Cervical health and pathology Flashcards
Outline the development of the cervix
How is this relevant?
It is derived from the Müllerian ducts, which develop around the sixth week of embryogenesis. During development, the outer parts of the two ducts fuse, forming a single urogenital canal that will become the vagina, cervix and uterus.
The embryology explains the anatomy of the cervix and the physiological changes that occur throughout life expose it to pathological events
Define genesis and dysgenesis
Cervical agenesis is a congenital disorder of the female genital system that manifests itself in the absence of a cervix.
Cervical dysgenesis is when the cervix is disformed.
How does ths size and shape of the cervix differ between parous and nulliparous women?
In the nulliparous female it is barrel shapped with a small circular external os at the center of the cervix
In parous women, cervix is bulky and the external os becomes slit like
How does the histology of the normal cervix differ between the ectocervix and and the endocervix?
The ectocervix is covered by non-keratinizing, stratified squamous epithelium
The endocervix is lined by a simple columnar epithelium that secretes mucus
How does the histology of the cervix change after the menopause?
The original SCJ comprises a larger area and the transformation zone is more internal (higher up)
Describe the cervix in terms of:
a) the Stroma
b) Blood supply
c) Lymphatic drainage
d) Nerve supply
a) Collagenous connective tissue with 15% smooth muscle fibres
b) Uterine artery - descending branch, venous drainage as artery
c) Common iliacs, internal and external iliacs, obturator and parametrium
d) Pain fibres with the parasympathetics to S2-S4 (uterine to T11 & T12)
State 4 functions of the cervix
Produces mucus to faciliate sperm migration
Acts as a barrier to ascending infection
Holds a developing pregnancy in place
Efaces and filates to enable vaginal birth
CLINICAL APPLICATION
How do you perform a cervical examination?
Speculum exam
- The speculum is opened to widen the vagina so that the vagina and cervix can be seen
- Perform a Pap smear
Describe 6 physiological changes in pregnancy
- Hypertrophy (to a lesser extent than uterus)
- Becomes softer
- Increased vascularity/venous congestion “purple tinge”
- Glands distended with mucus “plug”
- Prominent ectropion
- Remains elongated until the onset of labour
Consider the physiological changes on cervix
How is oestrogen involved in cervical ectopy “Erosion” and Atrophin “Cervicitis”
Cervical ectopy “erosion” is an effect of oestrogen
Atrophic “Cervicitis” is caused by lack of oestrogen
State 4 cervical infections
Chlamydia
Gonorrhoea
Trichomonas Vaginalis
HPV
Describe the epidemiology of cervical cancer
When do we begin screening for it in the UK?
- It is the 2nd most common cancer amongst women worldwide
- > 200,000 deaths
- 80% occur in LEDCs
Screening begins at the age of 25 (up to 49 every 3 years) and every 5 years between 50–65 years
HPV is a known cause of cervical cancer. What other factors increase risk?
- Predisposing factors
- Smoking
- Multiple sexual partners
- Immune compromise
- Low socio-economic status
How is HPV transmitted? How can its transmission be reduced?
Relation to cancers?
Its a common infection which is transmitted by close sexual contact (skin-to-skin contact of genitals)
Condoms reduce the risk
An increasing proportion of oropharyngeal cancers are HPV related.
Anal cancer rates are higher in women with CIN and their male partners
Higher rates of tongue and tonsil cancer in male partners of women with cervical cancer
CLINICAL APPLICATION
How do you diagnose and manage cervical cancer?
- Cytology (examination of cells)
- Colposcopy (look at cervix)
- Histology
- Treatment by ablation or excision
