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Anatomy > Cervical cancer > Flashcards

Cervical cancer Flashcards

1
Q

List some DDx for intermenstrual and post-coital PV bleeding?

A

Vaginal
- vaginal atrophy, trauma/tear
- neoplasia: vaginal ca
- infective: STI, PID
- Bartholin cyst
Cervical
- neoplasia, cervical intraepithelial neoplasia, leiomyoma
- Nabothian cyst
- Infective: cervicitis
- cervical trauma
- cervical ectropion (protruding columnar portion of SCJ)
Uterine
- inflammatory: endometriosis
- neoplasia: uerine polyps, fibroids, cancer
- pregnancy: miscarriage/cervical incompetence, ectopic at cervix
- mechanical: uterine prolapse
Haematological- bleeding diathesis (e.g. platelet disorder, haemophilia, vWF)
Bleeding from non-gynae site

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2
Q

What does a colposcopy examine?

A
  • examine vascularity
  • 1% acetic acid wash (acetowhite indicates incerased cellular proteins -> neoplastic cells) -> white areas for punch biopsy
  • iodine stain -> cells dye blue normally (due to glycogen in cells)
  • > abnormal cells stay yellow (less glycogen due to high N:C ratio)
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3
Q

What is a papnicolaou smear test?

A

Aim: identify abnormal cell samples of cervical transformation zone (SCJ) where dysplasia and cancers arise
Method: cervical sample obtained by brush, placed in liquid based medium for HPV partial genotype screen

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4
Q

What does a positive pap smear result mean?

A

Tested for HPV w partial genotyping- positive indicates possibility of HPV infection

  • Positive HPV 16, 18, 45 -> liquid based cytology (LBC) and colposcopy referral
  • Positive other HPV types -> reflex LBC -> colposcopy
  • Negative HPV -> repeat screening in 5 years
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5
Q

List some risk factors for cervical cancer?

A

Non-modifiable
o Gender
o Age (>40yo)
o FMHx

Modifiable
o	Smoking 
o	OCP (>10years increased risk x4) 
o	Immunosuppression 
o	HPV (types 16 and 18 are high risk, 70%)
o	Early onset sexual activity (<21yo)
o	Multiple sexual partners
o	High-risk sexual partners
o	Prior STI history 
o	Multiple pregnancies
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6
Q

Describe the cervix?

A

Cervix: the tapered end of the uterus that projects into the superior vagina
• Supravaginal segment (endocervix)- communicates w uterus via internal os
• Vaginal segment (ectocervix)- extends into vagina through external os

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7
Q

Describe the relations of the cervix?

A

• Anteriorly: bladder
- (Cervix below vesicouterine pouch -> cervical ca invades bladder directly)
• Posteriorly: posterior vaginal fornix, rectouterine pouch, rectum
• Laterally: vaginal fornices
• Inferiorly: vagina

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8
Q

Name the pelvic ligaments?

A
  1. Broad ligament
  2. Lateral cervical ligs (cardinal lig)
  3. Round lig of uterus
  4. Pubercervical lig
  5. Uterosacral sig
  6. Suspensory lig
  7. Ovarian lig
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9
Q

Describe the structure and function of the broad lig?

A

Broad ligament:
• Structure- double layer of peritoneum connecting uterus to pelvic wall and floor. Comprised of mesovarium, mesosalpins and mesometrium.
• Function- mesentery for ovaries fallopian tubes and uterus

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10
Q

Describe the structure and function of the lateral cervical ligaments?

A

Lateral cervical ligaments (cardinal lig):
• Structure - thickened CT at the base of broad lig, runs inferiorly to ureters and uterus
• Function- prevents lateral movement of cervix

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11
Q

Describe the structure and function of the round lig of the uterus?

A

Round ligament of the uterus:
• Structure - cord-like segment running from intramural part of fallopian tube to inguinal canal, attaching to labium majora
• Function- holds uterus forward in anteversion and anteflexion

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12
Q

Describe the structure and function of the pubocervical lig?

A

Pubocervical ligament
• Structure - runs from cervix to anterior pelvix wall, inserting into pubic symphysis
• Function- anchors cervix to anterior pelvic wall

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13
Q

Describe the structure and function of the uterosacral lig?

A

Uterosacral ligament:
• Structure- thickest cervical lig, extending from cervix posteriorly around rectum to attach to fascia over piriformis at sacrum
• Function- resists forward pull of round ligaments and anchors uterus posteriorly, keeping cervix anteflexed

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14
Q

Describe the structure and function of the suspensory lig?

A

Suspensory lig:
• Structure- peritoneal fold extending from ovary to pelvic wall
• Function- contains neovascular supply

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15
Q

Describe the structure and function of the ovarian lig?

A

Ovarian lig:
• Structure- fibrous lig running in the broad ligament of the uterus, connecting the ovary with the lateral aspect of the uterus
• Function- attaches ovary to uterus

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16
Q

Describe the arterial supply of the uterus and cervix?

A

Arterial supply: uterine artery

  • Course: Internal iliac artery -> uterine artery -> travels in lateral cervical ligament (passes over ureter)
  • Supplies: supravaginal part of cervix and vagina
17
Q

Describe the venous drainage of the uterus and cervix?

A

Venous drainage: uterine veins
- Course: uterine veins -> enter broad lig -> form uterine venous plexus (on each side of cervix) -> internal iliac veins

18
Q

Describe the lymphatic drainage of the uterus and cervix?

A

Lymphatic drainage:

  • Fundus -> lumbar LNs -> external iliac LNs or superficial inguinal LNs
  • Uterine body -> external iliac LNs -> para-aortic LNs
  • Uterine cervix -> internal iliac LNs and sacral LNs (via uterosacral lig)
19
Q

Describe the innervation of the uterus and cervix?

A

Innervation: uterovaginal plexus

  • Course: inferior hypogastric plexus -> uterovaginal plexus
  • Function: sympathetic, parasympathetic and visceral afferent fibers
20
Q

How does cervical ca spread:

A 
Direct invasion (rarely metastasises) 
-> uterine body, vagina, parametria, peritoneal cavity, bladder, rectum
21
Q

Describe the pelvic floor?

A

Structure: levator ani msucles (include the ischiococcygeus, iliococcygeus and pubococcygeus)

  • Covered above and below by the superior and inferior fascia of the pelvic diaphragm. Below the inferior fascia is the ischiorectal fossa.
  • lateral wall muscles: piriformis and obturator internus

Functions:

  • supports pelvic viscera
  • increased abdo pressure for parturition, micturition and defecation
22
Q

Describe the lateral wall muscles of the pelvic floor?

A
  1. Piriformis
    - Structure: originates from anterior part of sacrum, gluteal region of spine and superior margin of greater sciatic notch -> exits pelvis through greater sciatic foramen and inserts on greater trochanter of femur
    - Innervation: piriformis nerve (from sacral plexus, L5, S1 and S2)
    - Function: external rotation of hip
  2. Obturator internus:
    - Structure: originates from ischiopubic ramus and obturator membrane -> inserts on medial aspect of greater trochanter
    - Innervation: internus nerve (from sacral plexus, L5, S1, S2)
    - Function: abduction and lateral rotation of extendd hip

Anatomy (21 decks)

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