Gynaecological masses and malignancies Flashcards

Question

Discuss trend of incidence rates of cervical cancer

Answer 1

Incidence decreasing because of cervical ca screening and HPV vaccine

Answer 2

Squamous epithelium lining ectocervix or in glandular epithelium lining endocervix

Answer 3

Squamous celss = 75-80% HPV 16 = 55%, HPV 18 = 15%

Answer 4

HPV infections persist and lead to malfunctioning of p53 and Rn - cellular turnover increases and apoptosis decreases HPV 16, 18 and 33 produce oncogenes E6 and E7 E6: inhibits p53 (tumour suppressor) E7: inhibits Rb (tumour supressor)

Answer 5

CIN = cervical intraepithelial neoplasia CIN 1: unlilely cells will become cancerous - 12 month recall CIN 2: removal recommended CIN 3: removal recommended CIN = cervical glandular intraepithelial neoplasia, equivalent of CIN 3: removal recommended

Answer 6

Women aged 25-49 screened every 3yrs Women aged 50-64 screened every 5 years Immunisation of girls and boys (gardasil) aged 12-13 protects against HPV 16 & 18 (cancer) and 6 & 11 (warts)

Answer 7

30% cases are caused by HPV not covered by the vaccine - vaccine does not protect against all types

Answer 8

Most common age - 30-45yrs 50% asymptomatic and detected by screening Unusual vaginal bleeding Pelvic pain Back pain Urinary/ faecal leakage

Answer 9

Histological: cervical ca diagnosed following biopsy MRI: determine tumour size and spread Prognosis: if confined to cervix - 80-90% @ 5yrs

Answer 10

Surgery: early disease + chemo if narrow margins or positive LNs Chemoradio: cisplatin + brachytherapy + pelvic external xRT

Answer 11

**Step 1: smear looks for high risk HPV** Not found: repeat screen in 3 or 5 yrs depending on age Found: proceed to step 2 **Step 2: HPV +/- abnormal cells** HPV + abnormal cells: colposcopy HPV - abnormal cells: repeat smear in 12 months Inadequate sample: repeat in 3 months Following treatment for CIN1, 2 or 3 - follow up in 6 months

Answer 12

5% gynae malignancies Disease of elderly - 74yrs mean age 90% = SCC 5% = malignant melanoma Becoming more common in younger women due to HPV

Answer 13

Vulval intra-epithelial neoplasia Lichen sclerosus Paget's disease

Answer 14

Persistent infection with HPV Older women: lichen sclerosus and chronic inflammation Extra-mammary Paget's

Answer 15

Lump/ ulcer associated with pain, itch or bleed

Answer 16

Rare - 1-2% gynae malignancies 80% due to mets from cervix or endometrium 90% SCCs Vaginal clear cell ca occurs in young women exposed to DES in utero Aetiology: HPV found in 60% tumours RFs: prev. cervical neoplasia, xRT, vulval intraepithelial neoplasia Clinical features: vaginal bleeding, discharge, late disease causes haematuria, urinary retention, constipation and tenderness Examination: mass or ulcer, usually at top of vagina Ix: MRI, cystoscopy, sigmoidoscopy Tx: surgery, xRT

Answer 17

50% women 20% white women 50% black women

Answer 18

Functional cysts: common, small, fluid filled, resolve spontaneously Endometrioma: chocolate cysts: endometrium within ovary, may cause pelvic pain Teratoma: germ cell tumour, very common Cystadenoma: common, originate from ovarian epithelium and produce mucinous or serous fluid, 10-15% are bilateral Thecoma: originate from hormone secreting stromal cells, solid and cystic components, secrete oestrogen, 20% have associated endometrial pathology, can cause abnormal vaginal bleeding

Answer 19

Most common in women of reproductive age Ovary twists on pedicle and blood supply is lost Venous retuns lost first so ovary engorged n Presence of cysts makes torsion more likely (most commonly dermoid cysts) OHSS makes torsion more likely Presentation: acute pain, radiation to thigh/ groin, N&V, low grade pyrexia, mild shock, local tenderness Examination: cervical excitation, adnexal tenderness, adnexal mass USS: enlarged ovary, **whirlpool sign**

Answer 20

Endometrial

Answer 21

Every year

Answer 22

No - done 3 months PP

Gynaecological masses and malignancies Flashcards

(46 cards)