
• Smoking
• Immunodeficiency

Question 5

Symptoms of cervical cancer?

Answer 5

Early disease usually asymptomatic.

• Postcoital bleeding is the most common complaint.
• Othersx may include watery discharge, pelvic pain/pressure, rectal or urinary tract symptoms.

Question 6

Staging of cervical cancer?

Answer 6

Stage 0: Cervical carcinoma in situ

Stage 1: Strictly confined to cervix

• 1a: only microscopic lesion
• 1b: gross lesions

Stage 2: Spread beyond cervix, but not to pelvic wall

2a: no parametrial involvement
2b: parametrial involvement

Stage 3: Has spread to pelvic wall (IIIb), lower 1/3 of vagina or has caused hydronephrosis of a kidney

Stage 4: Has spread beyond the true pelvis or involves the mucosa of the bladder and/or rectum

Question 7

Management of Stage 0 and 1a1 ?

Answer 7

CKC or simple hysterectomy

Question 8

Management of Stages 1a2 and 2a ?

Answer 8

Radical hysterectomy or radiation

Question 9

Management of Stage 2b to 4?

Answer 9

Must be managed with chemoradiation. Some kind of surgery is often added.

Question 10

What chemo-regimen do you use in cervical cancer?

Answer 10

1. Up to stave 4a: Cisplatin and 5-FU
2. Metastatic (IVB) or recurrent: Various regimens with advanced chemotherapeutics; radiation if never recieved; pelvic exenteration.

Question 11

5 year-survival rate?

Answer 11

Stage 1: 85-90%
Stage 2: 65-70%
Stage 3: 35-45 %
Stage 4: 15-20%

Question 12

What are the (para)mesonephric ducts?

Answer 12

Paired structures of mesodermal origin which give rise to certain reproductive organs. All developing fetuses have paramesonephric (Mullerian) ducts and mesonephric(Wolffian) ducts.

Males: Production of AMH in the testes cause involution of the paramesonephric ducts; mesonephric ducts develop.

Females: Lack of AMH allows for development of paramesonephric ducts; mesonephric ducts involute

Question 13

What does the mesonephric ducts give rise to (males)?

Answer 13

Epidydimis, vas deferens, seminal vesicle

Question 14

What does the paramesonephric ducts give rise to? (females)

Answer 14

Fallopian tubes, uterus, proximal 1/3 of vagina.

Question 15

The most common presentation for uterine anomalies?

Answer 15

Recurrent preterm delivery

Question 16

Will an error in the mullerian ductal system have abnormal external appearance?

Answer 16

No, only the severe anomalies.

Question 17

What is the initial test in diagnosis of uterine anomalies?

Answer 17

Pelvic sonography. Followed by pelvic MRI (=most accurate)

Question 18

What happens if both ducts fail to form?

Answer 18

Mullerian agenesis or hypoplasia?

Question 19

What happens if one duct fail to form?

Answer 19

Unicornuate uterus

Question 20

If Complete failure of fusion?

Answer 20

Uterus didelphys

Question 21

If failure of fusion cranially?

Answer 21

Bicornuate uterus (partial, complete)

Question 22

Failure of septum dissolution?

Answer 22

Septate uterus

Question 23

Inconsequential septum?

Answer 23

Arcuate uterus

Question 24

What happens if there is a bilateral failure of Mullerian development, and what is this also known as?

Answer 24

Mullerian hypoplasia and agenesis. Also known as Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome.

This leads to absence or aplasia of the proximal vagina, cervic, uterus and fallopian tubes

Question 25

What is the difference of Mullerian agenesis and Mullerian hypoplasia?

Answer 25

Mullerian agenesis = complete failure of development.

Mullerian hypoplasia = partial failure of development.

Question 26

What is the most common presentation of mullerian hypoplasia and agenesis?

Answer 26

Primary amenorrhea. Pts are hormonally normal.

Question 27

What do you do to diagnose?

Answer 27

Sonography is a good initial test for diagnosis;MRI is more accurate. On diagnosis, pts should get IV pyelography and echocardiography (approx. 1/3 will have renal anomalies, 10% will have cardiac anomalies).

Question 28

What is the most common presentation of a unicornuate uterus?

Answer 28

Secondary dysmenorrhea, manifesting in adolescence.

• In the bsence of a rudimentary horn (a non-communicating uterus-like structure), the most common presentation is recurrent miscarriage and preterm delivery.
• There is a risk of implantation in the rudimentary horn, which can result in fatal rupture.

Question 29

The most common symptom of didelphys uterus?

Answer 29

Recurrent preterm delivery

Question 30

Complete bicornuate uterus vs partial bicornuate uterus?

Answer 30

Complete BU:
Two separate uterine cavities joined at the level of the cervic. Very similar to didelphys, however, does not have a double vagina.

Partial BU:
One single uterine cavity with fialure to fuse cranially, resulting in two distinct uterine horns.

Question 31

What is the most common uterine anomaly?

Answer 31

Bicornuate uterus (45% of all uterine anomalies)

Question 32

What is the most common presentation of bicornuate uterus?

Answer 32

Recurrent preterm delivery. Malpresentation is not uncommon.

Question 33

Septate uterus

Answer 33

Failure of median septum to dissolve, resulting in a persistent membranous structure seperating the uterus at the midline.
ONLY affects the uterus, there will always be one cervix and one vagina. Unlike uterine didelphys and bicornuate uterus, the uterus appears completely normal.

Question 34

Complete septate uterus vs partial septate uterus

Answer 34

Complete SU:
Two distinct uterine bodies but one confluent uterus externally (looks like didelphys)

Partial SU:
One uterine body split into two horns but one confluent uterus externally (looks like bicornuate)

Question 35

Most common presentation of septate uterus?

Answer 35

Recurrent preterm delivery.

Question 36

What is Arcuate uterus?

Answer 36

Persistence of a septal dimple on the cranial uterus, which represents a small remnant of septum. Classified separately because arcuate uterus has no OB complications.

Question 37

In which uterine anomalies can you see two cervixes?

Answer 37

Didelphys uterus

Question 38

In which uterine anomalies can you see two vaginas?

Answer 38

Didelphys uterus (se skjema)