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Path Week 2 > Hi - Gynae > Flashcards

Hi - Gynae Flashcards

1
Q

name the key components of the gynae tract

A

vulva
vagina
cervix
uterus
fallopian tubes
ovaries

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2
Q

what are presenting Sx of female genital tract disease

A

discharge
PV bleeding
pain - dyspareunia
dysuria
itching

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3
Q

name 3 congenital gynae abnormalities

A

duplication
agenesis / atresia

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4
Q

what is inflammation of the following called:
- vulvla
- vagina
- cervix
- endometrium
- fallopian tube
- ovary

A

vulvitis
vaginitis
cervicitis
endometritis
salpingitis
oophoritis

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5
Q

what gynae infections cause discomfort but not serious complications

A

candida
tichomonas vaginalis
gardenerella

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6
Q

what increases development of gynae candida infection

A

DM
OCP
pregnancy

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7
Q

which gynae infections have serious complications

A

chlamydia
gonorrhoea
mycoplasma
HPV

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8
Q

what gynae complication do chlamydia and gonorrhoea cause

A

infertility

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9
Q

what obstetric complication occurs with mycoplasma

A

spontaneous abortion and chorioamnionitis

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10
Q

what is the risk of contracting HPV

A

cancer

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11
Q

what is infection of upper female genital tract called

A

pelvic inflammatory disease

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12
Q

3 organisms causing PID which spread from lower genital tract via musocal surfaces

A

gonorrhoea
chlamydia
enteric bacteria

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13
Q

how do strep / staph etc cause PID

A

secondary to abortion
starts from uterus and spreads by BVs and lymphatics

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14
Q

complications of PID

A

peritonitis
bacteraemia
obstruction due to adhesions
infertility

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15
Q

how does salpingitis occur

A

direct ascent from vagina

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16
Q

complications of salpingitis

A

infertility & ectopic are the 2 key/worst ones !!
plical fusion, adhesions to ovary, absecess, peritonitis, hydrosalpinx

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17
Q

where do 95% of ectopics occur

A

fallopian tubes

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18
Q

3 diseases of the cervix

A

inflammation
polyps
dysplasia / carcinoma

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19
Q

how common is cervical cancer worldwide

A

2nd most common

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20
Q

mean age of cervical cancer

A

45-50 years old

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21
Q

what is the premalignant phase of cervical ca

A

cervical intraepithelial neoplasia

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22
Q

how can cervical cancer be prevented

A

possible vaccination
screening to detect premalignant stage

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23
Q

what % of cervical Ca has HPV

A

95%

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24
Q

RFs for cervical ca

A

HPV
many sexual partners
sexually active early in life
smoking
immunosuppressive disorders

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25
Q

what types of HPV are low risk

A

6 and 11

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26
Q

what does low risk HPV cause

A

genital and oral warts
low grade cervical dysplasia

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27
Q

what types of HPV are high risk

A

16 and 18

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28
Q

what does high risk HPV cause

A

low and high grade cervical dysplasia
cervical cancer
vulva / vagina / penis / anus cancer

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29
Q

describe the disease progression of cervical cancer from HPV

A
  1. normal epithelium
  2. HPV infection - causes some abnormal cells
  3. get low grade dysplasia in a single layer of epithelium
  4. mild/mod dysplasia in multiple layers of epithelium
  5. high grade dysplasia - covers the entire epithelium
  6. carcinoma - invades through basement membrane
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30
Q

name the 3 stages of dysplasia before it becomes cervical carcinoma

A

cervical intra epithelial neoplasia 1 (few dysplastic cells)
CIN 2 (multiple layers of dysplasia)
CIN 3 (whole epithelium is dysplastic)

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31
Q

what feature differentiates cervical intraepithelial neoplasia from carcinoma

A

invasion through BM

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32
Q

2 principle types of cervical carcinoma

A

squamous cell
adenocarcinoma

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33
Q

what % of invasive cervical cancer is adenocarcinoma

A

20%

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34
Q

how is prognosis determined for cervical cancer

A

FIGO staging 1 to 4
grade and type of tumour
lymphovascular space invasion

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35
Q

what % of survival is FIGO stage 1 vs 4

A

1 = 90%
4 = 10%

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36
Q

2 types of HPV infection

A

latent or active

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37
Q

in what phase of HPV infection is cancer more likley to occur

A

active, persistant infection
- in latent the virus is not producing virions so is largely undetectable

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38
Q

what ages are invited to the cervical screening programme

A

25 to 64

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39
Q

how frequently are smear tests done

A

25 - 49 = 3 yearly
50 - 64 = 5 yearly

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40
Q

what is the sensitivity / specificity of cervical cytology in detecting high grade cancers

A

50-95% / 90%

41
Q

who is given the HPV vaccine

A

12 to 13 year olds, then again after 24 months

42
Q

what is the uterine wall comprised of

A

myometrium
endometrium - glands and stroma

43
Q

indications for uterine biopsies

A

endometrium
- infertility
- uterine bleeding
- thickened endometrium on imaging
uterus or related mass
- lesion on imaging
- as part of wider resection

