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1. Reproduction > Cervical pathology > Flashcards

Cervical pathology Flashcards

1
Q

What is the transformation zone?

A

squamo-columnar junction

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2
Q

What type of epithelia line the ectocervix?

A

squamous

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3
Q

What type of epithelia line the endocervix?

A

columnar

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4
Q

Why does the position of the TZ alter throughout life?

A

in reponse to menarche, pregnancy and menopause

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5
Q

What are Nabothian follicles?

A

dilated endocervical glands that are benign

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6
Q

What is Cervicitis?

A

inflammation that can lead to simultaneous silent fallopian tube damage
often asymptomatic

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7
Q

What can cause cervicitis?

A

chlamidya trachoma’s
follicular cervicitis
herpes simplex infections

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8
Q

What are the properties of a cervical polyp?

A

localised inflammatory outgrowth that can cause bleeding if ulcerated

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9
Q

Are cervical polyps pre malignant?

A

NO

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10
Q

What are risk factors for CIN/Cervical cancer?

A 
perisistance of high risk HPV virus' - 16+18
many sexual partners
vulnerability of TZ in early life
smoking - x3
Peutz-jeghurs syndrome
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11
Q

What is the action of HPV?

A

invades basal cells at the TZ which then divide and increase in number and produce E6 and E7 proteins that inhibit p53

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12
Q

Is Peutz-jeghurs syndrome picked up on cervical smears?

A

NO

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13
Q

What makes the action of HPV worse?

A

STIs

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14
Q

What is cervical intraepithelial neoplasia (CIN)?

A

pre invasive stage of cervical cancer that occurs at the TZ

dysplasia of squamous cells

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15
Q

What is seen histologically in CIN?

A

hyperchromasia, increased N:C ratio, pleomorphism

excess mitotic activity

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16
Q

What is seen on cervical smears in CIN?

A

koilocytosis

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17
Q

What is dyskaryosis?

A

abnormality in the squamous part

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18
Q

What are glandular abnormalities?

A

abnormalities in the columnar/glandular part

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19
Q

What is CIN 1?

A

basal 1/3rd of epithelium occupied by abnormal cells

20
Q

Is there a chance that CIN 1 can turn back to normal?

A

YES

21
Q

What is CIN 2?

A

abnormal cells extend to middle 1/3rd

22
Q

What is CIN 3?

A

abnormal cells occupy full thickness in the epithelium

23
Q

How long does it take a HPV infection to turn into a high grade CIN?

A

6months -> 3 years

24
Q

How long does it take a high grade CIN to turn into an invasive cancer?

A

5-20years

25
Q

How does an invasive squamous carcinoma of the cervix arise?

A

from pre existing CIN

26
Q

What is the 2nd commonest female cancer world wide?

A

invasive squamous carcinoma of the cervix

27
Q

What are the symptoms of invasive squamous carcinoma of the cervix?

A

abnormal bleeding - post coital, post menopausal, brown/blood stained discharge
pelvic pain
haematuria/urinary infections
uteric obstruction/renal failure

28
Q

What is the local spread of invasive squamous carcinoma of the cervix?

A

vagina
bladder
uterus
rectum

29
Q

What is the lymphatic spread of invasive squamous carcinoma of the cervix?

A

pelvic and para aortic nodes

30
Q

What is the haematogenous spread of invasive squamous carcinoma of the cervix?

A

liver
lungs
bone

31
Q

What happens first - lymphatic or haematogenous spread?

A

lymphatic

32
Q

What is Cervical Glandular Intraepithelial Neoplasia (CGIN)?

A

pre malignant lesion - pre invasive phase of endocervical adenocarcinoma

33
Q

Why are CGINs difficult to diagnose with a smear?

A

often hidden down inside the gland

34
Q

How do you treat mild cervical cancer?

A

increase screening

35
Q

How do you treat moderate cervical cancer?

A

surgery - LLETZ, trachelectomy (fertility sparing), radical hysterectomy
radiotherapy followed up by brachytherapy
chemo therapy - give before treatement (cisplatin, carboplatin, paclitaxol)

36
Q

What is the 5 yr survical for cervical cancer with vaginal involvement?

A

75-78%

37
Q

What is the 5 yr survical for cervical cancer with lower vaginal or pelvic side wall involvement?

A

47-50%

38
Q

What is the 5 yr survical for cervical cancer with bladder/rectum involvement?

A

20-30%

39
Q

What % of cervical cancers does endocervical adenocarcinoma make up?

A

5-25%

40
Q

What are the risk factors for endocervical adenocarcinoma?

A

higher socioeconomic class
later onset of sexual activity
smoking
HPV - esp 18

41
Q

What two populations does vulvar intraepithelial neoplasia affect?

A

young women - recurrent or persistant

older women - greater risk to progress to invasive squamous carcinoma

42
Q

What can vulvar invasive squamous carcinoma arise from?

A

normal epithelium or VIN

43
Q

Who does vulvar invasive squamous carcinoma affect?

A

elderly women

44
Q

How does vulvar invasive squamous carcinoma present?

A

ulcer or exophytic mass

spreads to inguinal lymph nodes

45
Q

What is the treatment for vulvar invasive squamous carcinoma?

A

radical vulvectomy and inguinal lympahdenoctomy

46
Q

What is the 5yr survival for vulvar invasive squamous carcinoma if node -ve and +ve?

A 
-ve = 90%
\+ve = <60%
47
Q

What is Vulvar pagets disease?

A

crusting rash
tumour arises from the sweat glands
lots of keratin on the surface

1. Reproduction (50 decks)

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