Cervical Pathology Flashcards
what zone is susceptible to cancerous changes from the human papilloma virus?
transition zone: squamous-columnar junction
what is the pathophysiology of the human papilloma virus?
infection leads to viral lesions leading to a persistent infection creating a central intra-epithelial neoplasia then cervical cancer
what are the stages of cervical intra-epithelial neoplasia?
> CIN1 : low grade dysplasia
CIN2 : moderate dysplasia
CIN 3 severe dysplasia, unlikely to regress
what in cervical intraepithelial neoplasia?
disorganised proliferation of abnormal cells in squamous epithelium where the viral DNA integrates into the genome so there is overexpression of viral proteins and deregulation of the host cycle
what investigation indicates underlying CIN?
cervical smear then liquid based cytology (identifies increase in viral HPV DNA or RNA
describe the cervical smear screening programme?
between 25-64 years every 5 years
a patients liquid based cytology form her cervical smear comes back positive. how would you proceed with investigations?
> triage with cytology (microscopic assessment of cells in transformation zone)
then a colposcopy
when microscopically assessing cells in CIN what nuclear features might you see?
> increased size
variation in size and shape
coarse irregular chromatin
what is colposcopy used for in CIN assessment?
> excludes any obvious malignancy
> acetic acid +/- iodine identifies the limits of the lesion helping select the biopsy site and define the area to treat
what is the treatment for CIN?
> loop diathermy
thermal coagulation
laser ablation
what is the follow up for CIN?
> liquid based cytology at 6 months
- negative return to normal recall
- positive then do colposcopy
what are the risk factors for cervical cancer?
> 45-55years old > HPV > multiple partners > early of first intercourse > older age of partner > cigarette smoking
what makes up the majority of cervical cancers?
> squamous carcinoma
what are the symptoms of cervical cancer?
> discharge > abnormal vaginal bleeding > post coital bleeding > intermenstrual bleeding > pain
how is cervical cancer diagnosed?
with a biopsy
