Cervical Screening and Vulval Pathology Flashcards
endocervical cells are filled with what substance?
mucin
the endo/ectocervix is more fragile
endo (only 1 cell thick)
what is the transformation zone of the cervix?
squamocolumnar junction between ectocervical and endocervical epithelia
endocervical cells make up what epithelium?
columnar
ectocervical cells make up what epithelium?
squamous
name the cell layers of the ectocervix
exfoliating cells superficial cells intermediate cells parabasal cells basal cells BM
what can alter the position of the transformation zone?
menarche
pregnancy
menopause
why can you get physiological squamous epithelium in the cervix?
exposure of the delicate endocervical epithelium to acid can cause squamous metaplasia
the presence of what stuctures on the cervix indicate physiological squamous metaplasia?
nabothian follicles
cervicitis is often asymptomatic T or F
T
what STIs can cause cervicitis?
chlamydia
HSV
medical term for cervical pre-cancer
cervical intraepithelial neoplasia
name the 2 main cervical cancers
- squamous carcinoma
2. adenocarcinoma
what HPV strains cause cervical cancer?
16
18
what does HPV infect to cause cervical cancer?
invades epithelial cells in the cervical mucosa
risk factors for CIN/cervical cancer
vulnerability of SC junction
many sexual partners
smoking
immunosuppression
what can make the SC junction vulnerable?
young at first intercourse
long term use of COC
non-use of barrier contraception
“wrinkly, abnormal nuclei”
viral infection
describe the appearance of koilocytosis
thickened, papillomatous squamous epithelium with cytoplssmia vacuolation
what determines whether CIN has become cancer
cells need to break through the basement membrane
how long will it take for high grade CIN to become invasive cancer?
5-20 years
CIN 3 can also mean?
squamous cell carcinoma in situ
why does not everyone with HPV get cancer?
most develop immunity
Tx CIN 3
cold coagulation
laser excision of the transformation zone
CIN can be seen by the naked eye T or F
F
CIN gets worse as the cells get worse the further down the epithelium T or F
T
CIN gets worse as the cells get worse the further up the epithelium T or F
T
what is the stage between normal squamous epithelium and CIN 1
koilocytosis (HPV infection)
what does CIN look like histologically?
delay in maturation/differentiation
nuclear abnormalities eg pleomorphism
excess mitotic activity
what is pleomorphism?
variation in nuclear size and shape
define CIN 1
basal 1/3 of epithelium occupied by abnormal cells
define CIN 2
abnormal cells cover basal and middle 1/3
define CIN 3
abnormal cells occupy full thickness of epithelium
% risk of cancer if you have CIN 3
12%
symptoms of invasive carcinoma?
abnormal bleeding
pelvic pain
haematuria/urinary symptoms - invasion
ureteric obstruction/renal failure if late
hydronephrosis in cervical cancer indicates….
ureters are obstructed - stage 4
where does squamous cervical carcinoma spread to?
pelvic, para-aortic nodes
haematogenous spread goes to where in squamous cervical carcinoma?
liver
lungs
bone
if pelvic lymph nodes were involved how would the patient be treated?
not surgery, chemo/radio
what is CGIN?
preinvasive phase of endocervical adenocarcinoma; originates from endocervical epithelium
risk factors for cervical adenocarcinoma?
higher SE class
later onset sexual activity
smoking
HPV 18 in particular
what MSK disease can cause vulval intraepithelial neoplasia?
paget’s disease
older/younger women have a greater risk of progression to invasive squamous carcinoma in VIN?
older
women with VIN tend to also have IN of what structures?
cervical
vaginal
VIN is more recurrent/persistent in younger/older women
younger
presentation of vulvar invasive squamous carcinoma?
ulcer or exophytic mass on skin
vulvar squamous carcinoma tends to be well differentiated T or F
T
lymphatic spread of vulvar cancer?
inguinal LNs
Tx of vulvar squamous carcinoma
radical vulvectomy
inguinal lymphadenectomy if LNs involved
presentation of vulvar paget’s disease?
crusting rash, itching and soreness in older women
what vaginal cancer may appear as a polyp?
melanoma
who gets vaginal squamous carcinoma?
older women
