16. Pathology of the Female Reproductive Tract Flashcards Preview

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Flashcards in 16. Pathology of the Female Reproductive Tract Deck (32)
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1

Presenting Complaints

Vaginal Bleeding:
post-coital, inter-menstrual, post-menopausal, heavy periods, irregular periods

Pain:
pelvic, abdominal, painful sex, painful periods

Discharge:
heavy, bloody, offensive, itchy.

Infertility:
primary, secondary

2

Cervical Pathology

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

3

Cervical Screening-Smear Test

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.

4

Human Papilloma Virus

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

5

HPV

Many different types

Low risk types- wart/verrucas

High risk types- cervical cancer

Girls aged 12 -13 offered HPV vaccination
offers protection against infection for strains associated with 70% of cervical cancers

6

Screening programme

Cervical cancer screening programme
“Smear” test carried out in GP surgery

7

Cytology Screening

Normal- routine 3/5 year re-smear

Abnormal- referred to colposcopy

May have biopsies taken

8

Cervical Cancer

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

9

Cervical Carcinoma

Abnormal cells and invasion
Can present with inter-menstrual or post-coital bleeding

10

Treatment

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

11

Endocervical Polyps

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

12

Uterine Pathology

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

13

Menorrhagia

“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......

14

Treatment

Mirena coil
Mefanamic and tranexamic acid
COCP
Depo provera
Endometrial ablation
Hysterectomy

15

Fibroids (Leiomyomas)

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

16

Endometritis and Pelvic Inflammatory Disease

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

17

Endometriosis

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

18

Endometriosis Treatment

COCP
Mirena
Zoladex
Surgery

19

Endometrial Polyps

Benign growths from endometrial cavity

Can be removed at hysteroscopy

20

Endometrial Cancer

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 and BSO
Overall 20 year survival rate is 80%

21

Endometrial Carcinoma

Usually presents as post-menopausal bleeding- early stage
Risk factors include obesity and oestrogen exposure
Diagnosed by endometrial biopsy (pipelle or hysteroscopy)
Treatment usually hysterectomy

22

Ovarian Cysts

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

Cystadenomas
Can be very large fluid filled cysts
Symptoms caused by pressure effect

Benign Mature Teratomas
Large cysts filled with solid substance

23

Polycystic Ovarian Syndrome (1)

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

24

Polycystic Ovarian Syndrome (2)

Treatments
COCP
Metformin
Clomifene

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

25

Ovarian Cysts

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

26

Ovarian cancer

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

27

Pregnancy Associated Diseases

Miscarriage
Ectopic Pregnancies
Gestational Trophoblastic disease

28

Miscarriage

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

29

Treatment options

Conservative
Medical with misoprostol
Surgical usually by vacuum suction under GA

30

Ectopic Pregnancy (1)

Think about in any ‘young woman’ with abdominal or pelvic pain- always test!!!!!
Risk factors are PID, coil, IVF, previous ectopic, pelvic surgery.