Hi - Gynae Flashcards
name the key components of the gynae tract
vulva
vagina
cervix
uterus
fallopian tubes
ovaries
what are presenting Sx of female genital tract disease
discharge
PV bleeding
pain - dyspareunia
dysuria
itching
name 3 congenital gynae abnormalities
duplication
agenesis / atresia
what is inflammation of the following called:
- vulvla
- vagina
- cervix
- endometrium
- fallopian tube
- ovary
vulvitis
vaginitis
cervicitis
endometritis
salpingitis
oophoritis
what gynae infections cause discomfort but not serious complications
candida
tichomonas vaginalis
gardenerella
what increases development of gynae candida infection
DM
OCP
pregnancy
which gynae infections have serious complications
chlamydia
gonorrhoea
mycoplasma
HPV
what gynae complication do chlamydia and gonorrhoea cause
infertility
what obstetric complication occurs with mycoplasma
spontaneous abortion and chorioamnionitis
what is the risk of contracting HPV
cancer
what is infection of upper female genital tract called
pelvic inflammatory disease
3 organisms causing PID which spread from lower genital tract via musocal surfaces
gonorrhoea
chlamydia
enteric bacteria
how do strep / staph etc cause PID
secondary to abortion
starts from uterus and spreads by BVs and lymphatics
complications of PID
peritonitis
bacteraemia
obstruction due to adhesions
infertility
how does salpingitis occur
direct ascent from vagina
complications of salpingitis
infertility & ectopic are the 2 key/worst ones !!
plical fusion, adhesions to ovary, absecess, peritonitis, hydrosalpinx
where do 95% of ectopics occur
fallopian tubes
3 diseases of the cervix
inflammation
polyps
dysplasia / carcinoma
how common is cervical cancer worldwide
2nd most common
mean age of cervical cancer
45-50 years old
what is the premalignant phase of cervical ca
cervical intraepithelial neoplasia
how can cervical cancer be prevented
possible vaccination
screening to detect premalignant stage
what % of cervical Ca has HPV
95%
RFs for cervical ca
HPV
many sexual partners
sexually active early in life
smoking
immunosuppressive disorders
what types of HPV are low risk
6 and 11
what does low risk HPV cause
genital and oral warts
low grade cervical dysplasia
what types of HPV are high risk
16 and 18
what does high risk HPV cause
low and high grade cervical dysplasia
cervical cancer
vulva / vagina / penis / anus cancer
describe the disease progression of cervical cancer from HPV
- normal epithelium
- HPV infection - causes some abnormal cells
- get low grade dysplasia in a single layer of epithelium
- mild/mod dysplasia in multiple layers of epithelium
- high grade dysplasia - covers the entire epithelium
- carcinoma - invades through basement membrane
name the 3 stages of dysplasia before it becomes cervical carcinoma
cervical intra epithelial neoplasia 1 (few dysplastic cells)
CIN 2 (multiple layers of dysplasia)
CIN 3 (whole epithelium is dysplastic)
what feature differentiates cervical intraepithelial neoplasia from carcinoma
invasion through BM
2 principle types of cervical carcinoma
squamous cell
adenocarcinoma
what % of invasive cervical cancer is adenocarcinoma
20%
how is prognosis determined for cervical cancer
FIGO staging 1 to 4
grade and type of tumour
lymphovascular space invasion
what % of survival is FIGO stage 1 vs 4
1 = 90%
4 = 10%
2 stages of HPV infection
latent or active
in what phase of HPV infection is cancer more likley to occur
active, persistant infection
- in latent the virus is not producing virions so is largely undetectable
what ages are invited to the cervical screening programme
25 to 64
how frequently are smear tests done
25 - 49 = 3 yearly
50 - 64 = 5 yearly
what is the sensitivity / specificity of cervical cytology in detecting high grade cancers
50-95% / 90%
who is given the HPV vaccine
12 to 13 year olds, then again after 24 months
what is the uterine wall comprised of
myometrium
endometrium - glands and stroma
indications for uterine biopsies
endometrium
- infertility
- uterine bleeding
- thickened endometrium on imaging
uterus or related mass
- lesion on imaging
- as part of wider resection
types of uterine tumours
endometrial
mesenchymal
mixed
miscellaneous
precursor of endometrial epithelial tumour
endometrial hyperplasia
when do you get endometrial hyperplasia
xs hormone stimulation
- E therapy
- PCOS
- persistent anovulation
what is the most common gynae cancer
