46 Disease of female genital system Flashcards

1
Q

What do the intraepithelial neoplasia of the female genital system all share?

A

Common aetiology: human papilloma virus.

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2
Q

Which HPV subtypes are low risk? (2).

What are they associated with?

A

6 + 11.

Genital warts and low grade cytological abnormalities.

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3
Q

Which HPV subtypes are high risk? (4).

What are they associated with?

A

16, 18, 31, 33.

High grade pre-invasive and invasive disease.

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4
Q

Differentiate between the cervarix and gardasil vaccinations:

A

Cervarix: subtypes 6 + 11.
Gardasil: 6, 11, 16, 18.

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5
Q

How does high risk HPV lead to cancer?

A

Integrates into host cell chromosome. Upregulates E6 and E7.

E6 inactivates p53. E7 binds to RB1 gene product.

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6
Q

Differentiate between early and late genes (of viruses).

A

Early: control replication.
Late: code for capsid proteins.

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7
Q

What does p53 control?

A

Mediates apoptosis in response to DNA damage.

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8
Q

What does RB1 gene do?

A

Tumour supressor gene.

Controls G1/S checkpoint in the cell.

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9
Q

What is the epidemiology of classical vulval intraepithelial neoplasia?
Classification?

A

Associated with HPV, occurs in young people.
Classical/warty/baseloid.
Grades 1 to 3.

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10
Q

What is the epidemiology of differentiated vulval intraepithelial neoplasia?

A

Not graded. Not HPV related.
Related to chronic dermatoses e.g. lichen sclerosus.
Occurs in older people.

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11
Q

Describe the behaviour of vulval intraepithelial neoplasia:
Who does it progress to invasive in?
Who does in spontaneously regress in?

A

35-50% recur.
Menopausal, immunocompromised.
Young, postpartum.

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12
Q

What is the most common vulval cancer?

A

Squamous cell carcinoma.

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13
Q

What is squamous cell carcinoma associated with?

A

Under 60: CIN, HPV +ve

70: lichen scleosus, lichen planus.

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14
Q

How does vulval squamous cell carcinoma spread?

A

Locally: vagina, distal urethra.
Ipsilateral inguinal lymph nodes.
Contralateral inguinal lymph nodes, deep iliofemoral LNs.

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15
Q

Which staging system is used for vulval squamous cell carcinoma?

A

FIGO.

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16
Q

Describe the behaviour of malignant melanoma as a vulval cancer:
Age, recurrence. Spread.

A

50-60y/o. Recurrence in 1/3rd.

Lymph/haematogenous spread common. Correlated with invasion depth.

17
Q

What is Paget’s disease of the vulva? (extramammary).

A

Pruritic, burning, eczematous patch.

In situ-carcinoma that recurs following excision.

18
Q

Which area is most vulnerable to the effects of HPV?

A

Transformation zone.

19
Q

What is the transformation zone in women?

A

Physiological area of squamous metaplasia.

20
Q

Describe the changes that occur over a woman’s lifetime to the transformation zone:

A

During menarche, squamocolumnar junction moves out into vagina, establishing a transformation zone. During menopause the transformation zone moves up into the endocervical canal.

21
Q

What is cervical intraepithelial neoplasia?

A

The pre-invasive stage of squamous cell carcinoma.

22
Q

Why doesn’t the cervical screening program test for cancer?

A

In cases of cancer, the swab picks up the inflammatory detritus covering the cancer, and not the malignant cells.

23
Q

Who gets cervical screening?

A

25 -64.
25-49 is 3 yearly.
49-64 is 5 yearly.

24
Q

Why is there no cervical screening for under 25’s? (2).

A

High HPV carriage rate - reactive changes.

Too many LLETZ procedures have obstetric consequences.

25
Q

Who gets referred for colposcopy after a cervical screen? (2).

A

Low grade dyskaryosis with +HPV result.

High grade dyskaryosis.

26
Q

What does LLETZ stand for?

A

Large loop excision of the transformation zone.

27
Q

What are the risk factors for cervical squamous cell carcinoma? (5).

A
High risk HPV. (Most important).
Multiple partners, young first intercourse, high parity.
Low SEC.
Smoking.
Immunosuppression.
28
Q

What are the stages in the FIGO system for cervical carcinoma?

A

I Confined to cervix.
II Invades beyond uterus.
III Extends to pelvic wall, lower 1/3rd vagina, hydronephrosis.
IV Invades bladder/rectum/outside pelvis.

29
Q

Where does cervical carcinoma spread to via the lymph?

A

Pelvic and para-aortic lymph nodes.