Hi - Gynae Flashcards by Lottie Barot

name the key components of the gynae tract

vulva
vagina
cervix
uterus
fallopian tubes
ovaries

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what are presenting Sx of female genital tract disease

discharge
PV bleeding
pain - dyspareunia
dysuria
itching

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name 3 congenital gynae abnormalities

duplication
agenesis / atresia

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what is inflammation of the following called:
- vulvla
- vagina
- cervix
- endometrium
- fallopian tube
- ovary

vulvitis
vaginitis
cervicitis
endometritis
salpingitis
oophoritis

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what gynae infections cause discomfort but not serious complications

candida
tichomonas vaginalis
gardenerella

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what increases development of gynae candida infection

DM
OCP
pregnancy

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which gynae infections have serious complications

chlamydia
gonorrhoea
mycoplasma
HPV

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what gynae complication do chlamydia and gonorrhoea cause

infertility

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what obstetric complication occurs with mycoplasma

spontaneous abortion and chorioamnionitis

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what is the risk of contracting HPV

cancer

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what is infection of upper female genital tract called

pelvic inflammatory disease

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3 organisms causing PID which spread from lower genital tract via musocal surfaces

gonorrhoea
chlamydia
enteric bacteria

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how do strep / staph etc cause PID

secondary to abortion
starts from uterus and spreads by BVs and lymphatics

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complications of PID

peritonitis
bacteraemia
obstruction due to adhesions
infertility

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how does salpingitis occur

direct ascent from vagina

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complications of salpingitis

infertility & ectopic are the 2 key/worst ones !!
plical fusion, adhesions to ovary, absecess, peritonitis, hydrosalpinx

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where do 95% of ectopics occur

fallopian tubes

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3 diseases of the cervix

inflammation
polyps
dysplasia / carcinoma

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how common is cervical cancer worldwide

2nd most common

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mean age of cervical cancer

45-50 years old

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what is the premalignant phase of cervical ca

cervical intraepithelial neoplasia

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how can cervical cancer be prevented

possible vaccination
screening to detect premalignant stage

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what % of cervical Ca has HPV

95%

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RFs for cervical ca

HPV
many sexual partners
sexually active early in life
smoking
immunosuppressive disorders

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what types of HPV are low risk

6 and 11

what does low risk HPV cause

genital and oral warts low grade cervical dysplasia

what types of HPV are high risk

16 and 18

what does high risk HPV cause

low and high grade cervical dysplasia cervical cancer vulva / vagina / penis / anus cancer

describe the disease progression of cervical cancer from HPV

1. normal epithelium 2. HPV infection - causes some abnormal cells 3. get low grade dysplasia in a single layer of epithelium 4. mild/mod dysplasia in multiple layers of epithelium 5. high grade dysplasia - covers the entire epithelium 6. carcinoma - invades through basement membrane

name the 3 stages of dysplasia before it becomes cervical carcinoma

cervical intra epithelial neoplasia 1 (few dysplastic cells) CIN 2 (multiple layers of dysplasia) CIN 3 (whole epithelium is dysplastic)

what feature differentiates cervical intraepithelial neoplasia from carcinoma

invasion through BM

2 principle types of cervical carcinoma

squamous cell adenocarcinoma

what % of invasive cervical cancer is adenocarcinoma

20%

how is prognosis determined for cervical cancer

FIGO staging 1 to 4 grade and type of tumour lymphovascular space invasion

what % of survival is FIGO stage 1 vs 4

1 = 90% 4 = 10%

2 stages of HPV infection

latent or active

in what phase of HPV infection is cancer more likley to occur

active, persistant infection - in latent the virus is not producing virions so is largely undetectable

what ages are invited to the cervical screening programme

25 to 64

how frequently are smear tests done

25 - 49 = 3 yearly 50 - 64 = 5 yearly

what is the sensitivity / specificity of cervical cytology in detecting high grade cancers