endometrial cancer
RFs for endometrial ca
nulliparity
obesity
DM
xs oestrogen
most common type of endometrial ca
endometrioid
2 associations of endometrioid ca
oestrogen dependent
associated with atypical endometrial hyperplasia
who gets serous / clear cell endometrial ca
older, post menopausal women
which is higher grade / satge: serous/clear or endometrioid
serous / clear
what mutation is present in 90% of endometrioid ca
p53
what are the 4 FIGO stages of endometrium carcinoma
1 = tumour in corpus uteri
2 = tumour invades cervical stroma
3 = local and or regional spread
4 = tumour invades bladder / bowel / mets
what gene conveys a better prognosis for high grade endometrioid ca
POLE
what tx are POLE + endometrioid tumours sensitive to
anti PD 1
name a type of mesenchymal uterine tumour
leiomyoma
what is the lay term for leiomyoma
fibroid
what % of women over 35 have fibroids
20%
what is the malignant form of fibroids
leiomyosarcoma
who gets leiomyosarcoma and what is the prognosis
rare but postmenopausal women
20-30% 5 year survival
what marker diagnoses endometrial stromal sarcoma
cd10
what is endometriosis
presence of endometrial glands and stroma outside the uterus
what % of premenopausal women have endometriosis
10%
origin of endometriosis
metaplasia of pelvic peritoneum
implantaion of endometrium, retrograde menstruation
what is the problem with endometriosis, why can;t it be left alone
it is functional tissue so will bleed at menstruation causing pain, scaring and infertility
can also progress to hyperplasia
types of non neoplastic ovarian cysts
follicular / luteal
PCOS
endometriotic cyst
types of primary ovarian tumours
epithelial
sex cord stromal
germ cell
misc
what % of all tumours and malignant tumours are epithelial
65% of all
95% malignant
what is age peak of epithelial ovarian tumours
45-65
age peaks of germ cell tumours
15-21 and 65-69
age peaks of sex cord stromal tumours
25-30 but mainly post menopausal
which epithelial ovarian tumours are benign
serous cystadenomas
cystadenofibromas
mucinous cystadenomas
brenner tumours
RFs of malignant epithelial tumours of ovary
nulliparity
infertility
early menarche
late menopause
genetic predisposition inc FH of breast / ovarian ca
how common is malignant epithelial tumours of ovary
6th most common cancer in women
2nd commonest cancer causing death in women
why does malignant epithelial tumours of ovary have such high mortality
difficult to diagnose at early stage
develops resistance to chemo
what % of epithelial ovarian ca are hereditary
10%
name 3 familial syndromes of hereditary ovarian ca
familial breast ovarian cancer syndrome
site specific ovarian cancer
cancer family syndrome (lynch type 2)
what gene is associated with familial breast ovarian cancer syndrome and site specific ovarian cancer ?
BRCA1 and BRCA2
what is the commonest type of ovarian malignancy
high grade serous carcinoma (80%)
what gene mutation is present in high grade serous carcinoma of ovary
P53
some BRCA1/2
what gene mutation is present in low grade serous carcinoma of ovary
KRAS, BRAF
NOT BRCA
what gene mutation is present in mucinous tumour of ovary
KRAS
is mucinous tumour of ovary common
NO - very rare
where can secondary ovarian tumours come from
colorectal - 4-10% go to ovary
gastric / breast
what is krunkenberg tumour
bilateral mets composed of mucin producing signet ring cells - often from gastric / breast
what is clear cell carcinoma of ovary associated with
endometriosis
types of sex cord stromal tumour
pure stromal - fibroma, thecoma, microcytic stromal
pure sex cord - adult type and juvenile granulosa cell
mixed - sertoli leydig cell
gene change in adult type granulosa cell tumour
FOXL2 97%
gene change in microcytic stromal tumour
CTNNB1
stains for beta caretine
60% of sertoli leydig cell tumours are part of which hereditary syndrome
DICER1 syndrome
what hereditary syndrome can other sex cord stromal tumours be part of
Peutz Jeghers syndrome
are germ cell tumours bengin or malignant
95% benign
what % of ovarian tumours are germ cell
20%
who gets germ cell tumours
under 20s
what is the most common germ cell tumour
mature teratoma (dermoid)
features of mature teratoma
benign
solid / cystic
mature adult type tissues - can be teeth / bone / stomach
what is the malignant form of mature teratoma
immature teratoma
what part of female genital tract is commonest site to recieve mets
ovaries
