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Clinical Pathology > Diseases of the Female Genital System I > Flashcards

Diseases of the Female Genital System I Flashcards

1
Q

Name the different intraepithelial dysplasia that can occur?

A 
Vulvula 
Cervical 
Cervical Glandular
Vaginal 
Anal
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2
Q

What are intraepithelial neoplasia related to?

A

HPV infection

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3
Q

What is dysplasia?

A

The earliest manifestation of neoplasia

In situ, non-invasive, CURABLE (if l;eft, can become metastatic)

Forms the basis for the cervical screening program

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4
Q

What type of virus is the HPV? How are they divided?

A
  • DNA virus
  • Different types effect different tissues
  • Divided into LOW and HIGH Oncogenic risk
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5
Q

What types of HPV are low risk? What do they cause?

A

Types 6, 11

Associated with GENITAL WARTS (most common) - d not produce malignancies

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6
Q

What types of HPV are HIGH risk? What do they cause?

A

Types 16 and 1, 31 and 33
Associated with CERVICAL CANCER

(99.7% cervical cancers related to HPV infection)

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7
Q

What are the two vaccines against HPV? What types do they vaccinate against?

A

Cervarix - 16, 18
Gardasil 6, 11, 16, 18** - prevents genital warts and cervical cancer

** main one used in UK

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8
Q

How does the HPV virus exert its action?

A

Early genes

E6 - deactivates P53 responsible for apoptosis with damage to DNA - accumulation of genetic damage

E7 - deactivates RB1 - tumour suppressor gene which controls G1/S checkpoint in cell cycle - dysregulated cell proliferation

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9
Q

How do vulvulal intraepithelial neoplasia’s present?

A

Warty
White patches
Pigmented patches

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10
Q

What is another cause of vulvula intraepithelial neoplasms?

A

Lichen sclerosis (older people) - can cause malignancy unrelated to HPV

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11
Q

What is the most common type of cancer that occurs in the vulva?

A

Squamous cell carcinoma

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12
Q

What does squamous cell carcinoma look like? Where can they spread?

A
  • Ulcer, raised lesions
  • Spreads predictably - locally to vagina/distal urethra
    and inguinal lymph
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13
Q

If the depth of squamous cell carcinoma is less than 1mm, what is the risk of metastasis?

A

VERY RARE (local excision)

If more than 1mm, lymph node sampling

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14
Q

What staging system is used for vulval squamous cell carcinoma?

A

Figo staging

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15
Q

What other cancers other in the vulva?

A
  • Malignant melanomas (pigmented and non pigmented)

- Pagets disease - pruritic/burning/eczematous patch - like a shotgun to the vag - adenocarcinoma of squamous mucosa

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16
Q

What is weird about pages disease?

A

No underlying tumour - in situ disease, curable!

17
Q

What is the area where squamous metaplasia takes place and is highly prone to HPV infection?

A

Transformation zone

18
Q

Why does squamous metaplasia occur?

A

Oestrogen - increased cervical bulk - squamocolumnar junction everts outside

Columnar epithelium of cervix cannot withstand acidic environment

Therefore, undergoes squamous metaplasia - TRANSFORMATION ZONE (squamous cels can withstand!)

19
Q

What happens to the transformational zone with the menopause?

A

Cervical inversion - transformational zone inverts back down canal - more difficult to diagnose

20
Q

What is cervical intraepithelial neoplasia? How does this relate to the cervical screening programme?

A

Pre-invasive stage of cervical squamous cell carcinoma

  • aim of cervical screening programme is to identify CIN
21
Q

If diagnosed with CIN 1, whats the standard treatment?

A

None - high risk of regression but low risk of progression

22
Q

Is the cervical screening programme a test for cancer?

A

NO - its a test for cervical intraepithelial neoplasm

23
Q

What characteristics call for HPV testing/colposcopy?

A

Dyskaryosis - abnormal squamous cells

24
Q

What happens if CIN/Dyskaryosis is observed in the TZ?

A

Colposcopy

Long loop excision of the transformation zone

25
Q

What are the risk factors for cervical squamous cell carcinoma?

A

Multiple sexual partners
Male partners
Young age at intercourse
Smoking

26
Q

What are the treatment for squamous cell carcinoma?

A

Excision (LLETZ)

Chemotherapy

27
Q

What is the purcurose for cervical adenocarcinoma?

A

Cervical glandular intraepithelial neoplasm

Clinical Pathology (50 decks)

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