Cervical Disorders Lecture Flashcards
nulliparous cervix
before vaginal delivery
multiparous cevix
after vaginal delivery
where the inner lining meets the exterior surface of the cervix
squamocolumnar junction
where does cervical cancer occur?
squamocolumnar junction (this is where you want to get your pap smear sample!)
What happens to the squamouscolumnar junction (SCJ) as a woman ages
it becomes closer to center/smaller
normal for younger women to have a reddish, ulcer looking area on cervix..this will get smaller with age
the transformation zone is where what changes occur?
premalignant and neoplastic
cervical dysplasia is…
precursor to cervical cancer
Yellowish translucent raised pearl-like lesions on ectocervix
1 mm to 3 cm
Few or multiple
Benign
Nabothian cysts
- Small, pedunculated neoplasms
- Originate from endocervix
- Common
- Especially in multigravidas over age 20
- *Mostly benign
Can be easily removed if desired
Cervical polyps
**Asymptomatic or intermenstrual or postcoital bleeding/spotting
PE: red friable growth protruding from os
*Range of size: 2 mm to 3 cm
Remove by grasping w/ ring forceps then twist
Cervical polyps
**Purulent vaginal discharge Sometimes postcoital bleeding May have urethritis symptoms as well Variety of pathogens (usually infectious) Gonorrhea Chlamydia Candida Bacterial vaginosis Trichomonas (“strawberry cervix” in 2% of cases) Risk of PID if not treated
Acute cervicitis
Leukorrhea main symptom, noninfectious
Sometimes causes vulvar irritation
Postcoital or intermenstrual bleeding
Other symptoms: Dysmenorrhea Dyspareunia Low abdominal pain Low back pain Urinary symptoms
Chronic cervicitis
Narrowing of the endocervical canal, usually at level of internal os
Cervical stenosis
Causes: Congenital Hypoestrogenic state Neoplastic Post-surgical (eg, s/p LEEP)
- Partial to full occlusion of the os
- Obstruction of menstrual flow (can lead to amenorrhea)
Cervical stenosis
_____ is detected in 99.7% of cervical cancer cases
HPV
Most common histologic type of cervical cancers
squamous cell (69%)
adenocarcinoma is second
african americans and hispanics have a higher risk of..
cervical cancer
3rd most common GYN cancer diagnosis and death among GYN cancers
cervical cancer
Early onset sexual activity Multiple sex partners High risk sex partners History of STIs History of vulvar or vaginal squamous intraepithelial neoplasia or cancer Immunosuppression Smoking
Risk factors of Cervical CA
Clinical manifestations:
early cervical CA frequently asymptomatic
irregular or heavy vaginal bleeding
postcoital bleeding
cervical cancer
Cervical cancer usually originates at _______ _______ (@ SJC or junction between squamous epithelium of ectocervix and glandular epithelium of endocervical canal)
transformation zone
radical hysterectomy
fertility-sparing surgery
radiation ± chemotherapy
Treatment for early stage cervical cancer
Principal method for cervical cancer screening
Cervical cytology
biggest HPV types we look at?
responsible for 70% of cervical cancer
16 and 18
Which HPV is associated with higher rates of squamous cancers?
HPV 16
Which HPV is associated with higher rates of adenocarcinoma (not as well screened for by Pap)
HPV 18
Pap smears for ages 21-29 every….
3 years
Age 30-35, Pap + HPV “co test” every….
5 years
Start pap smears at age…
21 (continue until age 65)
women 21-24 with abnormal pap…
can just repeat in 1 year
Diagnostic procedure used to follow up some abnormal Pap results
Magnifies cervix
Staining to identify areas to be biopsied (acetic acid, iodine)
Colposcopy
When you apply acetic acid, pre cancer changes appear
white
treatment for highly abnormal cervical dysplasia
LEEP prodcedure
21 yo pt with LSIL (low grade changes), what should you do…
recheck in a year..wait and watch
(low grade and young)
STILL VACCINATE!
