Cervical Disorders

Question 1

What are cervical polyps?

Answer 1

Benign growths on the cervix

Question 2

What are the clinical features of cervical polyps?

Answer 2

Abnormal vaginal bleeding:

• Inter-menstrual bleeding
• Post-coital bleeding
• Post-menopausal bleeding

Question 3

Describe the epidemiology of cervical polyps

Answer 3

Older women (peak incidence between 50-60)

Question 4

Describe the management of cervical polyps

Answer 4

Cervical polyps have a very small change of undergoing malignant transformation, therefore management involves removal by excision/diathermy

Question 5

Describe the pathophysiology of cervical ectropion

Answer 5

Cervical ectropion occurs when the columnar epithelium of the endocervix extends out to the ectocervix

Question 6

Give some risk factors for developing cervical ectropion

Answer 6

Associated with higher level of oestrogen:

• Premenopausal women
• Pregnancy
• Oestrogen-containing medications, e.g. combined OCP

Question 7

What are the clinical features of cervical ectropion?

Answer 7

Abnormal vaginal bleeding (IMB, PCB)

Question 8

What would you see on speculum examination in the case of cervical ectropion?

Answer 8

Reddish ring surrounding the external cervical os

Question 9

Describe the investigation of cervical ectropion…

How is it diagnosed?

What other conditions do you need to rule out?

Answer 9

Diagnosis of cervical ectropion is clinical, therefore investigation is to rule out other differentials:

• Triple swabs to rule out infection
• Cervical smear to rule out CIN/cervical cancer

Question 10

Describe the management of cervical ectropion

Answer 10

• If asymptomatic no treatment is required
• If symptomatic, first line treatment is to stop taking an oestrogen-containing medications
• If symptoms persist, ablation can be considered

Question 11

What would you see on speculum examination in the case of cervical polyps?

Answer 11

Growths projecting through the external cervical os

Question 12

What is cervical intraepithelial neoplasia (CIN)?

Answer 12

CIN is a precancerous condition resulting from dysplasia of the cervical epithelium

Question 13

Give some risk factors for developing CIN

Answer 13

• HPV 16 and 18 (most significant risk factor)

- Immunodeficiency

Question 14

Describe the clinical features of CIN and cervical cancer

Answer 14

• Can be asymptomatic

- Can cause abnormal vaginal bleeding (e.g. IMB, PCB), dyspareunia and pelvic pain

Question 15

Describe the NHS screening programme for cervical cancer

Answer 15

• NHS screening programme invites all women aged 25-64 for cervical screening
• Between ages 25-49, screening is offered every 3 years
• Between ages 50-64, screening is offered every 5 years

Question 16

Are there any measures in place to try to prevent CIN? (and therefore cervical cancer)

Answer 16

• HPV vaccine

- Covers high risk serotypes 16 and 18 (cervical cancer) as well as low risk serotypes 6 and 11 (genital warts)

Question 17

Describe the management of CIN

Answer 17

Refer to colposcopy clinic

Question 18

A woman is HIV positive. How often should she attend cervical screening?

Answer 18

Annually

Question 19

Which treatment is performed for cervical cancer if…

1) A woman wishes to preserve her fertility
2) A woman has completed her family

Answer 19

1) Cone biopsy

2) Hysterectomy with lymph node clearance