5. The cervix in health and disease

Question 1

What is the cervix?

Answer 1

the neck of the womb

Question 2

Opening to vagina is called…

Answer 2

external os

Question 3

Ectocervix

Answer 3

portio vaginalis and external os

Question 4

Cervix in nulliparous women

Answer 4

Barrel shaped with a small circular external os at centre of cervix

Question 5

Cervix in parous women

Answer 5

cervix is bulky and external os becomes transverse slit-like

Question 6

What tissue type is the vagina and why?

Answer 6

Stratified squamous epithelium

to cope with the harsh acidic environment of the vagina

Question 7

What type of tissue is the ectocervix?

Answer 7

non-keratinised stratified squamous

because produces mucous

Question 8

What happens to the transformation zone with age?

Answer 8

emerges more during young adulthood, then recedes again after the menopause

Question 9

Stroma of cervix made of…

Answer 9

Collagenous connective tissue

Approx 15% smooth muscle fibres

Question 10

Blood supply of cervix

Answer 10

Uterine artery, descending branch

Venous drainage follows the arteries

Question 11

Lymphatic drainage

Answer 11

parametrium, obturator, int. iliacs, ext. iliacs, common iliac

Question 12

Nerve supply

Answer 12

pain fibres with the parasympathetics to S2, S3, S4

(uterine to T11 and T12 in addition)

Question 13

Functions of the cervix

Answer 13

Produces mucus to facilitate sperm migration
Acts as a barrier to ascending infection
Holds a developing pregnancy in place
Effaces and dilates to enable vaginal birth

Question 14

Mucous changes in the cervix

Answer 14

Midcycle mucous is thin and watery then thickens

Women can assess their fertility by seeing thickness of cervical mucous

Question 15

Physiological changes of cervix in pregnancy

Answer 15

Hypertrophies, but not as much as the uterus
Becomes softer
Increased vascularity/venous congestion, “purple tinge”
Glands distended with mucus, “mucus plug”
Prominent ectropion
Remains elongated until the onset of labour

Question 16

Physiological changes on cervix

Answer 16

Cervical Ectopy “Erosion”
effect of oestrogen

Atrophic “Cervicitis”
lack of oestrogen

Question 17

Cervical infections

Answer 17

Chlamydia
Gonorrheoa
Trichomonas vaginalis
HPV

Question 18

Cancer and precancerous changes

Answer 18

Worldwide Cervix cancer is the 2nd most common cancer amongst women

430,000 cases each year

> 200,000 deaths

80% occur in LEDC’s

Question 19

Causes of cervical cancer

Answer 19

HPV

Predisposing factors
Smoking
Multiple sexual partners
Immune compromise
Low socio-economic status

Question 20

HPV infection

Answer 20

HPV is a very common infection which is easily transmitted through close sexual contact

Acquisition can occur via skin to skin contact in the genital area

Up to 95% of sexually active women will be infected with HPV at some point in their lives

Condoms reduce the risk of infection but are not fully protective

The number of oropharyngeal cancers in women is rising of which an increasing proportion are HPV related

Male partners of women with cervix cancer have higher rates of tongue and tonsil cancer

Anal cancer rates are higher in women with CIN and their male partners

Question 21

HPV infection

Answer 21

Infection starts at basememnt membranes where cells are more naïve, then gains entry into the nucleus and cause precancerous changes (dyskariosis). If this change involves the lower 1/3 of basment membrane that’s CIN I, if lower half CIN II, if full thickness then its CIN III

Question 22

Smear test follow-up

Answer 22

Cytology, colposcopy, histology, treatment by ablation or excision

Question 23

The NHSCSP

Answer 23

Women are invited for cervical cytology sampling

  25 - 49yrs       3 yearly
  50 – 65yrs      5 yearly 

Referred for colposcopy if cytological abnormalities

Question 24

Cervical cancer current treatment

Answer 24

1a cone biopsy/excision
1b radical hysterectomy/trachelectomy
2a chemo-radiotherapy

Question 25

Radical trachelectomy

Answer 25

Get rid of cervix and attach to the top of the vagina, add stitch in top of vagina to hold future pregnancies but will have to give birth by C-section