Theme 3 - Gynae Pathology Flashcards
Vagina, acid or alkali and why?
Glycogen shed from stratified squamous epithelium acts as substrate for anaerobic lactobacilli produce acid keeping pH 4.5. So acid
Draw label the ectocervix, endocervix and transformation zone.
outside exo
then transformation
then endo
type of cells make up ectocervix?
strat sq epithelium
type of cells make up endocervix?
Single layer of tall, mucin producing columnar cells
What feature gives endocervix a larger surface area?
Clefts
What is the junction between the endo and ectcervix called?
squamo-columnar junction
What changes occur to the cervix during puberty, and what happens to the SCJ? 4 points
During puberty the cervix changes shape The lips of the cervix grow The distal end of the endocervix opens Endocervical mucosa becomes exposed to the vaginal environment So the SCJ moves inwards
During the pubertal changes to the cervix the columnar cells are exposed to the vaginal environment. What happens to them and why?
The distal endocervical columnar epithelium is exposed to the acidic vaginal environment
It is not suited to this, so undergoes an adaptive change called metaplasia
define neoplasm (4 points)
New growth,
abnormal
excessive
persists despite withdrawal of genetic or hormone stimulation
What are 3 features of a benign neoplasm?
Remains localised and doesn’t invade surrounding tissues
Generally grow slowly
Good resemblance of parent tissue
5 consequences of benign neoplasms?
Pressure on adjacent tissue Obstruction of lumen of a hollow organ Hormone production Transformation into a malignant neoplasm Symptoms for the patient
4 features of malignant neoplasms
Invade into surrounding tissues
Spread via lymphatics to lymph nodes and blood vessels to other sites (metastasis)
Generally grow relatively quickly
Variable resemblance to parent tissue
7 consequences of malignant neoplasms
Destruction of adjacent tissue Metastasis Blood loss from ulcerated surfaces Obstruction of a hollow viscera Production of hormones Weight loss and debility Anxiety and pain
Neoplasms have the suffix ….
oma
Malignant epithelial tumours are..
carcinomas
Carcinomas are named for the ..
epithelial cell type which they resemble
Carcinomas of glandular epithelium are called
adenocarcinomas
Malignant stromal tumours are
sarcomas
what is the pre malignant state of a neoplasm known as
dysplasia
define dysplasia
There is an accumulation of cells which look somewhat like malignant cells but do not invade the basement membrane
Term for dysplasia in the cervix - UK and US
UK: Cervical intra-epithelial neoplasia (CIN)
US: Squamous intra-epithelial lesion (SIL)
Difference between carcinoma and dysplasia?
invasion through the basement membrane
Most common HPV that cause cervical cancer?
16, 18
Most common HPV that cause genital warts?
6, 11
What are the 4 subtypes of endometrial cancer acoording to morphology (microscopic appearance)?
Endometrioid
Serous
Clear cell
Mixed (components of the previous 3)
What group of women is affected by type 1 endometrial cancer, type of cell, how does this spread and progonosis?
50-60yo Obese endometriod stimulated by oestrogen SLow transition spread by lympahtic system good prognosis
What group of women is affected by type 2 endometrial cancer, type of cell, how does this spread and progonosis?
60-70 year old non obese serous mixed non oestrogen stimulated spread into pertoneium poor prognosis
In the cervix, we recognize a precursor lesion to invasive squamous cell carcinoma
Wah6t is it called
Cervical Intra-Epithelial Neoplasia (CIN)
7 Risk factors for endometrial cancer?
Endogenous hormones and reproductive factors Excess body weight Diabetes mellitus and insulin Exogenous hormones & modulators Ethnicity Familial (Cowden’s syndrome; HNPCC) Smoking not a risk
What reproductive factors reduce the risk of endometrial cancer and why?
Pregnanacy and parity - break from unopposed oestrogen
Delivery - removal of abnormal cells diring delivery
What are the 3 parameters for evaluating tumors?
Type
Grade
Stage
What is tumor grading?
Grading reflects how much a tumour resembles its parent tissue
Has to be done on tissue under a microscope
Many use a three-point system
Well differentiated Grade 1
Moderately differentiated Grade 2
Poorly differentiated Grade 3
What are the tumor stages?
T for tumour: local spread
N for nodes: lymph node deposits
M for metastasis: metastatic deposits
What is the FIGO system?
Grading for gynaecological cancers
FIGO stages
Stage 1: Confined to corpus
Stage 2: Involving cervix
Stage 3: Serosa/Adnexa/Vagina/Lymph Nodes
Stage 4: Bladder, Bowel, Distant Metastasis
Where does the transforamtion zone relocate to post menopause?
