cervical pathology Flashcards
what cells are present in cervical ectropion
more columnar epithelial in transformation zone
RF ectropion
elevated oestrogen - ovulating, pregnant, COCP, menstruating women
causes postcoital bleeding
ectropion (most common) // cervicitis eg chlamydia // cancer // polyp // trauma
mx ectropion
speculum + cautery if problematic
which HPV subtypes are carcinogenic
16,18,33
which HPV is assoc with warts
6 + 11
what effect does HPV have on endocervical cells
develop into koilocytes
histology changes seen with HPV
enlarged nucleus // irregular nuclear membrane // stained darkr // perinuclear halo
which age group gets HPV tests every 3 years
25-49 (scotland every 5 years)
which age group gets HPV screening every 5 years
60-64
if pregnant when is cervical screening done
3 monts post partum
who is at risk of cervical cancer
sexually active, multiple partners, long term COCP, smoking
when is the best time to take a cervical smear
mid cycle
which cervical screening tests are cytologically examined
HPV +ive ones
if a HPV test is negative what action is taken
return to normal recall (unless previous CIN, CGIN, etc)
what abnormal changes can be seen on cytology
borderline changes, low grade dyskaryosis, carcinoma, neoplasm
further mx if cervical cytology is abnormal
colposcopy
what happens if cervical cytology is normal after +ive smear
repeat in 12 months
if the repeat HPV+ive but cytologically normal test is now -ive after 12 months what happens
return to normal call
if the repeat HPV+ive but cytologically normal test is still +ive after 12 months what happens
repeat test in 12 months
if the 2nd repeat HPV+ive but cytologically normal test is now -ive after 24 months what happens
return to normal recall
if the 2nd repeat HPV+ive but cytologically normal test is still +ive after 24 months what happens
colposcopy
what happens if smear is inadequate
repeat within 3 months, if 2 consecutive –> colposcopy
how is CIN diagnosed (CIS)
cervical smear
mx CIN
large loop excision tranzformation zone
most common age cervical cancer
25-29 (uo to 45)
RF cervical cancer
HPV 16,18,33 // HIV // smoking // early intercourse, multuple partners // lots of kids // COCP // low SE
types of cervical cancer
SCC (80%), adenocarcinoma (20%)
what staging is used for cervical cancer
FIGO
1A and 1B stage
1A - confined to cervix, not vissible and <7mm // 1B - confined to cervix, visible and larger >7mm
stage II cervical cancer
II = beyond cervix but not pelvic wall (uterus or upper 2/3 vagina)
stage III cervical cancer
beyond cervix and pelvic wall (pelvic wall or lower 1/3 vagina)
stage IV cervical cancer
rectum or bladder
mx stage CIN and 1A cervical tumour
LLETZ or cone biopsy
mx cervical cancer 1B–> 2A
radical hysterectomy + lymph + chemo + radio
mx cervical cancer III + IV
chemo + radio (IV maybe palliative)
most common chemo agent in cervical cancer
cisplatin
complication of cervical cancer surgery
bleeding, infection // cone biospy or trachelectomy –> preterm birth // hysterectomy –> ureteral fistula
complications radio
diarrhoea, vaginal bleeding, burns, pee problems // ovarian failure, fibrosis
