gynae path - cervix Flashcards
what staging is used for gynae tumours
FIGO - international federation of obs and gynae
what is inflammation of the vulva, vagina, cervix, endometrium, fallopian tube and ovary called
vulvitis
vaginitis
cervicitis
endometritis
salpingitis
oophoritis
infections of the genital tract that cause discomfort but no serious complications
Candida: Diabetes mellitus, oral contraceptives and pregnancy enhance development of infection
Tichomonas vaginalis: protozoan
Gardenerella: gram negative bacillus causes vaginitis
infections of the female genital tract that have serious complications
Chlamydia: infertility
Gonorrhoea: infertility
Mycoplasma: spontaneous abortion and chorioamnionitis
HPV: implicated in cancer
definition of PID
infection of the upper female genital tract
organisms that cause PID
Gonococci, chlamydia, enteric bacteria
* start from lower genital tract,
* spread upwards via mucosal surface
Staph, strept, coliform bacteria and clostridium perfringens
* 2ndary to abortion
* start from uterus - spread by lymphatics and blood vessels up
* deep tissue layer involvement
complications of PID
Peritonitis
Bacteraemia and septicaemia
Intestinal obstruction due to adhesions
Infertility - from lesions
summarise the sequence of events in salipingitis
acute, chronic or granulomatous
direct ascent from vagina (except with TB)
can resolve
complications:
* Plical fusion
* Adhesions to ovary
* Tubo-ovarian abscess - from obstruction of lumen -> abdo mass
* Peritonitis
* Hydrosalpinx
* Infertility - path of ovum disrupted
* Ectopic pregnancy
where can you get ectopics
tubal - most common
ovarian
peritoneal
benign endocervical polyp
epidemiology of cervical ca
2nd most common cancer affecting women
mean age - 45-50yrs
viruses involved in aetiology
screening
intervention is possible at preinvasive stage
possibly prevent with vaccine
pre-malignant phase is cervical intraepithelial neoplasia
RF for cervical cancer
Human Papilloma Virus -present in 95%
Many sexual partners
Sexually active early
Smoking
Immunosuppressive disorders
what are the low risk HPVs
types that cause oral and genital warts
Most common types: 6, 11
Other types: 40, 42, 43, 44, 54, 61, 72, 73, 81
Low grade cervical dysplasia
what are the high risk HPVs
cancer causing types - cervical, Vulval, vaginal, penile, and anal
low and high grade dysplasia
Most common types: 16, 18
Other types: 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68,82
compare L and R
Transitional zone of cervix
L normal
R - high grade dysplasia - lots of mitotic activity, disorganisation of cells.
summarise disease progression of cervical cancer
CIN3 - severe dysplasia
If cells breach bottom layer = ca
what is cervical intraepithelial neoplasia
dysplasia
epi cells have undergone phenotypic and genetic changes -> premalignant and preinvasive
basal membrane in tact
squamous epi (CIN) involved more than glandular (CGIN)
CGIN -> adenoca
CIN -> sq ca
define cervical ca
invasion through the basement membrane changes CIN to cancer
the 2 main types are
* squamous cell ca
* adenoca - HPV dependent/independent
what does the Px of cervical cancer depend on
Tumour type
Tumour grade
Tumour stage: FIGO Stage I (90%) – IV (10%)
5 year survival
Lymphovascular space invasion
summarise latent HPV infection
- HPV DNA resides in basal cells
- infectious virons are not produced
- Replication of viral DNA is coupled to replication of the epithelial cells with replication of the host DNA
- Complete viral particles not produced
- cellular effects of HPV infection not seen
- Infection can only be identified by molecular methods
summarise productive viral infection
viral DNA replication independantly of host DNA synth
-> large number of viral DNA
-> infectious virons
cytological and histological features
How does HPV transform cells
proteisn E6 and E7 encoded by virus have effect on genes
they bind and inactivate tumour suppressor genes - retinoblastoma gene (Rb) (E7), p53 (E6)
-> interfere with apoptosis
-> increase cellular proliferation
-> oncogenesis
Px with HPV
most people - immune system eliminate HPV -> undetectable in 2yrs
few will have sx
persistent infection with high-risk HPV - associated with cancerous and pre-cancerous changes
summarise the cervical screening program
start at 25yrs
every 3yr until 50
then every 5yr until 64