Recedes towards endocervix
4 functions of the cervix
Produces mucus to facilitate sperm migration
Acts as a barrier to ascending infection
Holds a developing pregnancy in place
Effaces and dilates to enable vaginal birth
What 6 physiological changes occur to the cervix in pregnancy?
Hypertrophies, but not as much as the uterus
Becomes softer
Increased vascularity/venous congestion, “purple tinge”
Glands distended with mucus, “mucus plug”
Prominent ectropion
Remains elongated until the onset of labour
What is cervical ectopy and its cause?
Erosion effect of oestrogen
What is cervical atrophy ?
Cervicitis due to lack of oestrogen
Name 4 infections of the cervix
Chlamydia
Gonorrhoea
Trichomonas Vaginalis
HPV
What are the three treatment options for cervical cancer?
1a cone biopsy / excision
1b radical hysterectomy / trachelectomy
2a chemo-radiotherapy
Are most ovarian cysts benign or malignat?
Benign 90%
Surgical interventions for ovarian cystes are mostly 45% performed on what pt group
Post meonpausal women
4 complications of ovarian cysts
Torsion
rupture
haemorrhage
infection
22 y.o. Woman G0P0 seen by G.P. With vague RIF pain USS 5cm right ovarian cyst presented to A & E with lower abdominal pain tenderness and guarding lower abdo USS: no cyst some free fluid Diagnosis and why?
Ovarian Cyst Rupture
Peritonitis absence of cyst on ultrasound scan
pain
29 y.o. Woman presents with acute lower right sided abdominal pain. minimal abdominal symptoms Tender 6cm mass right adnexum USS haemorrhage into a cyst management determined by symptoms Diagnosis and why?
haemorrage into ovarian cyst
72 y.o woman G3 P2 occasional left sided twinges presents with acute abdominal pain with nausea and vomiting. Tachycardia and temperature 37.8C Lower abdo guarding and rigidity leucocytosis Tender 10cm mass high on left side of pelvis Diagnosis and why?
Ovarian Cyst Torsion
necrosis of ovary
infection like symptoms
19 year old female presents with two year history of “fullness” in the right side of the pelvis.
deep dysparunia, but increasing urinary frequency
Periods normal
otherwise fit and well
mass felt in right adnexum
USS complex cystic mass ?
Diagnosis and why?
Dermoid cyst
complex cystic mass
18 year old female. Nulliparous
presents with recent onset of amenorrhoea
noted also hair recession and hirsuitism
on examination: clitoromegaly and slightly tender 10cm mass in left side of the pelvis.
USS complex mass in pelvis mainly solid and vascular
Daignosis and why?
sertoli-leydig tumour of ovary
hormone producing because stromal in origin
3 categories of epithelial ovarian tumors?
Benign
borederline
malignant
What is the peri menopause?
transition from reproductive cycles to post menopause
Age and mean duration of peri menopause?
typical age at start 45-50 y, median 47.5 y
mean duration: 3.8 y
4 symptoms of perimenopause?
irregular menstrual cycles
occasional heavy bleeding
hot flushes
nervousness, irritability
3 primary symptoms of menopause
menstrual cycle changes - (oligomenorrhea, amenorrhea)
vasomotor symptoms - (Hot flushes, night sweats)
vaginal dryness
7 secondary symptoms of menopause
urinary stress/urge incontinence cystitis-like symptoms depression/irritability changes musculoskeletal pains (joint aches & osteoporosis) dry skin, hair thinning, nail changes decreased concentration decreased libido
2 components of HRT?
Oestrogen
Progestogens
What are each of the HRT hormones used to manage/treat?
Oestrogen - menopausal symptoms
Progetrogens - prevent endometrial cancer
Other than HRT, what drugs can be used as an altrenative treatment for osteoperosis?
Biphosphonates - (Alendronate and Risedronate)
Other than HRT, what drugs can be used as an altrenative treatment for the vasomotor symptoms?
Progesterone
SERMs – Raloxifene
Beta-blocker
Clonidine
Via what 6 routes can HRT be given?
Oral Patches Implants Vaginal rings Transdermal gel Nasal
If no uterus then what HRT given?
Oestrogen only.
If uterus remaining, what HRT is given?
