What is Fibrocystic Disease?
Benign changes seen in the breast, including apocrine change, ductal hyperplasia & sclerosing adenois.
Can from a lump (can mimic cancer)
Can cause discomfort related to the menstrual cycle
What is fibroadenoma?
Usually women ages 10-40 years.
Most common breast mass in the adolescent & young adult population.
What are some risk factors of breast cancer?
(all linked to oestrogens)
- Early menarche, late menopause
- Oral contraceptives & hormonal replacement therapy for menopause
- Alcohol
- Mutations in certain genes
Main types of breast cancer?
- Ductal (75%)
- Lobular (12%)
- Tubular/cribriform
(DCIS= Ductal carcinoma in situ: the presence of abnormal cells inside a milk duct in the breast. Considered the earliest form of breast cancer)
What is the Triple Assessment in Breast Cancer?
1) Clinical examination
2) Imaging (usually mammography, ultrasonography)
3) Needle biopsy
What is Dysplasia?
The earliest morphological manifestation of multistage process of neoplasia.
The abnormal cells have not yet acquired the capacity for invasion, so elimination removes the basis on which cancer will develop (this is the whole basis of the cervical screening program)
What is the Human Papilloma Virus (HPV)?
Double stranded DNA viruses. Genital HPVs are grouped into low and high oncogenic risk:
- Low risk: Associated with genital warts & other low-grade cytological abnormalities (6, 11 most common)
- High risk: Associated with high grade pre-invasive and invasive diseases (16, 18) (~70% cervical cancers)
Mode of action of high risk HPVs?
They upregulate E6 and E7 expression.
- E6 inactivates p53 (which mediates apoptosis in response to DNA damage)= accumulation of genetic damage.
- E7 binds to RB1 gene product (RB1 is tumour suppressor gene controls G1/S checkpoint in cell cycle)= Dysregulation of cell proliferation.
(types of Vulval Intraepithelial Neoplasia- VIN)
What are the 2 types of VIN?
- Classical/Warty/Baseloid: Graded VIN 1-3. related to HPV infection, younger people
- Differentiated VIN: Not graded. Not HPV related. Occurs in chronic dermatoses. older people.
What is the most common type of vulval cancer?
Squamous cell carcinoma.
Associated with a)VIN, and b)inflammatory dermatoses.
What are Gynaecological cancers staged by instead of the TNM system?
FIGO (starts in cervix, then invades uterus and beyond and to bladder/rectum or outside the pelvis)
What are the 3 types of Vulval cancers?
Squamous cell carcinoma (90%) - associated with a)VIN or b)Inflammatory dermatoses
Malignant Melanoma (5%) - mean age 50-60
Paget’s Disease (5%) - mean age 80
Features of Paget’s disease of the vulva and comparison with Paget’s disease of the breast?
Mean age 80
Pruritic/ burning/ eczematous patch
In-situ adenocarcinoma of squamous mucosa, can develop invasive
(in comparison of breast: due to underlying ductal carcinoma in-situ, spreading into the epidermis. In the vulva there is no underlying tumour)
(Cervical Pathology)- What is the transformation zone?
Physiological area of squamous metaplasia. Vulnerable to oncogenic effects of HPV (site of development of CIN)
What is treatment of Cervical Intraepithelial Neoplasia (CIN)?
Large Loop Excision of the Transformation Zone
What are some causes of Cervical Intraepithelial Neoplasia (CIN)?
- High risk HPV is most important causative factor
- Multiple sexual partners
- Smoking
- Young age at first intercourse
What is Cervical Adenocarcinoma related to and a precursor of?
Related to high risk HPV (‘high risk’ HPV subtypes are 16 & 18)
Precursor is Cervical Glandular Intraepithelial Neoplasia (CGIN)
What infections can be transmitted from mother to baby in utero? (haematogenous)
Cytomegalovirus (CMV), Parvovirus, Toxoplasmosis, Syphilis, Varicella Zoster virus (VZV), Rubella, Zika virus.
What neonatal infections are acquired during passage through Birth Canal?
Group B Streptococcus Herpes Simplex Virus Gonorrhoea Chlamydia HIV Hep B
What will Asymptomatic Bacteriuria in Pregnancy develop into if left untreated?
It will develop into acute pyelonephritis. (continuing bacteriuria is associated with premature delivery and increased perinatal mortality)
What antimicrobials are considered ‘safe’ in pregnancy?
Penicillins, Cephalosporins
What antimicrobials are considered ‘unsafe’ in pregnancy?
Chloramphenicol, Tetracycline, Fluoroquinolones
What is Puerperal Endometritis?
Infection of the womb during puerperium (the period of about 6 weeks after childbirth when the mother’s reproductive organs return to their normal position)
What are the causative organisms of puerperal endometritis?
E coli, Beta-haemolytic streptococci