44
Q

types of uterine tumours

A

endometrial
mesenchymal
mixed
miscellaneous

45
Q

precursor of endometrial epithelial tumour

A

endometrial hyperplasia

46
Q

when do you get endometrial hyperplasia

A

xs hormone stimulation
- E therapy
- PCOS
- persistent anovulation

47
Q

what is the most common gynae cancer

A

endometrial cancer

48
Q

RFs for endometrial ca

A

nulliparity
obesity
DM
xs oestrogen

49
Q

most common type of endometrial ca

A

endometrioid

50
Q

2 associations of endometrioid ca

A

oestrogen dependent
associated with atypical endometrial hyperplasia

51
Q

who gets serous / clear cell endometrial ca

A

older, post menopausal women

52
Q

which is higher grade / satge: serous/clear or endometrioid

A

serous / clear

53
Q

what mutation is present in 90% of endometrioid ca

A

p53

54
Q

what are the 4 FIGO stages of endometrium carcinoma

A

1 = tumour in corpus uteri
2 = tumour invades cervical stroma
3 = local and or regional spread
4 = tumour invades bladder / bowel / mets

55
Q

what gene conveys a better prognosis for high grade endometrioid ca

A

POLE

56
Q

what tx are POLE + endometrioid tumours sensitive to

A

anti PD 1

57
Q

name a type of mesenchymal uterine tumour

A

leiomyoma

58
Q

what is the lay term for leiomyoma

A

fibroid

59
Q

what % of women over 35 have fibroids

A

20%

60
Q

what is the malignant form of fibroids

A

leiomyosarcoma

61
Q

who gets leiomyosarcoma and what is the prognosis

A

rare but postmenopausal women
20-30% 5 year survival

62
Q

what marker diagnoses endometrial stromal sarcoma

A

cd10

63
Q

what is endometriosis

A

presence of endometrial glands and stroma outside the uterus

64
Q

what % of premenopausal women have endometriosis

A

10%

65
Q

origin of endometriosis

A

metaplasia of pelvic peritoneum
implantaion of endometrium, retrograde menstruation

66
Q

what is the problem with endometriosis, why can;t it be left alone

A

it is functional tissue so will bleed at menstruation causing pain, scaring and infertility
can also progress to hyperplasia

67
Q

types of non neoplastic ovarian cysts

A

follicular / luteal
PCOS
endometriotic cyst

68
Q

types of primary ovarian types

A

epithelial
sex cord stromal
germ cell
misc

69
Q

what % of all tumours and malignant tumours are epithelial

A

65% of all
95% malignant

70
Q

what is age peak of epithelial ovarian tumours

A

45-65

71
Q

age peaks of germ cell tumours

A

15-21 and 65-69

72
Q

age peaks of sex cord stromal tumours

A

25-30 but mainly post menopausal

73
Q

which epithelial ovarian tumours are benign

A

serous cystadenomas
cystadenofibromas
mucinous cystadenomas
brenner tumours

74
Q

RFs of malignant epithelial tumours of ovary

A

nulliparity
infertility
early menarche
late menopause
genetic predisposition inc FH of breast / ovarian ca

75
Q

how common is malignant epithelial tumours of ovary

A

6th most common cancer in women
2nd commonest cancer causing death in women

76
Q

why does malignant epithelial tumours of ovary have such high mortality

A

difficult to diagnose at early stage
develops resistance to chemo

77
Q

what % of epithelial ovarian ca are hereditary

A

10%

78
Q

name 3 familial syndromes of hereditary ovarian ca

A

familial breast ovarian cancer syndrome
site specific ovarian cancer
cancer family syndrome (lynch type 2)

79
Q

what gene is associated with familial breast ovarian cancer syndrome and site specific ovarian cancer ?

A

BRCA1 and BRCA2

80
Q

what is the commonest type of ovarian malignancy

A

high grade serous carcinoma (80%)

81
Q

what gene mutation is present in high grade serous carcinoma of ovary

A

P53
some BRCA1/2

82
Q

what gene mutation is present in low grade serous carcinoma of ovary

A

KRAS, BRAF
NOT BRCA

83
Q

what gene mutation is present in mucinous tumour of ovary

A

KRAS

84
Q

is mucinous tumour of ovary common

A

NO - very rare

85
Q

where can secondary ovarian tumours come from

A

colorectal - 4-10% go to ovary
gastric / breast

86
Q

what is krunkenberg tumour

A

bilateral mets composed of mucin producing signet ring cells - often from gastric / breast

87
Q

what is clear cell carcinoma of ovary associated with

A

endometriosis

88
Q

types of sex cord stromal tumour

A

pure stromal - fibroma, thecoma, microcytic stromal
pure sex cord - adult type and juvenile granulosa cell
mixed - sertoli leydig cell

89
Q

gene change in adult type granulosa cell tumour

A

FOXL2 97%

90
Q

gene change in microcytic stromal tumour

A

CTNNB1
stains for beta caretine

91
Q

60% of sertoli leydig cell tumours are part of which hereditary syndrome

A

DICER1 syndrome

92
Q

what hereditary syndrome can other sex cord stromal tumours be part of

A

Peutz Jeghers syndrome

93
Q

are germ cell tumours bengin or malignant

A

95% benign

94
Q

what % of ovarian tumours are germ cell

A

20%

95
Q

who gets germ cell tumours

A

under 20s

96
Q

what is the most common germ cell tumour

A

mature teratoma (dermoid)

97
Q

features of mature teratoma

A

benign
solid / cystic
mature adult type tissues - can be teeth / bone / stomach

98
Q

what is the malignant form of mature teratoma

A

immature teratoma

99
Q

what part of female genital tract is commonest site to recieve mets

A

ovaries

Path Week 2 (18 decks)

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