Cervical Pathology Flashcards
Define Cervical Polyps
Benign growths protruding from inner cervix that have the ability to undergo malignant change
Due to focal hyperplasia of columnar epithelium of endocervix
Give three potential causes of Cervical Polyps
Chronic Inflammation
Abnormal response to Oestrogen
Localised congestion of vasculature
Give four potential clinical features of Cervical Polyps
- May be Asymptomatic
- Abnormal Vaginal Bleeding (PMB, Post Coital, Intermenstrual)
- Increased Vaginal Discharge
- Subfertility if blocking cervical canal
Describe four investigations that should be carried out for Cervical Polyps
- Triple Swabs
- Cervical Smear
- USS for Endometrial Polyps
- Histological Analysis after removal
What are Triple Swabs?
- High Vaginal Charcoal (TV,BV,Candida, GBS)
- Endocervical Charcoal (Gonorrohea)
- Endocervical NAAT (Chlamydia)
How are Cervical Polyps removed?
Small: Polypectomy with forceps in primary care setting
Large: Colposcopy
Removed due to 0.5% malignancy risk
Define Ectropian
Eversion of the endocervix, exposing columnar epithelium to vaginal environment
Explain two symptoms of Cervical Ectropians and why this occurs
Post coital/ IMB (due to exposure of fine blood vessels)
Heavy Discharge (Endocervix is columnar epithelium mucous secreting)
Give three risk factors for Cervical Ectropians
Menstruating Age
COCP
Pregnancy
What are the three main investigations for a Cervical Ectropian?
Triple Swabs
Cervical Smear
Pregnancy Test
Cervical Ectropian are normal variants that don’t require treatment unless symptomatic, what are the treatment options?
1) COCP
2) Ablation (warn patients of heavy discharge until healed)
Define Cervicitis
Inflammation of Uterine Cervix, primarily affecting Columnar Epithelium
Give an Acute and Chronic cause of Cervicitis
Acute - Infection
Chronic - Local Irritant (Tampons, Latex)
What is CIN?
Varying degrees of Dyskaryosis in the transformation zone of the cervix
Describe the three stages of CIN
1 - involved 1/3 of basal epithelium (mild)
2 - involves 2/3 of basal epithelium (moderate)
3 - involves full thickness, AKA Carcinoma In Situ
How is CIN managed?
1 - Expectant
2 and 3 - large loop excision and retest for HPV in 6m
Give three risk factors for Cervical Cancer
- Smoking
- HPV (high risk oncogenic strains 16 and 18, low risk 6 and 11)
- Other STIs
Name four features of the pathology of Cervical Cancer
Majority caused by HPV infection
70% SCC, 15% Adenocarcinoma
Occurs as progression from CIN over 10-20 years
Commonly metastasises to lung/liver/bone/bowel
What is the peak age of Cervical Cancer diagnosis?
25 - 29
Describe 5 features of Cervical Cancer
Abnormal Vaginal Bleeding (IMB,PMB,PCB) Vaginal Discharge (Foul, Blood Stained) Dyspareunia Pelvic Pain Weight Loss
State two signs of advanced Cervical Cancer
- Oedema
- Loin Pain
How would you investigate a Pre-Menopausal woman for Cervical Cancer?
1) Test for Chlamydia
2) If symptoms persist/test is negative then Colposcopy and Biopsy
How would you investigate a Post Menopausal woman for Cervical Cancer?
Urgent Colposcopy and Biopsy
Acetic Acid stains the dysplastic areas (binds to proteins - white) and biopsies are taken
Describe the FIGO staging 0 and 1 for Cervical Cancer
0- Carcinoma in Situ
1A - Confined to Cervix , identified only microscopically
1B - Confined to Cervix, gross lesions clinically identifiable
Describe the FIGO staging 2 for Cervical Cancer
Beyond Cervix but not beyond pelvis (and not involving lower 1/3 of Vagina)
A) No Parametrial Involvement (involves upper 2/3 Vagina though)
B) Gross Parametrial Involvement
Describe the FIGO staging 3 for Cervical Cancer
Extends to pelvic side wall/involves lower vaginal third/hydronephrosis
‘B’ - Hydronephrosis
Describe the FIGO staging 4 for Cervical Cancer
A) Involves bladder/rectum
B) Involves distant organs
When are Women invited for Cervical screening?
Every three years from 25-49
Every five years from 50-64
If HIV +ve then screened every year
Why are Women not invited for screening before the age of 25?
CIN1 is common in<25 and often self resolves
Would lead to over treatment
What happens if the HPV screening sample is positive?
No abnormal cells - recalled in 12 months to see if virus has cleared
Inadequate Sample - recalled in 3 months
Dyskaryosis - Colposcopy
If there were no abnormal cells still but the patient was still HPV positive 12 months later, how would you manage?
Recheck in another 12m
If still positive then - Colposcopy
Should you have HPV screening if you have had a previous Hysterectomy?
Only if Subtotal
Should you have HPV screening if you have had previous radiotherapy to the area?
No
Name two reasons a Cervical Screening appointment should be delayed
- Menstruation
- <12w post partum/miscarriage/TOP
Other than the procedure, name four things you should discuss with the patient pre Cervical Smear
- The purpose of screening and its limitations
- The likelihood of a normal result (93%)
- That a normal result means LOW risk but not NO risk of cancer
- What happens if the result is inadequate or positive
How is a Cervical Smear taken?
- Insert the correct size lubricated speculum so that you can visualise the cervix
- Insert the brush swab up to the cervical os, and rotate 360 degrees 5 times
- Insert back into tube, replace lid, and shake gently
How is Cervical Cancer stage 1a managed?
Radical Trachelectomy (Cervix and Upper Vagina - fertility preserved)
Or come biopsy to retain fertility
How is Cervical Cancer stage 1b and above managed?
Radical Hysterectomy
Radiochemotheapy for 5-8 weeks
How is Cervical Cancer stage 4a and above managed?
Removal of all of pelvis +/- bladder and rectum
How should Cervical Cancer patients be followed up?
Every 4m for first 2y
Then
Every 6m for next 3y
