Cervical Disease Flashcards
What is a cervical ectropion/erosion?
physiological squamous metaplasia
exposure of endocervical epithelium to acidic environment of vagina
What can cause a cervical ectropion?
OCP
How do cervical ectropions present?
bleeding
e.g. post coital
How are cervical ectropion treated?
usually no treatment required
cryocautery
What can cause cervicitis?
chlamydia
gonorrhoea
herpes
Why is cervical screening carried out?
to detect CIN
What is CIN?
cervical intraepithelial neoplasia
pre invasive phase of cervical cancer
dysplasia of squamous cells
Where does CIN occur?
in transformation zone (squamocolumnar junction) - between ecto and endo cervix
What is CIN associated with?
HPV 16 and 18
What is the time line from HPV infection to invasive cancer?
HPV infection to high grade CIN - 6 months to 3 years
high grade CIN to invasive cancer - 5 to 20 years
When is cervical screening carried out?
25-50 every 3 years
50-65 every 5 years
(new change - every 3 years until 60)
How is CIN investigated?
smear test
microscopy - degree of dyskaryosis mirrors severity of CIN
What is the treatment of CIN 1 ?
CIN 1 - not treated (high rate of spontaneous resolution in 12 months)
HPV test - if positive come back in 6 months
How does cervical carcinoma develop?
from preexisting CIN - so most cases are preventable by screening
What are the majority of cervical carcinomas?
squamous
15-30% adenocarcinomas
How does cervical carcinoma spread?
local - rectum, ureters, bladder, uterine body, vagina
lymphatic - paraaortic, pelvic
What are risk factors for developing cervical carcinoma?
high risk HPB - 16 and 18 immunocompromised family history multiple sexual partners, partner with multiple sexual partners early sexual intercourse
How does cervical carcinoma present?
microinvasive/early stages: asymptomatic, screening detected
later: pelvic pain, ureteric obstruction, UTIs, haematuria, abnormal bleeding (most common)
What is stage 1 cervical carcinoma?
tumour confined to cervix
What is stage 2 cervical carcinoma?
has extended locally to adjacent organs
What is stage 3 cervical carcinoma?
involving pelvic wall
What is stage 4 cervical carcinoma?
spread to bladder, rectum
distant mets
How is cervical carcinoma investigated?
cervical smear
colposcopy and biopsy
HPV test
CT/MRI to stage (treatment depend on stage)
What is the treatment of cervical carcinoma?
excise
hysterectomy
chemo, radiation
Who gets the HPV vaccination?
11-13 year olds
HIV and MSM <45 if requested
What kind of cells are in the ectocervix?
squamous
What kind of cells are in the endocervix?
glandular/columnar
What is the treatment of CIN 2/3?
CIN2/3 - colposcopy within 2 weeks - remove or ablate it, cold coagulation, large loop excision
Why is cold coagulation preferred over large loop excision?
loop excision can cause cervical incompetence
What happens if you get called for your smear while you’re pregnant?
come back for smear 2 months after given birth
