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Reproductive and Sexual Health > Cervical Pathology > Flashcards

Cervical Pathology Flashcards

1
Q

What is an ectropion?

A

This is cervical metaplasia (the change from columnar to squamous in response to erosion) and occurs at the TZ

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2
Q

What is the TZ?

A

this is the transitional zone and is the area of transition between endocervical columnar epithelium and ectocervical squamous epithelium

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3
Q

Is the TZ a fixed point?

A

no - it changes with menarche, pregnancy and menopause

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4
Q

What is a natholion follicle?

A

a mucous filled cyst caused by the growth of squamous epithelium over the columnar

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5
Q

What is a cervical polyp?

A

This is an inflammatory outgrowth - NOT premalignant

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6
Q

What is an ectropion associated with?

A

High levels of oestrogen

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7
Q

What is the presentation of an ectropion?

A

red area around the os, increased secretion of mucous, post-coital bleeding

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8
Q

How is ectropion treated?

A

Removal of OCP/oestrogens

ablation therapy

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9
Q

Can a cervical polyp bleed?

A

Yes if ulcerated

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10
Q

What is cervicitis?

A

This is an inflammatory process where the lymphoid follicles of the cervix become reactive in response to infection e.g. chlamydia/HSV

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11
Q

What can cervicitis present as?

A

Usually asymptomatic so will often go unnoticed - this can thus cause silent damage to the fallopian tubes and eventual infertility

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12
Q

Which cells at the cervix are cilliated?

A

columnar (endocervical)

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13
Q

what is CIN?

A

cervical intra-epithelial neoplasia - dysplasia of the squamous cells

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14
Q

What can cause CIN?

A

most commonly HPV 16 and 18 is there is persistent infection

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15
Q

What are the RF for CIN development?

A

Anything that increases HPV infection risk e.g. multiple partners, long term oral contraceptive use, barrier methods not used
Disruption to the TZ at earlier age e.g. early sexual age
Smoking (x3)
immunosuppression

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16
Q

What is koilocytosis?

A

This is the presence of vacuolation in the cell film and is indicative of HPV infection

17
Q

What is the timeline of progression from HPV infection to CIN to invasive carcinoma?

A

HPV to CIN = 6 months to 3 years

CIN to invasive carcinoma = 5 to 20 years

18
Q

What is dyskaryosis?

A

The presence of abnormal cells on a cervical blood film

19
Q

Explain dyskaryotic cell features?

A

increased NC ration, hyperchromatic, open chromatin structure, increased mitotic figures, pleomorphism

20
Q

Explain CIN 1

A

the presence of dyskaryosis affecting the 1/3 of the epithelium closest to the BM

21
Q

Explain CIN 2

A

The presence of dyskaryosis affecting 2/3 of the epithelium (closest to the BM)

22
Q

Explain CIN 3

A

full thickness dyskaryosis without invasion through the BM

23
Q

What is invasive squamous carcinoma?

A

Malignant tumour of the cervix (75-95% of all) which develops from CIN and is assoicated with HPV infection

24
Q

Explain stages 1-4 of invasive squamous carcinoma?

A 
1 = confined to cervix
2= spread to local structures (uterus, vagina)
3 = spread to the pelvic wall
4 = distance mets or spread to the bladder/rectum
25
Q

How will invasive squamous carcinoma present?

A

Usually picked up at smear (almost entirely preventable) but if not then will present with abnormal bleeding e.g. post-coital, post-menopause, contact bleeding or blood stained discharge
pelvic pain, haematuria, urine infection and ureteric obstruction/renal failure are all other presenatations

26
Q

What is CGIN?

A

this is the precursor for adenocarcinoma - screening is less effective

27
Q

What is invasive adenocarcinoma?

A

this represents 5-25% of malignant cervical cancers and is to do with the glandular tissue overgrowth - will appear to have lots of abnormal glands under microscope.

28
Q

What are the RF for adenocarcinoma?

A

higher SE class, later sexual activity, HPV 18, smoking

29
Q

What is the most commonly used treatment for CIN2 and 3?

A

LLETZ - large loop excision of the TZ with diathermy

30
Q

What other surgeries can be carried out for invasive squamous/adeno carcinoma?

A

Fertility sparing or a Werthiem-Mieg’s procedure

31
Q

What is werthiem-Mieg’s procedure?

A

This is an abdominal procedure for the total hysterectomy, lymphectomy and removal of vaginal tissue (between the obturator foramen and the pelvic floor)

32
Q

What is brachytherapy?

A

This is radiotherapy that is administered directly on to the cervix

33
Q

What chemotherapy can be used?

A

cisplatin + carboplatin/paclotaxel

Reproductive and Sexual Health (27 decks)

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