Cervical Disorders Flashcards
What are the clinical features of cervical polyps?
Often asymptomatic
Can cause abnormal vaginal bleeding
On speculum exam:
- polypoid growths projecting through external os
How are cervical polyps managed?
Removed due to small risk of malignant transformation
- polypectomy forceps in GP is small
- diathermy loop excision in colposcopy clinic if larger
- always send for histology
What is a cervical ectropion?
Eversion of the endocervix, exposing the columnar epithelium to the vaginal milieu
What are the risk factors for cervical ectropion?
COCP
Pregnancy
Adolescence
Menstruating age
What are the clinical features of an ectropion?
Asymptomatic Post-coital bleeding Intermenstrual bleeding Excessive discharge Red ring around external os
What is the management for an ectropion?
Doesn’t require treatment unless symptomatic
Stopping COCP is usually effective
Ablation with cryotherapy of electrocautery
Where on the cervix does metaplasia tend to occur?
Transformation zone
–> where the columnar epithelium of endocervix meets squamous epithelium of ectocervix
(where cervical smear is taken from)
What is CIN?
Cervical intraepithelial neoplasia –> preinvasive phase of squamous cervical cancer
What are the risk factors for cervical cancer?
HPV 16 + 18 Smoking Other STIs/multiple partners Long term (>8 years) COCP use Immunodeficiency e.g. HIV
What is CGIN?
Cervical glandular intraepithelial neoplasm –> preinvasive phase of endocervical adenocarcinoma
(harder to diagnose on smear)
What age of women get cervical screening?
Age 25-65
women on routine recall for abnormal results are invited up to age 70
What happens to the sample obtained at smear test?
First tested for high risk HPV
- if positive –> cytology testing
- if negative –> cytology not required
What happens following the smear test?
If sample HPV negative:
–> recalled for screening in 5 years
If sample HPV positive but cytology negative:
–> repeat screening in 1 year
If HPV positive and cytology positive:
–> colposcopy (regardless of grade of dyskaryosis)
What happens at colposcopy?
Squamocolumnar junction visualised
Acetic acid applied –> abnormal epithelium shows up white
Biopsies then taken
What is the difference between dyskaryosis and CIN?
Dyskaryosis is a cytological diagnosis from cells collected on smear
CIN is a histological diagnosis from biopsy taken at colposcopy
Which finding, indicating HPV infection, is often seen on histology in CIN?
Koilocytosis
How is CIN classified?
CIN I = abnormal mitoses occupying 1/3 of basal epithelium
CIN II = abnormal cell extend to middle third
CIN III = abnormal cells span full thickness of epithelium
What is the management of CIN I?
Usually regresses spontaneously - follow up with repeat colposcopy
What is the management of CIN II/III?
Excision at time of colposcopy or after biopsy results
–> large loop excision of transformational zone (LLETZ)
Thermal ablation also an option if no features of invasion
What are the clinical features of cervical cancer?
Post-coital bleeding Intermenstrual bleeding Menorrhagia Pelvic pain Offensive discharge
If advanced disease:
- backache
- leg pain
- haematuria
- weight loss
- anaemia
- altered bowel habit
Which type of cervical cancer is most common?
Squamous (75-95%)
Where does cervical cancer most commonly spread?
Adjacent structures and via lymphatics
- pelvic + para-aortic nodes
What is the management for cervical cancer stage IA1-IA2?
IA1:
- local excision with LLETZ/cone biopsy with close follow up if fertility required
- hysterectomy if fertility not required
IA2:
- hysterectomy + pelvic nodes
- adjuvant RT if nodes positive
What is the management for cervical cancer stage IB1-IIA?
Radical hysterectomy + pelvic nodes
or radical RT + cisplatin chemotherapy
What is the management for cervical cancer stage IIB-IV?
Radical RT + chemotherapy
If you see a patient and suspect cervical cancer, what should be done to investigate?
Urgent referral for colposcopy + biopsy
