Cervical pathology Flashcards
What is the transformation zone?
squamo-columnar junction
What type of epithelia line the ectocervix?
squamous
What type of epithelia line the endocervix?
columnar
Why does the position of the TZ alter throughout life?
in reponse to menarche, pregnancy and menopause
What are Nabothian follicles?
dilated endocervical glands that are benign
What is Cervicitis?
inflammation that can lead to simultaneous silent fallopian tube damage
often asymptomatic
What can cause cervicitis?
chlamidya trachoma’s
follicular cervicitis
herpes simplex infections
What are the properties of a cervical polyp?
localised inflammatory outgrowth that can cause bleeding if ulcerated
Are cervical polyps pre malignant?
NO
What are risk factors for CIN/Cervical cancer?
perisistance of high risk HPV virus' - 16+18 many sexual partners vulnerability of TZ in early life smoking - x3 Peutz-jeghurs syndrome
What is the action of HPV?
invades basal cells at the TZ which then divide and increase in number and produce E6 and E7 proteins that inhibit p53
Is Peutz-jeghurs syndrome picked up on cervical smears?
NO
What makes the action of HPV worse?
STIs
What is cervical intraepithelial neoplasia (CIN)?
pre invasive stage of cervical cancer that occurs at the TZ
dysplasia of squamous cells
What is seen histologically in CIN?
hyperchromasia, increased N:C ratio, pleomorphism
excess mitotic activity
What is seen on cervical smears in CIN?
koilocytosis
What is dyskaryosis?
abnormality in the squamous part
What are glandular abnormalities?
abnormalities in the columnar/glandular part
What is CIN 1?
basal 1/3rd of epithelium occupied by abnormal cells
Is there a chance that CIN 1 can turn back to normal?
YES
What is CIN 2?
abnormal cells extend to middle 1/3rd
What is CIN 3?
abnormal cells occupy full thickness in the epithelium
How long does it take a HPV infection to turn into a high grade CIN?
6months -> 3 years
How long does it take a high grade CIN to turn into an invasive cancer?
5-20years
How does an invasive squamous carcinoma of the cervix arise?
from pre existing CIN
What is the 2nd commonest female cancer world wide?
invasive squamous carcinoma of the cervix
What are the symptoms of invasive squamous carcinoma of the cervix?
abnormal bleeding - post coital, post menopausal, brown/blood stained discharge
pelvic pain
haematuria/urinary infections
uteric obstruction/renal failure
What is the local spread of invasive squamous carcinoma of the cervix?
vagina
bladder
uterus
rectum
What is the lymphatic spread of invasive squamous carcinoma of the cervix?
pelvic and para aortic nodes
What is the haematogenous spread of invasive squamous carcinoma of the cervix?
liver
lungs
bone
What happens first - lymphatic or haematogenous spread?
lymphatic
What is Cervical Glandular Intraepithelial Neoplasia (CGIN)?
pre malignant lesion - pre invasive phase of endocervical adenocarcinoma
Why are CGINs difficult to diagnose with a smear?
often hidden down inside the gland
How do you treat mild cervical cancer?
increase screening
How do you treat moderate cervical cancer?
surgery - LLETZ, trachelectomy (fertility sparing), radical hysterectomy
radiotherapy followed up by brachytherapy
chemo therapy - give before treatement (cisplatin, carboplatin, paclitaxol)
What is the 5 yr survical for cervical cancer with vaginal involvement?
75-78%
What is the 5 yr survical for cervical cancer with lower vaginal or pelvic side wall involvement?
47-50%
What is the 5 yr survical for cervical cancer with bladder/rectum involvement?
20-30%
What % of cervical cancers does endocervical adenocarcinoma make up?
5-25%
What are the risk factors for endocervical adenocarcinoma?
higher socioeconomic class
later onset of sexual activity
smoking
HPV - esp 18
What two populations does vulvar intraepithelial neoplasia affect?
young women - recurrent or persistant
older women - greater risk to progress to invasive squamous carcinoma
What can vulvar invasive squamous carcinoma arise from?
normal epithelium or VIN
Who does vulvar invasive squamous carcinoma affect?
elderly women
How does vulvar invasive squamous carcinoma present?
ulcer or exophytic mass
spreads to inguinal lymph nodes
What is the treatment for vulvar invasive squamous carcinoma?
radical vulvectomy and inguinal lympahdenoctomy
What is the 5yr survival for vulvar invasive squamous carcinoma if node -ve and +ve?
-ve = 90% \+ve = <60%
What is Vulvar pagets disease?
crusting rash
tumour arises from the sweat glands
lots of keratin on the surface
