Pathology of the Female Reproductive Tract

Question 1

Cervical Pathology

Answer 1

Cervical Screening – Smear Test
Cervical Intra-epithelial Neoplasia (CIN)
Cervical Carcinoma
Endocervical Polyps

Question 2

Cervical screening Smear test

Answer 2

View cervix and take sample of cells
Every 3 years from age 25 to 49 years.
Every 5 years from age 49 to 64.
After age 64, screening only if no previous smears or abnormal smears.
Aims to detect early disease stages before becomes invasive.

Question 3

Human Papilloma Virus

Answer 3

Transmitted by sexual contact
Risk increases with increased numbers of sexual partners
No symptoms
Thought to be main cause of CIN and therefore cervical cancer

Question 4

Cytology Screening of smear tests

Answer 4

Normal- routine 3/5 year re-smear

Abnormal- referred to colposcopy / May have biopsies taken

Question 5

Cervical Intra-epithelial Neoplasia CIN

Answer 5

CIN is a microscopic lesion in that affects the cervix that could potentially develop into cervical cancer if left untreated

Question 6

Cervical Cancer

Answer 6

2nd most common female malignancy
Risk factors
HPV, smoking, non attendance to CSP
Symptoms
Abnormal discharge and bleeding
On examination the cervix appears abnormal

Question 7

Treatment of Cervical Cancer

Answer 7

Treatment

Depends on stage either local excision or radical hysterectomy +/- chemoradiotherapy

Question 8

Endocervical Polyps

Answer 8

Usually present with irregular vaginal bleeding ‘spotting’
Benign lesions
Can remove at hysteroscopy

Question 9

Uterine Pathology

Answer 9

Menorrhagia
Fibroids
Endometritis and Pelvic Inflammatory Disease
Endometriosis
Endometrial Polyps
Endometrial Cancer

Question 10

Menorrhagia

Answer 10

“Heavy periods” >80ml blood loss
Very common
1 in 20 women consult their GP a year
Costing the NHS £7 million in prescriptions
Causes
DUB in 50%
Fibroids, endometriosis, polyps

Question 11

Menorrhagia treatment

Answer 11

Mirena coil 
Mefanamic and tranexamic acid
combined oral contraceptive pill COCP
Depo provera
Endometrial ablation
Hysterectomy

Question 12

Fibroids (Leiomyomas)

Answer 12

Very common benign tumours
Arise from myometrium (uterine muscular wall)
Can present with heavy or painful periods, pelvic pain or distension
Treatment depends on symptoms and wishes for pregnancy

Question 13

Endometritis and Pelvic Inflammatory Disease

Answer 13

Caused by Infections, usually sexually transmitted.
Can present with abnormal discharge, pain or bleeding.
Can be asymptomatic
Major cause of infertility

Question 14

Endometriosis

Answer 14

Endometrial tissue in the wrong location i.e outside the endometrium
Very common benign condition
Can present with heavy or painful periods, pelvic pain, painful sex
Treatment depends on symptoms and often difficult

Question 15

Endometriosis treatment

Answer 15

Treatment
COCP
Mirena
Zoladex
Surgery

Question 16

Endometrial Polyps

Answer 16

Benign growths from endometrial cavity

Can be removed at hysteroscopy

Question 17

Endometrial Cancer

Answer 17

Cancer of the lining of the uterus
Often presents as post menopausal bleeding and so is detected early
Risk factors are nulliparity, high BMI, HRT and late menopause
Diagnosed on biopsy
Either pipelle or hysteroscopy
Usually undergo TAH (total abdominal hysterectomy) and BSO Bilateral salpingo-oophorectomy excision of both ovaries
Overall 20 year survival rate is 80%

Question 18

Follicular cysts

Answer 18

Benign, very common
Usually less than 6cm
Often asymptomatic, no treatment needed

Question 19

Cystadenomas

Answer 19

Can be very large fluid filled cysts

Symptoms caused by pressure effect

Question 20

Benign Mature Teratomas

Answer 20

Large cysts filled with solid substance

Question 21

Polycystic Ovarian Syndrome

Answer 21

Common condition
Multiple cysts on ovaries
Usually presents as irregular periods, no periods, infertility, other symptoms
Major cause of infertility

Question 22

Polycystic Ovarian Syndrome treatments and complications

Answer 22

Treatments
COCP
Metformin
Clomifene

Complications
Increased CV risk
Increased risk of T2DM
Increased problems in pregnancy

Question 23

Ovarian Cysts

Answer 23

Can be benign or malignant
Can be HUGE!!!
Can occur in young women- usually benign (20-45)
Can occur in older women- usually malignant (>45)
Usually need ovary to be removed with the cyst if large

Question 24

Ovarian Cancer

Answer 24

Often asymptomatic especially if small
Usually present late when already spread
Poorer prognosis than endometrial cancer

Question 25

Miscarriage

Answer 25

Loss of pregnancy before 24 weeks
Occurs in approx 15% of pregnancies
Usually first trimester
Classification
Threatened, Inevitable, Incomplete and Missed
Often no cause found
Risk factors
Increasing age, multiple pregnancies, smoking, alcohol, connective tissue disorders in mother and diabetes
Presentation is usually with pv bleeding

Question 26

Miscarrisge treatment options

Answer 26

Conservative
Medical with misoprostol
Surgical usually by vacuum suction under GA

Question 27

Ectopic pregnancy

Answer 27

An extra uterine pregnancy usually occurring in the Fallopian tubes
Occurs in 1% of pregnancies
Can occur very early before a period has been missed
Can be a gynaecological emergency as rupture of the pregnancy carries a high mortality
Risk factors for ectopics
Fertility treatments, PID, previous ectopics, smokers
Presentation pain and unilateral lower abdominal pain

Question 28

Ectopic pregnancy treatment and diagnosis

Answer 28

Raised beta-HCG levels on blood testing

Treatment almost always surgical