Cervical Screening and Vulval Pathology

Question 1

endocervical cells are filled with what substance?

Answer 1

mucin

Question 2

the endo/ectocervix is more fragile

Answer 2

endo (only 1 cell thick)

Question 3

what is the transformation zone of the cervix?

Answer 3

squamocolumnar junction between ectocervical and endocervical epithelia

Question 4

endocervical cells make up what epithelium?

Answer 4

columnar

Question 5

ectocervical cells make up what epithelium?

Answer 5

squamous

Question 6

name the cell layers of the ectocervix

Answer 6

exfoliating cells
superficial cells
intermediate cells
parabasal cells
basal cells
BM

Question 7

what can alter the position of the transformation zone?

Answer 7

menarche
pregnancy
menopause

Question 8

why can you get physiological squamous epithelium in the cervix?

Answer 8

exposure of the delicate endocervical epithelium to acid can cause squamous metaplasia

Question 9

the presence of what stuctures on the cervix indicate physiological squamous metaplasia?

Answer 9

nabothian follicles

Question 10

cervicitis is often asymptomatic T or F

Answer 10

T

Question 11

what STIs can cause cervicitis?

Answer 11

chlamydia

HSV

Question 12

medical term for cervical pre-cancer

Answer 12

cervical intraepithelial neoplasia

Question 13

name the 2 main cervical cancers

Answer 13

1. squamous carcinoma

2. adenocarcinoma

Question 14

what HPV strains cause cervical cancer?

Answer 14

16

18

Question 15

what does HPV infect to cause cervical cancer?

Answer 15

invades epithelial cells in the cervical mucosa

Question 16

risk factors for CIN/cervical cancer

Answer 16

vulnerability of SC junction
many sexual partners
smoking
immunosuppression

Question 17

what can make the SC junction vulnerable?

Answer 17

young at first intercourse
long term use of COC
non-use of barrier contraception

Question 18

“wrinkly, abnormal nuclei”

Answer 18

viral infection

Question 19

describe the appearance of koilocytosis

Answer 19

thickened, papillomatous squamous epithelium with cytoplssmia vacuolation

Question 20

what determines whether CIN has become cancer

Answer 20

cells need to break through the basement membrane

Question 21

how long will it take for high grade CIN to become invasive cancer?

Answer 21

5-20 years

Question 22

CIN 3 can also mean?

Answer 22

squamous cell carcinoma in situ

Question 23

why does not everyone with HPV get cancer?

Answer 23

most develop immunity

Question 24

Tx CIN 3

Answer 24

cold coagulation

laser excision of the transformation zone

Question 25

CIN can be seen by the naked eye T or F

Answer 25

F

Question 26

CIN gets worse as the cells get worse the further down the epithelium T or F

Answer 26

T

Question 27

CIN gets worse as the cells get worse the further up the epithelium T or F

Answer 27

T

Question 28

what is the stage between normal squamous epithelium and CIN 1

Answer 28

koilocytosis (HPV infection)

Question 29

what does CIN look like histologically?

Answer 29

delay in maturation/differentiation
nuclear abnormalities eg pleomorphism
excess mitotic activity

Question 30

what is pleomorphism?

Answer 30

variation in nuclear size and shape

Question 31

define CIN 1

Answer 31

basal 1/3 of epithelium occupied by abnormal cells

Question 32

define CIN 2

Answer 32

abnormal cells cover basal and middle 1/3

Question 33

define CIN 3

Answer 33

abnormal cells occupy full thickness of epithelium

Question 34

% risk of cancer if you have CIN 3

Answer 34

12%

Question 35

symptoms of invasive carcinoma?

Answer 35

abnormal bleeding
pelvic pain
haematuria/urinary symptoms - invasion
ureteric obstruction/renal failure if late

Question 36

hydronephrosis in cervical cancer indicates….

Answer 36

ureters are obstructed - stage 4

Question 37

where does squamous cervical carcinoma spread to?

Answer 37

pelvic, para-aortic nodes

Question 38

haematogenous spread goes to where in squamous cervical carcinoma?

Answer 38

liver
lungs
bone

Question 39

if pelvic lymph nodes were involved how would the patient be treated?

Answer 39

not surgery, chemo/radio

Question 40

what is CGIN?

Answer 40

preinvasive phase of endocervical adenocarcinoma; originates from endocervical epithelium

Question 41

risk factors for cervical adenocarcinoma?

Answer 41

higher SE class
later onset sexual activity
smoking
HPV 18 in particular

Question 42

what MSK disease can cause vulval intraepithelial neoplasia?

Answer 42

paget’s disease

Question 43

older/younger women have a greater risk of progression to invasive squamous carcinoma in VIN?

Answer 43

older

Question 44

women with VIN tend to also have IN of what structures?

Answer 44

cervical

vaginal

Question 45

VIN is more recurrent/persistent in younger/older women

Answer 45

younger

Question 46

presentation of vulvar invasive squamous carcinoma?

Answer 46

ulcer or exophytic mass on skin

Question 47

vulvar squamous carcinoma tends to be well differentiated T or F

Answer 47

T

Question 48

lymphatic spread of vulvar cancer?

Answer 48

inguinal LNs

Question 49

Tx of vulvar squamous carcinoma

Answer 49

radical vulvectomy

inguinal lymphadenectomy if LNs involved

Question 50

presentation of vulvar paget’s disease?

Answer 50

crusting rash, itching and soreness in older women

Question 51

what vaginal cancer may appear as a polyp?

Answer 51

melanoma

Question 52

who gets vaginal squamous carcinoma?

Answer 52

older women