Flashcards in Diseases of the female genital system part 1 Deck (13):
what is Dysplasia?
Earliest morphological manifestation of multistage process of neoplasia. It is in situ with no invasion so curable.
Human Papilloma Virus is an ---------- stranded DNA virus?
HPV is a double stranded. DNA virus.
HPV risk groups
Genital HPV is grouped into low risk and high oncogenic risk. Low risk HPV (6,11) linked to genital warts. High risk linked to invasive cancer. Types 16 and 18 are associated with 70% of cervical cancer.
What are the 2 HPV Vaccinations?
How does high risk HPV cause cancer?
-High risk HPV is integrated into host chromosomes.
-Up-regulates E6 and E7 expression.
-E6 binds to and inactivates P53 gene. (P53 mediates apoptosis in response to DNA damage - so no apoptosis)
-E7 binds to RB1 gene product. (RB1 is the tumour suppressor gene, controls G1/S checkpoint in cell cycle)
Results in accumulation of DNA damage and dysregulation of cell proliferation.
What is the classic presentation of Vulval Intraepithelial neoplasia (VIN)?
-related to young people.
-It is graded from 1-3. The higher the grade the more likely it is to become invasive.
What are the characteristics of differetiated vulval intraepithelial neoplasia (VIN)?
-not HPV related
-in older people.
-occurs in chronic dermatoses esp. lichen sclerosus.
-lichen sclerosus is a chronic inflammatory disease that affects the vulva.
-differentiated VIN can develop into cancer.
Squamous cell carcinoma (vulval) oncogenic pathways
-Associated with Vulval intraepithelial neoplasia and HPV.
-Also associated with inflammatory dermatoses e.g. Lichen Sclerosus.
-Spreads locally to vagina and urethra. Then to lymph nodes.
Malignant Melanoma (vulval tumour)
-5% of vulval cancer
-aggressive, spreads via lymph nodes and blood.
Paget's Disease (vulval tumour)
-in situ adenocarcinoma of squamous mucosa.
-can develop into invasive adenocarcinoma!!
-usually no underlying tumour
Cervical Pathology - describe the anatomy of the cervix from pre-puberty to menopause.
The external os of the cervix is lined by squamous epithelium. The endocervical cancal is lined by columnar epithelium. They meet at the squamo-columnar junction (transformational zone)
Before puberty this squamo-columnar junction lies within the endocervial.
During menarche and pregnancy the squamo-columnar junction comes to lie on the vaginal aspect of the external os.
After menopause the junction retreats back into the canal.
What are the risk factors od Cervical Squamous cell carcinoma?
-multiple sexual partners
-young age at first intercourse