Cervical Disease

Question 1

What is a cervical ectropion/erosion?

Answer 1

physiological squamous metaplasia

exposure of endocervical epithelium to acidic environment of vagina

Question 2

What can cause a cervical ectropion?

Answer 2

OCP

Question 3

How do cervical ectropions present?

Answer 3

bleeding

e.g. post coital

Question 4

How are cervical ectropion treated?

Answer 4

usually no treatment required

cryocautery

Question 5

What can cause cervicitis?

Answer 5

chlamydia
gonorrhoea
herpes

Question 6

Why is cervical screening carried out?

Answer 6

to detect CIN

Question 7

What is CIN?

Answer 7

cervical intraepithelial neoplasia
pre invasive phase of cervical cancer
dysplasia of squamous cells

Question 8

Where does CIN occur?

Answer 8

in transformation zone (squamocolumnar junction) - between ecto and endo cervix

Question 9

What is CIN associated with?

Answer 9

HPV 16 and 18

Question 10

What is the time line from HPV infection to invasive cancer?

Answer 10

HPV infection to high grade CIN - 6 months to 3 years

high grade CIN to invasive cancer - 5 to 20 years

Question 11

When is cervical screening carried out?

Answer 11

25-50 every 3 years
50-65 every 5 years
(new change - every 3 years until 60)

Question 12

How is CIN investigated?

Answer 12

smear test

microscopy - degree of dyskaryosis mirrors severity of CIN

Question 13

What is the treatment of CIN 1 ?

Answer 13

CIN 1 - not treated (high rate of spontaneous resolution in 12 months)
HPV test - if positive come back in 6 months

Question 14

How does cervical carcinoma develop?

Answer 14

from preexisting CIN - so most cases are preventable by screening

Question 15

What are the majority of cervical carcinomas?

Answer 15

squamous

15-30% adenocarcinomas

Question 16

How does cervical carcinoma spread?

Answer 16

local - rectum, ureters, bladder, uterine body, vagina

lymphatic - paraaortic, pelvic

Question 17

What are risk factors for developing cervical carcinoma?

Answer 17

high risk HPB - 16 and 18
immunocompromised 
family history 
multiple sexual partners, partner with multiple sexual partners 
early sexual intercourse

Question 18

How does cervical carcinoma present?

Answer 18

microinvasive/early stages: asymptomatic, screening detected
later: pelvic pain, ureteric obstruction, UTIs, haematuria, abnormal bleeding (most common)

Question 19

What is stage 1 cervical carcinoma?

Answer 19

tumour confined to cervix

Question 20

What is stage 2 cervical carcinoma?

Answer 20

has extended locally to adjacent organs

Question 21

What is stage 3 cervical carcinoma?

Answer 21

involving pelvic wall

Question 22

What is stage 4 cervical carcinoma?

Answer 22

spread to bladder, rectum

distant mets

Question 23

How is cervical carcinoma investigated?

Answer 23

cervical smear
colposcopy and biopsy
HPV test
CT/MRI to stage (treatment depend on stage)

Question 24

What is the treatment of cervical carcinoma?

Answer 24

excise
hysterectomy
chemo, radiation

Question 25

Who gets the HPV vaccination?

Answer 25

11-13 year olds

HIV and MSM <45 if requested

Question 26

What kind of cells are in the ectocervix?

Answer 26

squamous

Question 27

What kind of cells are in the endocervix?

Answer 27

glandular/columnar

Question 28

What is the treatment of CIN 2/3?

Answer 28

CIN2/3 - colposcopy within 2 weeks - remove or ablate it, cold coagulation, large loop excision

Question 29

Why is cold coagulation preferred over large loop excision?

Answer 29

loop excision can cause cervical incompetence

Question 30

What happens if you get called for your smear while you’re pregnant?

Answer 30

come back for smear 2 months after given birth