Medicine Notes Gynaecology Notes
Complete set of notes covering gynaecology. Includes pathophysiology, presenting features, investigation and management. Uses colour coding for different topics and tables and diagrams. Ideal for written or clinical finals...
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Endometrial carcinoma
Type 1 disease | Type 2 disease |
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Disease usually starts in the fundus and spreads slowly to muscle, cervix and peritoneum and metastasises to ovaries and lymph nodes
Risk factors
Obesity
Unopposed oestrogen therapy or tamoxifen
Nulliparity, early menarche, late menopause
FHx of breast, ovarian or colon ca
PCOS
Presentation
Usually presents after menopause
Pre-menopausal
Irregular abnormal bleeding
Post-menopausal
Bleeding (10% with PMB have malignancy) – initially lights but increases
Discharge
Pathology
Endometrial hyperplasia
Pre-malignant stage
Classified into simple, complex + atypical
Atypical = risk for malignancy
Endometrial carcinoma
Can be adenocarcinoma, papillary,
Adenosquamous or clear cell
Staging
1 = in body of uterus only
2 = in body and cervix
3 = advanced beyond uterus but within pelvis
4 = extends outside pelvis e.g bladder, bowel
Management
Stage I+II may be cured by TAHBSO +/- radiotherapy
In advanced disease consider radio +/- high dose progesterone (shrink tumour)
Chemo may be used if unresponsive
Prognosis
Overall survival rate 70%
Worse prognosis if
Poorly differentiated
Invasion of myometrium
Periotneal/nodal/vascular involvement
Cervical cancer + CIN
Commonest cancer in women in developing countries
In developed countries there are screening programmes aiming to identify a pre-malignant/pre-invasive stage – cervical intraepithelial neoplasia (CIN)
CIN
Develops in transformative zone (area at junction between endo + ectocervix)
Endocervix = columnal epithelium
Ectocervix = squamous epithelium
Oestrogen causes eversion of part of the endocervix and the columnar cells undergo metaplasia to become squamous cells leading to increased risk of CIN
During cervical smear, cells are taken from both endo and ectocervix to look for dyskaryosis
Dyskaryosis = cytological dx
CIN = histological dx
Smear results may be normal or show mild (CINI)/mod (CINII)/severe (CINIII) dyskaryosis
1/3 of cases of abnormal smear results will regress, 1/3 will stay the same, 1/3 will progress
In the UK, screening is recommended every 3 years between ages 25-65 years
If moderate/severe dyskaryosis is found, colposcopy is recommended
Uses microscope to look at cervix in more detail
Acetic acid can be applied to cervix
Stains abnormal areas white (due to raised intracellular protein and less glycogen)
Take punch biopsies for histology
If mild dyskaryosis – repeat smear in 4 months
Management of CIN
Loop excision: performed under LA in OPD. Risk of causing cervical incompetence/stenosis
Radical electrodiathermy: OPD procedure, can’t tell depth of tissue destruction
Cryotherapy
CO2 laser vaporization
Cone biopsy: used in CINIII, surgical excision under GA, risk of cervical incompetence + stenosis
Patient needs annual smears for 10 years
Cervical cancer
Aetiology
Arises from areas of CIN (30% of CINIII = invasive disease)
Is a cancer of sexually active women
Strong association with HPV 16+18
HPV thought to impair function of p53 gene (DNA repair)
Risk factors include
Multiple sexual partners
Early age of intercourse
No barrier contraception use
Prolonged COCP use in HPV +ve patients
High parity
HIV, other STDs
Pathology
Most are squamous cell carcinomas
Usually keratinizing
10-25% are adenocarcinomas
Most commonly spread via lymphatics or local spread to vagina, pelvic walls, bladder etc
Oncological presentation
Symptoms
Post-coital bleeding
Inter-menstrual bleeding
Menorrhagia
Offensive vaginal discharge
May be incidental finding on cervical smear
Advanced disease may also present with
Backache
Leg pain
Oedema
Haematuria
Wt loss, anorexia, malaise
Investigations
Clinical examination, colposcopy, biopsy
USS, CT< MRI for staging (FIGO system)
Management
Depends on stage
Simple excision/cone biopsy
Radical hysterectomy + pelvic lymphadenectomy
Radical radiotherapy – external beam to pelvic, brachytherapy to vagina
May cause
Vaginal dryness
Cystitis
Proctitis
Vaginal stenosis
Chemotherapy
If recurrent – palliative
Ovarian Tumours
Any of the Ovary’s tissue can become neoplastic
Benign tumours (94%)
Usually cystic
Functional cysts (25%)
Enlarged/persistent follicular/corpus luteum cysts
So common they are considered normal if <5mm
May cause pain by
Rupture, failure to rupture at ovulation, bleeding
Serous...
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Complete set of notes covering gynaecology. Includes pathophysiology, presenting features, investigation and management. Uses colour coding for different topics and tables and diagrams. Ideal for written or clinical finals...
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