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Y3 - Repro > Cervical Pathology > Flashcards

Cervical Pathology Flashcards

1
Q

What is cervical ectropion?

A

Exposure of endocervical columnar epithelium to acidic vaginal environment resulting in squamous metaplasia in a circular area around the external os

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2
Q

Is cervical ectropion a pathological or physiological change, and why?

A

Physiological

Transitional bone changes position during reproductive life

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3
Q

What factors exacerbate cervical ectropion?

A

Increased oestrogen - COCP, pregnancy

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4
Q

What is the presentation of cervical ectropion?

A

Clear non-smelling vaginal discharge

Abnormal bleeding - post-coital, intermenstrual

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5
Q

What is the management of cervical ectropion?

A

Cautery with silver nitrate

Ablation with cold coagulation

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6
Q

What complications can cervical ectropion cause?

A

Ante/post-partum haemorrhage

Vasa praevia

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7
Q

What is a cervical polyp?

A

Benign growth of endocervix

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8
Q

What is the presentation of a cervical polyp?

A

Asymptomatic
Clear non-smelling vaginal discharge
Abnormal bleeding - post-coital, intermenstrual

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9
Q

What is the management of a cervical polyp?

A

Avulsion

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10
Q

What is a complication of cervical polyps?

A

Antepartum haemorrhage

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11
Q

What is the pre-invasive phase of squamous cervical carcinoma?

A

Cervical intraepithelial neoplasia

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12
Q

Has cervical intraepithelial neoplasia breached the epithelium?

A

No

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13
Q

What are risk factors for cervical intraepithelial neoplasia?

A 
HPV 16 and 18
Higher number of sexual partners
No condom use
Long term use of COCP
Smoking
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14
Q

What is cervical glandular intraepithelial neoplasia?

A

Pre-invasive phase of cervical adenocarcinoma

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15
Q

Who are screened for cervical neoplasia?

A

Patients with cervixes aged 25-64

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16
Q

What is done in cervical screening?

A

Speculum examination and sample of cells from transformational zone

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17
Q

What does cervical screening test for?

A

HPV

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18
Q

If a cervical screening test is HPV negative, what does this mean, and what is done next?

A

Low risk of developing cervical cancer in the next 5 years - so next appointment in 5 years

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19
Q

What is done if a cervical screening test is HPV positive?

A

Cytology will be carried out

20
Q

What is the transformational zone?

A

Where the columnar epithelium of the endocervix transitions to the squamous epithelium of the ectocervix

21
Q

Where is the cervical screening sample taken from?

A

Transitional zone

22
Q

What is done if HPV is positive but then cytology is negative?

A

HPV test in 12 months

23
Q

What is done is HPV is positive, cytology is negative, then the next HPV is negative?

A

Return for next screening in 5 years

24
Q

What is done is HPV is positive, cytology is negative, then the next HPV is positive?

A

Perform cytology again

25
Q

What is done is HPV is positive, cytology is negative, then the next HPV is positive but cytology is still negative?

A

Test HPV again (3rd time) in 12 months - if negative again return in 5 years

26
Q

What is done if cytology is positive?

A

Colposcopy

27
Q

What is done if high grade dyskaryosis is found on cytology?

A

Urgent 2 week colposcopy and biopsy

28
Q

What is the grading system of cervical intraepithelial neoplasia?

A

CIN I = abnormal cells occupying a third of the basal epithelium
CIN II - abnormal cells have spread to the middle third
CIN III - abnormal cells span the full thickness of the epithelium

29
Q

What is the purpose of colposcopy?

A

Detailed examination of the cervix

Visualise squamocolumnar junction

30
Q

What is the next step in management of a patient with symptoms suggest of cervical cancer?

A

Urgent colposcopy and biopsy

31
Q

What are the options for what happens next in cervical intraepithelial neoplasia?

A

Regression (CIN I 60%, CIN III, 32%)

Progression to cancer (CIN I 1%, CIN III 12%)

32
Q

How long does CIN take to progress to cervical cancer?

A

Years - CIN III can take 5-20 years

33
Q

What is the management of CIN I?

A

Repeat biopsy in 6 months

34
Q

What is the management of CIN II or III?

A

Excision at time of colposcopy or after a biopsy
Laser ablation
Cryotherapy

35
Q

What management is done post-treatment of CIN?

A

Smear and HPV est at 6 months
If both negative - back to routine screening
If either positive - refer to colposcopy

36
Q

What is the presentation of cervical cancer?

A 
Abnormal bleeding (post-coital, intermenstrual, menorrhagia)
Offensive vaginal discharge (brownish, blood stained)
Pelvic pain
37
Q

What are the symptoms of advanced cervical cancer?

A 
Backache
Leg pain
Haematuria
Weight loss
Anaemia
Changes in bowel habit
38
Q

What is the most common type of cervical cancer?

39
Q

What are the subtypes of squamous cervical cancer, and which is most common?

A

Keratinising (most common)
Large cell
Non-keratinising
Small cell

40
Q

What is the spread of cervical cancer?

A 
Adjacent structures
- prametrium
- upper vagina
- pelvic side wall
- bladder
- rectum
Draining lymphatics
- pelvic nodes
- para-aortic nodes
41
Q

How is cervical cancer staged?

A

Stage 1 - depth up to 5mm, width up to 7mm, confined to the cervix
Stage 2 - spread to adjacent organs
Stage 3 - involvement of pelvic wall
Stage 4 - distant metastases or involvement of rectum or bladder

42
Q

What is the management of stage 1 cervical cancer?

A

Local excisioon

Can do simple hysterectomy and pelvic lymphadenopathy

43
Q

What is the management of stage 2 cervical cancer?

A

Radical hysterectomy and pelvic lymphadenopathy

Or radical radiotherapy, can be combined with chemotherapy

44
Q

When is chemoradiotherapy preferred over radical hysterectomy in stage 1-2 cervical cancer?

A

If extension past the cervix

45
Q

What is the management of stage 3-4 cervical cancer?

A

Radical radiotherapy plus chemotherapy

46
Q

What is the recurrence risk of cervical ceancer?

Y3 - Repro (13 decks)

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