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Year 4 OBGYN > Cervical Pathology > Flashcards

Cervical Pathology Flashcards

1
Q

Define Cervical Polyps

A

Benign growths protruding from inner cervix that have the ability to undergo malignant change
Due to focal hyperplasia of columnar epithelium of endocervix

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2
Q

Give three potential causes of Cervical Polyps

A

Chronic Inflammation
Abnormal response to Oestrogen
Localised congestion of vasculature

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3
Q

Give four potential clinical features of Cervical Polyps

A
  • May be Asymptomatic
  • Abnormal Vaginal Bleeding (PMB, Post Coital, Intermenstrual)
  • Increased Vaginal Discharge
  • Subfertility if blocking cervical canal
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4
Q

Describe four investigations that should be carried out for Cervical Polyps

A
  • Triple Swabs
  • Cervical Smear
  • USS for Endometrial Polyps
  • Histological Analysis after removal
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5
Q

What are Triple Swabs?

A
  • High Vaginal Charcoal (TV,BV,Candida, GBS)
  • Endocervical Charcoal (Gonorrohea)
  • Endocervical NAAT (Chlamydia)
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6
Q

How are Cervical Polyps removed?

A

Small: Polypectomy with forceps in primary care setting
Large: Colposcopy

Removed due to 0.5% malignancy risk

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7
Q

Define Ectropian

A

Eversion of the endocervix, exposing columnar epithelium to vaginal environment

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8
Q

Explain two symptoms of Cervical Ectropians and why this occurs

A

Post coital/ IMB (due to exposure of fine blood vessels)

Heavy Discharge (Endocervix is columnar epithelium mucous secreting)

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9
Q

Give three risk factors for Cervical Ectropians

A

Menstruating Age
COCP
Pregnancy

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10
Q

What are the three main investigations for a Cervical Ectropian?

A

Triple Swabs
Cervical Smear
Pregnancy Test

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11
Q

Cervical Ectropian are normal variants that don’t require treatment unless symptomatic, what are the treatment options?

A

1) COCP

2) Ablation (warn patients of heavy discharge until healed)

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12
Q

Define Cervicitis

A

Inflammation of Uterine Cervix, primarily affecting Columnar Epithelium

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13
Q

Give an Acute and Chronic cause of Cervicitis

A

Acute - Infection

Chronic - Local Irritant (Tampons, Latex)

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14
Q

What is CIN?

A

Varying degrees of Dyskaryosis in the transformation zone of the cervix

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15
Q

Describe the three stages of CIN

A

1 - involved 1/3 of basal epithelium (mild)

2 - involves 2/3 of basal epithelium (moderate)

3 - involves full thickness, AKA Carcinoma In Situ

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16
Q

How is CIN managed?

A

1 - Expectant

2 and 3 - large loop excision and retest for HPV in 6m

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17
Q

Give three risk factors for Cervical Cancer

A
  • Smoking
  • HPV (high risk oncogenic strains 16 and 18, low risk 6 and 11)
  • Other STIs
18
Q

Name four features of the pathology of Cervical Cancer

A

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

19
Q

What is the peak age of Cervical Cancer diagnosis?

A

25 - 29

20
Q

Describe 5 features of Cervical Cancer

A 
Abnormal Vaginal Bleeding (IMB,PMB,PCB)
Vaginal Discharge (Foul, Blood Stained)
Dyspareunia
Pelvic Pain
Weight Loss
21
Q

State two signs of advanced Cervical Cancer

A
  • Oedema

- Loin Pain

22
Q

How would you investigate a Pre-Menopausal woman for Cervical Cancer?

A

1) Test for Chlamydia

2) If symptoms persist/test is negative then Colposcopy and Biopsy

23
Q

How would you investigate a Post Menopausal woman for Cervical Cancer?

A

Urgent Colposcopy and Biopsy

Acetic Acid stains the dysplastic areas (binds to proteins - white) and biopsies are taken

24
Q

Describe the FIGO staging 0 and 1 for Cervical Cancer

A

0- Carcinoma in Situ
1A - Confined to Cervix , identified only microscopically
1B - Confined to Cervix, gross lesions clinically identifiable

25
Q

Describe the FIGO staging 2 for Cervical Cancer

A

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

26
Q

Describe the FIGO staging 3 for Cervical Cancer

A

Extends to pelvic side wall/involves lower vaginal third/hydronephrosis
‘B’ - Hydronephrosis

27
Q

Describe the FIGO staging 4 for Cervical Cancer

A

A) Involves bladder/rectum

B) Involves distant organs

28
Q

When are Women invited for Cervical screening?

A

Every three years from 25-49
Every five years from 50-64
If HIV +ve then screened every year

29
Q

Why are Women not invited for screening before the age of 25?

A

CIN1 is common in<25 and often self resolves

Would lead to over treatment

30
Q

What happens if the HPV screening sample is positive?

A

No abnormal cells - recalled in 12 months to see if virus has cleared
Inadequate Sample - recalled in 3 months
Dyskaryosis - Colposcopy

31
Q

If there were no abnormal cells still but the patient was still HPV positive 12 months later, how would you manage?

A

Recheck in another 12m

If still positive then - Colposcopy

32
Q

Should you have HPV screening if you have had a previous Hysterectomy?

A

Only if Subtotal

33
Q

Should you have HPV screening if you have had previous radiotherapy to the area?

A

No

34
Q

Name two reasons a Cervical Screening appointment should be delayed

A
  • Menstruation

- <12w post partum/miscarriage/TOP

35
Q

Other than the procedure, name four things you should discuss with the patient pre Cervical Smear

A
  • 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
36
Q

How is a Cervical Smear taken?

A
  • 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
37
Q

How is Cervical Cancer stage 1a managed?

A

Radical Trachelectomy (Cervix and Upper Vagina - fertility preserved)

Or come biopsy to retain fertility

38
Q

How is Cervical Cancer stage 1b and above managed?

A

Radical Hysterectomy

Radiochemotheapy for 5-8 weeks

39
Q

How is Cervical Cancer stage 4a and above managed?

A

Removal of all of pelvis +/- bladder and rectum

40
Q

How should Cervical Cancer patients be followed up?

A

Every 4m for first 2y
Then
Every 6m for next 3y

Year 4 OBGYN (15 decks)

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