Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Ok. Hi, everyone. Thank you for coming on a Friday evening. Um So today we have she with us again to give us a lecture on gynecological cancers. So I'll pass it over to her again. If you have any questions, just pop them into the chat and yeah, hope you enjoy. Hi guys. Thank you Ida. Um So yeah, today I'm giving Electron on Gynecological Cancers. If you guys remember me from last week, I did the gyne infections one too. Let me quickly share my screen. OK. So I hope everyone can see that. So, yeah, I'm doing the Gyne Cancers lecture today. Um This lecture should is a bit content heavy, but I've tried to keep it high yield only. I haven't really put a lot of pathology on it at all. It's just completely clinical, just keeping in mind that this is for the clinical exam rather than the other one. Um So I've not really put a lot of like hist or anything like that on it. It's just clinical presentation and how you manage it essentially. So I hope it's useful for your uh specialties exam because that's the kind of questions you're gonna find for the Gyne cancers um stuff and it's quite high yield as a lecturer in, in general. So, um yeah, I hope you find it useful just a bit about myself for those of you who are joining the first time and were not able to join last week. I'm sure that I'm finally a medical student. Uh Here's a picture of mine in front of inferior. Um And yeah, I'm going to elective to Australia and India as well. So if you guys have any questions about arranging that as well, let me know you can reach out to me at my email and this is just a session structure slide just to kind of sign post the headings that I'm going to be using in the lecture. Um So just to be aware of that. Ok, so let's get started. We'll start with cervical screening. I actually don't know why this one bullet point is on there, but yes, we'll just get started with cervical screening because that's sort of a really important topic um to know about and obviously cervical screening that ties into cervical cancer. So it's a good topic to get started on in a sense, in essence, it's just a screening that's done every three years uh for people with the Cervix at the age of 25 to 49. Um And every five years for people who have Cervix from the age of 50 to 64 it's done annually if you have HIV or other immunosuppression. Um, because of which you are at a higher risk of developing cervical cancer. It's done to pick up cervical inter inter uh epithelial neoplasia, which is C in, um, which is caused by high risk HP infections which is strain 16 and 18. All of these things are really important to know because they will have one or two MC QS on, on just these four lines. So, um definitely keep all of this in the back of your head. Um So yeah, just a flu shot for what it looks like. Um In general, if everybody doesn't know what, what it is essentially, you insert a speculum and then you use a brush rotated clockwise on the cervix to pick up a cytology sample. You put it in the collecting sample tube, um just kind of dump it 10 times really fast, really quickly so that you can collect all the cells and you send it off. The cells are first tested for high risk HPV infection. So 16 and 18, only if the infection is positive, you then look at the cytology of the cells. And if there's any dyskaryosis, which means if any nuclear changes have happened in the cells itself, if the high risk HPV is negative, you do don't go ahead with the screening program. After that, you just kind of discharge them back and then you call them in the next um three years or five years. Depending upon their age group. So the next few flow charts that I have on are only there for the people who are positive for high risk HPV. Because that's when you then continue the screening process. So if somebody's positive for high risk HPV, and then the second step, which is a cytology to look for any nuclear changes in the cells of the epithelium. If that's negative, that means that there's no nuclear changes at all, then you call them back in one year because they're still positive for the infection. There could be a possibility that it, within one year, the cells start showing changes basically, if there are three consecutive uh positive results for the infection, but the cytology comes back negative, you then uh refer them to Colposcopy, which is the outpatient gynecological uh clinic where they can take biopsy. If the gynecologist thinks that that's the best way to proceed for this person. OK. So that's the first pathway. The second one is if the infection is positive and there are also nuclear changes in the cytology sample, then you again uh refer them to Colposcopy. And the third one is if they are positive for high risk HPV. But the sample is inadequate, which means you couldn't find cells or it's contaminated or whatever, then you ca call them back to repeat screening in three months. If you have another inadequate sample, then you again, refer them to Colposcopy because at that point you just kind of think that um this sort of technique to pick up any sort of ch nuclear changes, it's not enough for this person and they might just require a biopsy in general. So usually at Colposcopy, they will be taking a punch biopsy, uh which is what is used to perform