Cervical Pathology

Question 1

What is the squamocolumnar junction?

Answer 1

It is the junction between the squamous epithelium and columnar epithelium of the cervix.

Question 2

What is the cervical transformation zone?

Answer 2

It is the area between the original squamocolumnar junction and the new squamocolumnar junction of the cervix and contains areas of metaplasia.

Question 3

How does the position of the SCJ change?

Answer 3

Pre-pubertal: ecto squamous, endo columnar
Puberty: endo epithelium expands, ectropion
Pregnancy and the pill also favour ectropion
Post-puberty: glandular epithelium exposed to low pH and undergoes squamous metaplasia

Question 4

What is the 5 year survival rate for cervical cancer?

Answer 4

66%

Question 5

What are the risk factors for cervical carcinoma?

Answer 5

HPV 16 or 18
Oral contraceptive pill
High parity
Multiple sexual partners
Immunosuppression
Nicotine

Question 6

What are the types of cervical carcinoma?

Answer 6

Squamous cell (80%)
Adenocarcinoma (15%)
Adenosquamous
Neuroendocrine
(All caused by high oncogenic risk HPV)

Question 7

How is cervical carcinoma staged?

Answer 7

Stage 1: confined to cervix
Stage 2: extension to upper 2/3 vagina
Stage 3: extension to lower 1/3 vagina
Stage 4: bladder or rectum or distant organs

Question 8

What is CIN?

Answer 8

It is a precancerous lesion of the cervix characterised by disordered maturation and nuclear abnormalities in cells of cervical epithelium.

Question 9

What are the types of CIN?

Answer 9

CIN 1: mild dysplasia and lower 1/3 epithelium
CIN 2: moderate dysplasia and 2/3 epithelium
CIN 3: severe dysplasia and full thickness

Question 10

What is the evidence for a role of HPV in cervical cancer?

Answer 10

Sexually transmitted disease aetiology
HPV detected in cervical cancer and other genital cancers.
HPV 16 in 60% cervical cancers, 18 in 10%
But it is not causative, just priming.

Question 11

What are the molecular interactions of HPV?

Answer 11

Viral genome integrated in host cell DNA.
E6 and E7 expressed.
E7 binds to RB and causes proteolysis, releasing E2F and causing cell cycle progression.
E6 binds to p53 and causes degradation. Also activates telomerase.

Question 12

How is CIN diagnosed?

Answer 12

Cytologically from Pap smear or liquid cytology.

Question 13

What is the normal cytology on a Pap smear?

Answer 13

Superficial cells are large, have pink cytoplasm with small oval nucleus.
Intermediate cells have blue green cytoplasm and slightly larger nucleus.

Question 14

What are the features of dyskaryosis on Pap smear?

Answer 14

Abnormal nucleocytoplasmic ratio.
Variation in nuclear size and shape.
Hyperchromasia.
Cytoplasmic halos (koilocytic atypia)

Question 15

What are the stains used at colposcopy?

Answer 15

Acetic acid (dysplasia white)
Schiller's test (surround is brown)

Question 16

What is micro invasive carcinoma of cervix?

Answer 16

An area of cancer cells that extends 0.5cm or less below the epithelial basement membrane and has horizontal extent of 0.7cm or less.

Question 17

What are the classes of micro invasive carcinoma?

Answer 17

1A1: less than 3mm depth
1A2: 3-5mm depth

Question 18

Who needs to have a Pap smear?

Answer 18

Women between the age of 25 to menopause need to have one every 3 years.
From menopause to 64, every 5 years.

Question 19

What is the HPV vaccine made of?

Answer 19

Virus-like particles (empty protein shell) encoded by L1 gene product.