Pathology of the Female Reproductive Tract Flashcards Preview

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Flashcards in Pathology of the Female Reproductive Tract Deck (28)
1

Cervical Pathology

Cervical Screening – Smear Test
Cervical Intra-epithelial Neoplasia (CIN)
Cervical Carcinoma
Endocervical Polyps

2

Cervical screening Smear test

View cervix and take sample of cells
Every 3 years from age 25 to 49 years.
Every 5 years from age 49 to 64.
After age 64, screening only if no previous smears or abnormal smears.
Aims to detect early disease stages before becomes invasive.

3

Human Papilloma Virus

Transmitted by sexual contact
Risk increases with increased numbers of sexual partners
No symptoms
Thought to be main cause of CIN and therefore cervical cancer

4

Cytology Screening of smear tests

Normal- routine 3/5 year re-smear

Abnormal- referred to colposcopy / May have biopsies taken

5

Cervical Intra-epithelial Neoplasia CIN

CIN is a microscopic lesion in that affects the cervix that could potentially develop into cervical cancer if left untreated

6

Cervical Cancer

2nd most common female malignancy
Risk factors
HPV, smoking, non attendance to CSP
Symptoms
Abnormal discharge and bleeding
On examination the cervix appears abnormal

7

Treatment of Cervical Cancer

Treatment
Depends on stage either local excision or radical hysterectomy +/- chemoradiotherapy

8

Endocervical Polyps

Usually present with irregular vaginal bleeding ‘spotting’
Benign lesions
Can remove at hysteroscopy

9

Uterine Pathology

Menorrhagia
Fibroids
Endometritis and Pelvic Inflammatory Disease
Endometriosis
Endometrial Polyps
Endometrial Cancer

10

Menorrhagia

“Heavy periods” >80ml blood loss
Very common
1 in 20 women consult their GP a year
Costing the NHS £7 million in prescriptions
Causes
DUB in 50%
Fibroids, endometriosis, polyps

11

Menorrhagia treatment

Mirena coil
Mefanamic and tranexamic acid
combined oral contraceptive pill COCP
Depo provera
Endometrial ablation
Hysterectomy

12

Fibroids (Leiomyomas)

Very common benign tumours
Arise from myometrium (uterine muscular wall)
Can present with heavy or painful periods, pelvic pain or distension
Treatment depends on symptoms and wishes for pregnancy

13

Endometritis and Pelvic Inflammatory Disease

Caused by Infections, usually sexually transmitted.
Can present with abnormal discharge, pain or bleeding.
Can be asymptomatic
Major cause of infertility

14

Endometriosis

Endometrial tissue in the wrong location i.e outside the endometrium
Very common benign condition
Can present with heavy or painful periods, pelvic pain, painful sex
Treatment depends on symptoms and often difficult

15

Endometriosis treatment

Treatment
COCP
Mirena
Zoladex
Surgery

16

Endometrial Polyps

Benign growths from endometrial cavity

Can be removed at hysteroscopy

17

Endometrial Cancer

Cancer of the lining of the uterus
Often presents as post menopausal bleeding and so is detected early
Risk factors are nulliparity, high BMI, HRT and late menopause
Diagnosed on biopsy
Either pipelle or hysteroscopy
Usually undergo TAH (total abdominal hysterectomy) and BSO Bilateral salpingo-oophorectomy excision of both ovaries
Overall 20 year survival rate is 80%

18

Follicular cysts

Benign, very common
Usually less than 6cm
Often asymptomatic, no treatment needed

19

Cystadenomas

Can be very large fluid filled cysts
Symptoms caused by pressure effect

20

Benign Mature Teratomas

Large cysts filled with solid substance

21

Polycystic Ovarian Syndrome

Common condition
Multiple cysts on ovaries
Usually presents as irregular periods, no periods, infertility, other symptoms
Major cause of infertility

22

Polycystic Ovarian Syndrome treatments and complications

Treatments
COCP
Metformin
Clomifene

Complications
Increased CV risk
Increased risk of T2DM
Increased problems in pregnancy

23

Ovarian Cysts

Can be benign or malignant
Can be HUGE!!!
Can occur in young women- usually benign (20-45)
Can occur in older women- usually malignant (>45)
Usually need ovary to be removed with the cyst if large

24

Ovarian Cancer

Often asymptomatic especially if small
Usually present late when already spread
Poorer prognosis than endometrial cancer

25

Miscarriage

Loss of pregnancy before 24 weeks
Occurs in approx 15% of pregnancies
Usually first trimester
Classification
Threatened, Inevitable, Incomplete and Missed
Often no cause found
Risk factors
Increasing age, multiple pregnancies, smoking, alcohol, connective tissue disorders in mother and diabetes
Presentation is usually with pv bleeding

26

Miscarrisge treatment options

Conservative
Medical with misoprostol
Surgical usually by vacuum suction under GA

27

Ectopic pregnancy

An extra uterine pregnancy usually occurring in the Fallopian tubes
Occurs in 1% of pregnancies
Can occur very early before a period has been missed
Can be a gynaecological emergency as rupture of the pregnancy carries a high mortality
Risk factors for ectopics
Fertility treatments, PID, previous ectopics, smokers
Presentation pain and unilateral lower abdominal pain

28

Ectopic pregnancy treatment and diagnosis

Raised beta-HCG levels on blood testing
Treatment almost always surgical