50-95% / 90%

who is given the HPV vaccine

12 to 13 year olds, then again after 24 months

what is the uterine wall comprised of

myometrium endometrium - glands and stroma

indications for uterine biopsies

endometrium - infertility - uterine bleeding - thickened endometrium on imaging uterus or related mass - lesion on imaging - as part of wider resection

types of uterine tumours

endometrial mesenchymal mixed miscellaneous

precursor of endometrial epithelial tumour

endometrial hyperplasia

when do you get endometrial hyperplasia

xs hormone stimulation - E therapy - PCOS - persistent anovulation

what is the most common gynae cancer

endometrial cancer

RFs for endometrial ca

nulliparity obesity DM xs oestrogen

most common type of endometrial ca

endometrioid

2 associations of endometrioid ca

oestrogen dependent associated with atypical endometrial hyperplasia

who gets serous / clear cell endometrial ca

older, post menopausal women

which is higher grade / satge: serous/clear or endometrioid

serous / clear

what mutation is present in 90% of endometrioid ca

p53

what are the 4 FIGO stages of endometrium carcinoma

1 = tumour in corpus uteri 2 = tumour invades cervical stroma 3 = local and or regional spread 4 = tumour invades bladder / bowel / mets

what gene conveys a better prognosis for high grade endometrioid ca

POLE

what tx are POLE + endometrioid tumours sensitive to

anti PD 1

name a type of mesenchymal uterine tumour

leiomyoma

what is the lay term for leiomyoma

fibroid

what % of women over 35 have fibroids

20%

what is the malignant form of fibroids

leiomyosarcoma

who gets leiomyosarcoma and what is the prognosis

rare but postmenopausal women 20-30% 5 year survival

what marker diagnoses endometrial stromal sarcoma

cd10

what is endometriosis

presence of endometrial glands and stroma outside the uterus

what % of premenopausal women have endometriosis

10%

origin of endometriosis

metaplasia of pelvic peritoneum implantaion of endometrium, retrograde menstruation

what is the problem with endometriosis, why can;t it be left alone

it is functional tissue so will bleed at menstruation causing pain, scaring and infertility can also progress to hyperplasia

types of non neoplastic ovarian cysts

follicular / luteal PCOS endometriotic cyst

types of primary ovarian tumours

epithelial sex cord stromal germ cell misc

what % of all tumours and malignant tumours are epithelial

65% of all 95% malignant

what is age peak of epithelial ovarian tumours

45-65

age peaks of germ cell tumours

15-21 and 65-69

age peaks of sex cord stromal tumours

25-30 but mainly post menopausal

which epithelial ovarian tumours are benign

serous cystadenomas cystadenofibromas mucinous cystadenomas brenner tumours

RFs of malignant epithelial tumours of ovary

nulliparity infertility early menarche late menopause genetic predisposition inc FH of breast / ovarian ca

how common is malignant epithelial tumours of ovary

6th most common cancer in women 2nd commonest cancer causing death in women

why does malignant epithelial tumours of ovary have such high mortality

difficult to diagnose at early stage develops resistance to chemo

what % of epithelial ovarian ca are hereditary

10%

name 3 familial syndromes of hereditary ovarian ca

familial breast ovarian cancer syndrome site specific ovarian cancer cancer family syndrome (lynch type 2)

what gene is associated with familial breast ovarian cancer syndrome and site specific ovarian cancer ?

BRCA1 and BRCA2

what is the commonest type of ovarian malignancy

high grade serous carcinoma (80%)

what gene mutation is present in high grade serous carcinoma of ovary

P53 some BRCA1/2

what gene mutation is present in low grade serous carcinoma of ovary

KRAS, BRAF NOT BRCA

what gene mutation is present in mucinous tumour of ovary

KRAS

is mucinous tumour of ovary common

NO - very rare

where can secondary ovarian tumours come from

colorectal - 4-10% go to ovary gastric / breast

what is krunkenberg tumour

bilateral mets composed of mucin producing signet ring cells - often from gastric / breast

what is clear cell carcinoma of ovary associated with

endometriosis

types of sex cord stromal tumour

pure stromal - fibroma, thecoma, microcytic stromal pure sex cord - adult type and juvenile granulosa cell mixed - sertoli leydig cell

gene change in adult type granulosa cell tumour

FOXL2 97%

gene change in microcytic stromal tumour

CTNNB1 stains for beta caretine

60% of sertoli leydig cell tumours are part of which hereditary syndrome

DICER1 syndrome

what hereditary syndrome can other sex cord stromal tumours be part of

Peutz Jeghers syndrome

are germ cell tumours bengin or malignant

95% benign

what % of ovarian tumours are germ cell

20%

who gets germ cell tumours

under 20s

what is the most common germ cell tumour

mature teratoma (dermoid)

features of mature teratoma

benign solid / cystic mature adult type tissues - can be teeth / bone / stomach

what is the malignant form of mature teratoma

immature teratoma

what part of female genital tract is commonest site to recieve mets

ovaries

Hi - Gynae Flashcards

(99 cards)