Lecture 34 - Cervical and vulval pathology Flashcards

Question

Squamous cell carcinoma associated with inflammatory dermatoses

Answer 1

age more than 70 licen sclerosis Lichen planus

Answer 2

15% risk of malignancy

Answer 3

Associated with VIN associated with inflammatory dermatoses eroded plaque or ulcer

Answer 4

locally to involve vagina and distal urethra to ipsilateral inguinal LNs to contralateral inguinal LNs, deep iliofemoral LNs (25% if inguinal nodes +ve)

Answer 5

Depth of invasion LN Mets < 1 mm Very rare 1 - 3 mm 10% - wide local excision > 4 mm 40 % - Lymph node sampling groin node dissection or sentinel node biopsy

Answer 6

``` stage 1 - 95% stage 2- 90% stage 3 - 70% stage 4a - 20% stage 4b - <10% ``` overall prognosis 70% FIGO staging system

Answer 7

5% of vulval cancers Mean age 50 - 60 Local recurrence in 1/3, spread to urethra frequent Lymph node/ haematogenous spread common Depth of invasion correlates with LN involvement

Answer 8

Extramammary - 5% Vulval cancers, mean age 80 - pruritic/burning/eczematous patch - In-situ adenocarcinoma of squamous mucosa - Tend to recur following excision - Can develop invasive adenocarcinoma

Answer 9

bladder cervix exclude primary rectal ca wherever there is a prominent perianal component

Answer 10

Physiological area of squamous metaplasia | TZ is vulnerable to oncogenic effects of HPV - site of development of CIN

Answer 11

pre-invasive stage of cervical SCC Detection is aim of cervical screening programme graded according to increasing abnormality

Answer 12

Regression 60% Persistence 30 % Progression to CIN III 10% Progression to invasion 1%

Answer 13

Regression 40% Persistence 40 % Progression to CIN III 20% Progression to invasion 5%

Answer 14

Regression 33% Persistence ~56% Progression to invasion 20% - 70%

Answer 15

``` Available test has high sensitivity and specificity Test is not harmful Defined pre-invasive stage Long enough to allow intervention Simple, successful treatment ``` Is not a test for cancer

Answer 16

Age group (years) Frequency of screening 25 First invitation 25 – 49 3 yearly 50 – 64 5 yearly 65+ Only screen those who have not been screened since age 50 or have had recent abnormal tests Uses liquid based cytology and focused high risk HPV testing

Answer 17

Evidence does not support its use High HPV carriage rate, incl high risk types – 70-80% will be eliminated Reactive changes produce confusing cytology Unnecessary LLETZ procedures can have obstetric consequences

Answer 18

Abnormal cytologic changes of squamous epithelial cells characterized by hyperchromatic nuclei and/or irregular nuclear chromatin

Answer 19

HPV testing if +ve - refer for colposcopy + Rx if -ve = normal recall

Answer 20

Refer for a colposcopy + Rx

Answer 21

Large Loop Excision of the Transformation Zone (LLETZ)

Answer 22

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

Answer 23

Presentation/spread same as SCC Related to high risk HPV Precursor is Cervical Glandular Intraepithelial Neoplasia (CGIN) Treated same as CIN/SCC Stage for stage worse prognosis that SCC ?due to radioresistance

Answer 24

Cervical Glandular Intraepithelial Neoplasia

Answer 25

Simplified FIGO staging I Confined to cervix II Invades beyond uterus, not to pelvic side wall III Extends to pelvic wall, lower 1/3 vagina, hydronephrosis IV Invades bladder or rectum or outside pelvis Metastasis Predictably to pelvic and para-aortic lymph nodes Via blood to lungs, bone etc

Lecture 34 - Cervical and vulval pathology Flashcards

(49 cards)