the histology of the, of the colposcopy sample. Um This can be a bit confusing for some people essentially. What we're trying to say is that when you're screening somebody, you're only really looking for the cells, the individual cells, which is cytology to check if there's any nuclear changes happening. If there are any nuclear changes happening, then you um put them up for colposcopy where you're taking a histology sample, which is the entire tissue of the cervix. And then you look at the tissue to see what changes have happened and if there are any changes at all in general, OK. I hope that makes sense. So in the histology, what you can see is that if there's one, less than one third of the epithelial layer involved, that's called C in one. So I intraepithelial neoplasia, one or stage one, which is what I referred to on this diagram as well. So assuming that this entire um I hope you guys can see my mouse if not, let me know. Uh assuming that this entire layer is your epithelial layer of the cervix, only one third of that layer is going to be uh having the abnormal cells essentially. So that's c in one, if less than 23 of two thirds of the epithelial layers involved. And that's C in two. As you can see here, if greater than two thirds to complete a full thickness, epithelial uh layer of the cervix is involved, that's called C in three. Once the nuclear changes start happening beyond this, which means once they breach the basement membrane and go beyond the epithelial layer, that's when you call it um cervical cancer. I hope that makes sense to everyone because it is a very important slide. It kind of summarizes everything you need to know about. So I could screening. So if you haven't really understood it, please let me know in um the questions and I can always come back to them uh later as well. OK, I hope this is clear. Um So now talking about C in, in general and how you treat it. It's precancerous changes. As I said, if they've not involved the basement membrane yet, it's C in um it's caused because of HPV 16 or 18, as you've just said, and the Carios, which means nuclear changes in the transformation zone of the cervix. The transformation zone is a zone where um the cells go from squamous cells to column epithelial cells essentially. So that's the transformation zone and usually that's the place where most amount of cell don over is happening. So that's the point where most amount of nuclear changes can happen as well. Uh The risk factors of ci are smoking multiple partners, non viral, contraception and immunosuppression. Just so just something to keep in back of your mind for the question stands. Um, usually c in is asymptomatic and that's why we have to screen for it. Um, investigations is essentially just the screening and colposcopy at colposcopy. There's two different things that you can do to check first, whether there is any um changes that have taken place at all or not because sometimes people get referred because of an inadequate sample and actually no changes have taken place. So just to screen for that at colposcopy, you can use two agents, one is acetic acid and one is glucose iodine. Um when you sort of put acetic acid on a person's cervix and there are abnormal areas, those abnormal areas will appear white as compared to the rest of the cervix that will remain pink. Um So you know that there are some abnormal cells there, the same with loose iodine. If you put low iodine on a person's cervix and some areas start to appear yellow as compared to the rest of the cervix that will come uh that will look brown because of the iodine. Then you know that there are some abnormal cells and then you can basically aim your punch biopsy to that abnormal area to check for um whether the how much involvement there is and just to send for biopsy in general if that makes sense to everyone. Um The way you manage it is that only C in two and three are treated. C in one usually just goes back to normal. Uh It's kind of self healing, self treated. It can also progress to two and three, but it's so benign that you usually don't treat it. So, only C in two and three are treated the few ways. The most common way is the lets procedure, which is essentially a large loop diathermy. And you just use that to excise the abnormal areas of the cervix. Essentially, it can cause problems in future pregnancies because it makes the cervix weaker. If you can imagine that you, if you're taking a big chunk out of the cervix, um it becomes difficult for the cervix to kind of hold the pregnancy. Um So it can cause uh freedom labor or it can cause pre dilatation of the cervix as well in the future. So that's something to keep at the back of your mind. Um In terms of like a very important high yield point in case it comes in your obstetrics questions. And one of the risk factors of freedom labor is a previous let's procedure. For example, the other thing that you can do is a nets procedure or a nets biopsy, which is the same thing. But instead of a loop, you're using a needle to excise a transformation zone. Um cryotherapy and laser coagulation also used. But they are very rare options. Like in, I think in most cases it's just a letts procedure, a simple, straightforward procedure takes less than two minutes and it can be done under local anesthetic at um.