Disease of the female genital system

Question 1

What types of neoplasias are often caused by Human papillomaviruses?

Answer 1

intraepithelial neoplasias

i.e. vulva, cervical, cervical glandular, vaginal, anal

Question 2

What is dysplasia and how does it progress into neoplasia?

Answer 2

the earliest stage of change into neoplasia
shows all the signs of cancer except invasion (in situ)
still curable at the stage

Question 3

What is the human papillomavirus?

Answer 3

double stranded DNA virus

different types invade different tissues

Question 4

Genital HPV’s are categorised how?

Answer 4

low oncogenic risk

high oncogenic risk

Question 5

What are the two most common subtypes of low HPV risk?

Answer 5

6

11

Question 6

What are the two most common subtypes of high HPV risk?

Answer 6

16

18

Question 7

99.7% of which type of cancer contains HPV DNA?

Answer 7

cervical

Question 8

What do low risk HVP’s normally present as?

Answer 8

warts

benign

Question 9

What do high risk HVP’s normally present as?

Answer 9

invasive carcinomas

Question 10

What are the two vaccines for HPV and what subtypes do they target? Also which one is used currently?

Answer 10

Cervarix - HPV 16 and 18

Garasil - HPV 6, 11, 16 and 18 (Currently used)

Question 11

How many and what sets of genes does HPV have?

Answer 11

2 - early and late sets of genes

Question 12

What do late genes express for?

Answer 12

codes of capsid proteins

Question 13

What are the 2 early genes and what do they do?

Answer 13

E6 - binds to and inactivates p53 (mediates apoptosis when DNA damage has occured)
E7 - binds to RB1 gene product (tumour supressor gene that controls G1/S checkpoint in cell cycle)

Question 14

What happens in the presence of HPV?

Answer 14

high risk HPV integrates into the host chomosomes

upregulates E6/E7 expression

Question 15

How does vulval intraepithelial neoplasia (VIN) present?

Answer 15

warts
white patches
pigmented patches

Question 16

Classical VIN is caused by what and more common in what age range?

Answer 16

HPV

younger people

Question 17

Differetiated VIN is caused by what and more common in what age range?

Answer 17

not HPV related - occurs commonly in conjunction with chronic inflammatory skin conditions, esp lichens sclerosus (precursor to cancer)
older people

Question 18

Why is it important that VIN is treated?

Answer 18

untreated = 87% of those can lead to invasive cancer

only treatment is surgical

Question 19

Who is VIN invasion more likely to occur in?

Answer 19

postmenopausal

immunocompromised

Question 20

How does vulval squamous cell carcinoma present?

Answer 20

eroded plaque

ulcer

Question 21

What is the spread of vulval squamous cell carcinoma typically like?

Answer 21

very predictable
spreads to ipsilateral ingiunal lymph nodes first
Then to contralateral inguinal lymph nodes & deep iliofemoral lymph nodes

Question 22

What is the staging system used for vulval squamous cell and cervical carcinomas?

Answer 22

FIGO staging system

Question 23

What is the mean age of people with malignant melenoma of the vulva and how likely is it to spread?

Answer 23

50-60 years old
aggressive
spreads to urethra frequently
lymph nodes/haematogenous spread common

Question 24

What is the mean age of people with extramammary Pagets disease is how does present?

Answer 24

80 years old
burning/eczema like patches - should be diagnoised via biopsy
arise in the intraepidermal portion of sweat ducts
in situ adenocarcinoma of squamous mucosa
can develop into invasive adenocarcinoma

Question 25

Explain the histology of the cervix in its original state

Answer 25

squamous epithelium at the base columnar epithelium further up and inside squamocolumnar junction present at the external os

Question 26

Explain the histology of the cervix during first menstrual cycle

Answer 26

oestrogen increases increased sqaumous epithelium squamocolumnar junction becomes wider

Question 27

Explain the histology of the cervix during the development of the transformational zone

Answer 27

due to the vaginal acidic environment, metaplasia occurs | squamous epithelium turns into columnar epithelium = transformational zone

Question 28

Explain the histology of the cervix during menopause

Answer 28

squamocolumnar junction moves up

Question 29

Where does specifically cervical intraepithelial neoplasia happen?

Answer 29

transformational zone

Question 30

What can cervical intraepithelial neoplasia lead to?

Answer 30

squamous cell cervical cancer

Question 31

What does the cervical screening programme detect?

Answer 31

cervical intraepithelial neoplasia | NOT cancer

Question 32

How is cervical intraepithelial neoplasia catagorised?

Answer 32

``` Low grade (CIN I) High grade (CIN II/III) ```

Question 33

At what age do you receive your first invitation for cervical screening programmes?

Answer 33

25

Question 34

Why can cervical screening programmes produce confusing cytology sometimes?

Answer 34

reactive changes, especially in younger people | i.e. inflammation/healing

Question 35

What is the next step if cervical screening shows low grade/borderline changes?

Answer 35

HPV testing if +ve then refer for colposcopy and biopsy if -ve then normal recall

Question 36

What is the next step if cervical screening shows high grade changes?

Answer 36

refer for colposcopy and biopsy

Question 37

What is the treatment for CIN?

Answer 37

Large Loop Excision of the Transformation Zone (LLETZ)

Question 38

What are risk factors for cervical squamous cell carcinoma?

Answer 38

``` high risk HPV is most important Multiple sexual partners Male partner with multiple partners Young age at first intercourse Low socioeconomic group SMOKING Immunosuppression ```

Question 39

What is the presentation and spread like for cervical adenocarcinoma?

Answer 39

arises from the mucosal glands | same as cervical squamous cell cancer

Question 40

What is the precursor for cervical adenocarcinoma?

Answer 40

Cervical Glandular Intraepithelial Neoplasia (CGIN)

Question 41

Which has a worse prognosis out of adenocarcinoma and squamous cell carcinoma?

Answer 41

adenocarcinoma due to radioresistance

Question 42

Metastasis is common from where and to where in regards to cervical carcinomas?

Answer 42

TO pelvic and para-aortic lymph nodes | FROM blood to lungs, bone etc