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Gynaecological oncology

5 modulespresentation to pathology

Screening and the four cancers, at the depth a clerk needs.

  1. 01Screening

    Cervical screening, HPV and the abnormal result

    A cancer that screening prevents: HPV testing is replacing cytology, colposcopy finds the lesion, and vaccination is closing the loop.

    How it arrives
    Nobody presents: the programme finds it. A screening sample, an HPV result, a colposcopy appointment.
    Where it sits
    Cervix
    Doors
    Module Pathway: Vaginal dischargeTaking the sample
    What the pathologist seesLow-grade squamous intraepithelial lesion with HPV effect: koilocytes beside normal squamous cells.

  2. 02Cancer

    Cervical cancer foundations

    The cancer of unscreened women. Staged clinically and by imaging, treated by surgery when small and by chemoradiation when not.

    How it arrives
    Postcoital or intermenstrual bleeding, discharge, and a cervix that looks or feels wrong. Biopsied, never screened.
    Where it sits
    CervixVaginaBroad and round ligaments
    Doors
    Module Pathway: Postmenopausal bleeding
    What the pathologist seesCervical cancer on sagittal T2 MRI: the mass at the cervix, and the parametrium and vagina it may reach, which is what FIGO staging now reads from imaging.

  3. 03Cancer

    Endometrial hyperplasia and cancer

    The commonest gynaecological cancer and the one that announces itself: postmenopausal bleeding is investigated every time.

    How it arrives
    Postmenopausal bleeding, every time, until an endometrial thickness or a biopsy says otherwise.
    Where it sits
    EndometriumBody and myometriumFundus and cornua
    Doors
    Module Pathway: Postmenopausal bleeding
    What the pathologist seesEndometrioid adenocarcinoma, FIGO grade III, invading slightly more than half the myometrium.

  4. 04Cancer

    Ovarian masses and ovarian cancer foundations

    Most adnexal masses are benign. The job is to sort them without operating on the ones that do not need it and without delaying the ones that do.

    How it arrives
    Bloating, early satiety, a mass, ascites; late by nature because the ovary has room to grow.
    Where it sits
    OvariesFallopian tubes
    Doors
    Module Pathway: Adnexal mass
    What the pathologist seesA multilocular cystadenoma of the ovary, opened: the septations the ultrasound shows are these walls.

  5. 05Cancer

    Vulvar conditions and vulvar cancer foundations

    Itch, pain and lesions that are looked at, named and, when persistent, biopsied.

    How it arrives
    Itch, a lump, a plaque that has not responded to steroid. The one that is biopsied when it does not settle.
    Where it sits
    Vagina
    Doors
    Module
    What the pathologist seesDifferentiated VIN, the lichen sclerosus-associated precursor of vulvar squamous carcinoma.