Cervical Pathology

Question 1

what infection is attributed to 70% of CIN?

Answer 1

HPV 16 and 18

Question 2

what zone of the cervix undergoes changes in CIN?

what is the histological change?

Answer 2

Transformation zone at the squamo-columnar junction

glandular –> squamous epithelium

Question 3

next step if woman has first inadequate smear result

Answer 3

repeat

Question 4

next step if woman has persistent (>3) inadequate smear results

Answer 4

asses by routine colposcopy

Question 5

next step if woman has boderline/ mild dyskaryosis smear result

Answer 5

test original sample for HPV

• If negative she goes back to routine call
• If positive she goes for routine colposcopy

Question 6

next step if woman has moderate dyskaryosis smear result

Answer 6

CIN II. urgent colposcopy – within 2 weeks

Question 7

next step if woman has severe dyskaryosis smear result

Answer 7

CIN III. urgent colposcopy – within 2 weeks

Question 8

next step if invasive cancer is suspected on smear result

Answer 8

urgent colposcopy – within 2 weeks

Question 9

at what age are women screened for cervical cancer? how often?

Answer 9

25-64 years
invited for screening every 3 years between 25-49
invited for screening every 5 years between 50-64

Question 10

mechanism of HPV in causing cervical cancer

Answer 10

HPV 16 produces oncogene E6 – inhibits p53 tumour suppressor gene
HPV 18 produces oncogene E7 – inhibits RB tumour suppressor gene

Question 11

name and characteristics of cells infected with HPV

Answer 11

koilocytes

• enlarged nucleus
• irregular nuclear membrane
• nucleus stains darker than normal (hyperchromasia)
• perinuclear halo

Question 12

Treatment of CIN II and III

Answer 12

large loop excision of the transformation zone (LLETZ)