Cervical Cancer Flashcards
What is the transformation zone?
- squamo-columnar junction between the ectocervic (squamous) and endocervix (columnar).
- It is where lesions (neoplasia) usually form
- Smears should be taken at this site
What is cervical erosion
-exposure of endocervical epithelium to acidic environment which causes squamous metaplasia
What are Nabothian follicles?
- benign expanded endocervical glands
- caused by growth of stratified squamous epithelium onto simple columnar epithelium which block the cervical crypt and traps cervical mucus within the crypts
What is cervicitis?
- non-specific acute/chronic inflammation
- can lead to infertility due to silent fallopian tube damage
What infections can cause cervicitis?
- chlamydia trachomatis
- HSV
What is a cervical polyp
It is a benign localised inflammatory outgrowth.
May be able to look for CIN
Which HPV types are typically known to cause cervical cancer?
HPV 16 and 18 causing 70% of all cervical cancers
What factors increase the vulnerability of transformation zone in early reproductive life?
- age at first intercourse
- long term use of oral contraception
- use of non barrier contraception
What are the risk factors for devleoping cervical cancer?
- vulnerable transformation zone
- smoking
- immunosuppression
What can HPV cause?
- genital warts
- cervical intraepithelial neoplasia
- cervical cancer
What are the histological features of genital warts (condyloma acuminatum)?
thickened papillomatous squamous epithelium with cytoplasmic vacuolation (koilocytosis)
What are the histological features of cervical intraepithelial neoplasia (CIN)?
infected epithelium may remain flat but koilocytosis may be detected in cervical smears
What does koilocytosis in cervical epithelium usually indicate and what does it look like?
- cells infected with HPV
- high nuclei to cytoplasm ratio
- darkened nuclei
- perinuclear halo
What is cervical cancer?
when virus is intergrated in the host cell DNA. CIN has broken through basement membrane
How long does it take for HPV infection to progress to high grade CIN?
6months-3years
How long does it take for high grade CIN to progress to cervical cancer?
5-20 years
What is CIN?
- preinvasive stage of cancer
- occurs at the transformation zone
- dysplasia/dyskaryosis of squamous cell
- detectable on smears
- asymptomatic
What are the histological features of CIN?
- nuclear abnomalities (hyperchromasia)
- excess mitotic activity (mitosis usually occurs just above basement membrane, abnormal if mitosis occuring in higher cell layers)
- delay in maturation and differentiation (immature basal cells occupying most of the epithelium)
What are the features of CIN I,II and III?
- I (basal 1/3 of epithelium occupied by abnormal cells)
- II (abnormal cells extend to middle 1/3)
- III (abnormal cells extend to upper 1/3)
What is the most common malignant cervical tumour?
invasive cervical squamous carcinoma
How does invasive cervical squamous carcinoma develop?
from pre-existing cervical intraepithelial neoplasia which can be easily screen and detected
What are the symptoms of invasive cervical squamous ca?
- asymptomatic (if detected early)
- abnormal bleeding (post-coital, post menopausal, contact bleeding, bloody vaginal discharge)
- pelvic pain
- hydronephrosis/ renal failure (blockage of ureters)
- hematuria/UTI (if bladder invaded)
Where would squamous carcinoma spread to?
- local spread(uterine body, vagina,bladder, ureters, rectum)
- lympathic (pelvic, para-aortic nodes)
- haematogenous (liver, lungs, bone)
What is the treatment for affected lymph nodes?
radiotherapy not surgery
