Cervical and vulval pathology

Question 1

What is neoplasia?

Answer 1

the presence or formation of new, abnormal growth of tissue.

Question 2

What is dysplasia?

Answer 2

the presence of cells of an abnormal type within a tissue, which may signify a stage preceding the development of cancer.

Question 3

Difference between neoplasia and dysplasia?

Answer 3

Dysplasia does not mean that it is definately cancerous. Whereas neoplasia is the development of cancerous tissue

Question 4

What are vulval and cervical neoplasia driven by?

Answer 4

Human papilloma virus

Question 5

What is Human Papilloma Virus (HPV)

Answer 5

Human papilloma virus (HPV) is the name for a group of viruses that affect your skin and the moist membranes lining your body.
Examples of this include your:
-cervix
-anus
-mouth and throat

They can cause cervical cancer

Question 6

How is HPV spread?

Answer 6

Sexual contact and skin to skin contact

Question 7

How are genital HPVs grouped?

Answer 7

• High oncogenic risk

- Low oncogenic risk

Question 8

What do low risk HPV cause?

Answer 8

They cannot cause cervical cancer. They can cause genital warts or minor cell changes on the cervix.

Question 9

What can high risk HPV cause?

Answer 9

cancer of the cervix, vagina, vulva, anus, penis and throat.

Question 10

Which type of HPV is the most common in low risk?

Answer 10

6 and 11

Question 11

What is the mode of action of oncogenic virus?

Answer 11

They integrate into host chromosomes and upregulate E6,E7 expression

Question 12

What is the most common vulval cancer?

Answer 12

Squamous cell carcinoma

Question 13

Where can vulval squamous cell carcinoma spread to?

Answer 13

Lymph nodes

Question 14

What are the clinical features of paget’s disease?

Answer 14

The presence of a pink or red lesion on the vulva
Rash and itchiness
The presence of scaly skin on the lesions
Formation of ulcers in the infected area
Bleeding in the affected area
Burning sensation
Increased sensitivity
Pain and discomfort

Question 15

What is the pathogenesis of paget’s disease?

Answer 15

In-situ adenocarcinoma of squamous mucosa

Question 16

What is the transformation zone of the cervix?

Answer 16

Columnar cells are constantly changing into squamous cells in an area of the cervix called the transformation (transitional) zone. The transformation zone is an area of changing cells, and it is the most common place on the cervix for abnormal cells to develop. These abnormal cells can be detected on a Pap smear.

Physiological area of squamous metaplasia. The TZ is what we sample in taking a cervical cytology sample.

Question 17

What is cervical intraepithelial neoplasia?

Answer 17

Cervical intra-epithelial neoplasia (CIN) is a term that describes changes in the squamous cells of the cervix.
CIN is not cancer, but you may need treatment to stop cervical cancer developing. You may hear doctors call CIN a pre-cancerous condition.

Question 18

What is the cervical screening programme?

Answer 18

Cervical screening is a method of preventing cancer by detecting and treating abnormalities of the cervix.

Uses liquid based cytology

starts off every 3 years, then every 5 years.

Question 19

What is colonoscopy?

Answer 19

Examination of the cervix with a low powered stereoscopic microscope.

Question 20

What is the biggest cause of cervical squamous cell carcinoma?

Answer 20

High risk HPV

Question 21

What staging system is used in cervical carcinoma?

Answer 21

FIGO staging

Question 22

What is vulval intraepithelial neoplasia (VIN)?

Answer 22

Vulval intraepithelial neoplasia (VIN) is a condition where there are pre-cancerous cells in the skin of the vulva.
In VIN, the pre-cancer cells are located within the epidermis or the very top layer and are only a millimetre or so thick. The abnormal cells do not penetrate deep down into the dermis so as a consequence, it is easy to see on the surface of the skin with the naked eye the affected areas. We use the word pre-cancer, NOT because the cells are cancerous or you have cancer, but because the cells MAY (or MAY NOT) develop into cancer over a period of years.