Oestrogen and progesterone
Oestradiol every day (white tablets)
Oestrogen plus progestagen (norgestrol) for 11 days (brown tablets)
Packet taken one after the other or 7 days break
Withdrawal bleeding during the brown tablets
`
5 absolute contraindications to HRT
Pregnancy Active venous thromboembolism Severe active liver disease Endometrial carcinoma with recurrence Breast carcinoma with recurrence
6 relative contraindication to HRT
Abnormal bleeding Breast lump (prior to investigation) Previous endometrial cancer Previous breast cancer Strong family history breast cancer Family history of thromboembolism
Side effects of HRT (up to 11)
Mood swings/Low mood Acne Backache Lower abdominal ache Bleeding Stomach upset (indigestion) Tender or painful breasts Fluid retention causing bloating and weight gain Nausea Headaches Leg cramps
2 short term benefits of HRT
Reduces vasomotor symptoms (eg hot flushes)
Improves psychological symptoms (eg mood swings)
5 long term benefits of HRT
Maintains bone mass and reduces the risk of fracture
Reduces urogenital problems (eg dry vagina)
Improves skin (cosmetic)
Reduces the risk of bowel cancer
May improve balance and reduce falls – less fractures
4 risks of HRT
Endometrial Cancer (if unopposed oestrogen used)
Breast Cancer
Cardiovascular disease (stroke and MI)
Venous thrombo-embolic disease (VTE)
6 Differnces between HRT and COCP
Ethinyl oestradiol (not natural)
Massive first pass metabolism by the liver
Increased clotting factors
High dose oestrogen suppressing GnRH/ FSH/LH
Stops ovulation
Progestagen given to prevent hyperplasia of endometrium not really to add to contraception
Oestradiol (natural)
Lower dose to the body
Some increased clotting factors
Doesn’t suppress the FSH and LH to the same degree as the COCP
Doesn’t stop ovulation
Progestagen given to prevent hyperplasia of endometrium
What is included in a biopsychosocial definition of “sexual health”?
a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence
Why is “sexual health” preferable to “reproductive health”?
doest take into account non reproductive sexual activity or how people adentify their sexuality
How could sexual coercion lead to poorer health outcomes?
sexual coercion has potentially long lasting effects on
- psychological well-being
e. g., higher prevalence of depression and anxiety - physical well-being
e. g., lower well-being, greater cigarette/drug/alcohol use - sexual well-being
e. g., more STIs, more negative attitudes attitudes
How do sexual health comcerns vary over youth, adulthood, older age?
e. g. youth – avoiding unintended pregnancy
- avoiding STIs
- treating STIs to protect reproductive health
e. g. adulthood - optimising reproductive health
- optimising sexual satisfaction
e. g. older age - optimising sexual function
- limiting impact of physical health on sexual health
Why is promoting preventative behavior in exual health important, give an example?
absence of vaccines, cures or effective treatment increases importance of behaviour
high and increasing rates of STIs, particularly among young people
comdom use
If you were asked to design an intervention to increase condom use but could only focus on one thing, what would you try to change?
Preventative skills
condom use
interventions that include a skills component in addition to knowledge/ attitudes are the most effective (Carey et al. 2000)
For what 6 reasons could STIs be increasing?
artefact?
- more sensitive tests - more people getting tested real increase - more young people sexually active - inconsistent condom use - lack of concern about HIV affects STI concern - belief that STIs are not serious
What are 7 increse risk groups for contracting an STI?
young age (<20 years) - low age at 1st intercourse - coitarche
frequent partner change, high no. lifetime partners, concurrency (simultaneous partners)
sexual orientation
ethnicity for some STIs
use of non barrier contraception
residence in inner city/ deprivation
history of previous STI
For what reasons are young people more at risk for contracting an STI?
Behaviourally more vulnerable to STI acquisition
higher numbers of sexual partners / partners change
greater numbers of concurrent partners
yet to develop skills and confidence to use condoms, negotiate safe sex,
more risk-taking behaviour/ experimentation
poor contraception awareness
STI most prevalant amonst young people especially young women
Chlamydia
What 5 vulnerabilites os early intercourse assocciated with ?
leaving home / not living with parents before 16 years
leaving school early
family disruption & disadvantage
lack of nurturing relationships
those whose main source of information on sex was not school / parents
6 main messages for young peole in terms of sexual health?
Don’t rush into it – avoid peer pressure
Use a condom with all new partners - continue until both screened
Sort out contraception
Avoid overlapping sexual relationships
Get screened for chlamydia/gonorrhoea when you have a new partner
MSM should have regular sexual health screens, including HIV, get vaccinated for hepatitis A/B and HPV & consider PrEP for HIV prevention
Most common STI daignosis in MSM?
Syphillis
Most common STI in young men?
Gonnorrhea
