Cervical, vulval pathology 2 Flashcards
How do invasive cervical carcinomas typically present and what do some rarely do making detection difficult?
As an unclerating mass protruding into the vagina
Note some carcinomas may grow inwards (rather than outwards to the vagina) resulting in a ‘barrel-shaped cervix’ adenocarcinomas are the most common type of carcinoma to potetially grow in this fashion, making it difficult to detect on cervical screening resulting in them potnetially being caught much later on
What is the most common type of cervical carcinoma ?
Squamous
Where do squamous cervical carcinomas arise ?
In the transformation zone developing from pre-exisiting CIN
Recall the guidelines for cervical screening in scotland
All women who are registered with a GP are invited for cervical screening:
- aged 25 to 49 – every 3 years
- aged 50 to 64 – every 5 years
- over 65 – only women who haven’t been screened since age 50 or those who have recently had abnormal tests
What are the symptoms of invasive cervical carcinomas
Usually no symptoms at microinvasive and early invasive stages (detected at screening):
- Abnormal bleeding
- Post coital
- Post menopausal
- Brownish or blood stained vaginal discharge
- Contact bleeding – friable epithelium
Pelvic pain
Haematuria / urinary infections
Ureteric obstruction / renal failure
What is the different staging of squamous cervical carcinoma ? (FIGO staging for cervical cancers)
Stage 1 - tumours confined to the cervix
- Stage 1A1 - depth up to 3mm, width up to 7mm
- Stage 1A2 - depth up to 5mm, width up to 7mm
- Low risk of lymph node metastases
- Stage 1B – clinically visible or dimensions greater than 1A
Stage 2 - spread to adjacent organs (vagina, uterus, etc..)
Stage 3 - involvement of pelvic wall
Stage 4 - distant metastases or involvement of rectum or bladder.
Describe the different areas squamous carcinoma can spread too
- Local e.g. uterine body, vagina, bladder, ureters, rectum
- Lymphatic (in early spread) e.g. pelvic, para-aortic nodes
- Haematogenous (in late spread) e.g. liver, lungs, bone
Appreciate that squamous carcinoma can be graded from:
Well-differentiated to poorly differentiated
What implications does this have on prognosis ?
Poorly differentiated carcinomas tend to have a more aggressive progression and ==> worse prognosis
What is the precursor lesion for cervical adenocarcinomas ?
Cervical Glandular Intraepithelial Neoplasia (CGIN) - note this is not graded like CIN
Where does Cervical Glandular Intraepithelial Neoplasia (CGIN) originate in the cervix ?
Endocervical epithelium ==> adenocarcinomas of the cervix typically arise from the endocarvical epithelium (columnar)
Why is it more difficult to diagnose cervical adenocarcinomas comapred to squamous ?
Becuase they arise in endocervical epithelium which is not as easily swabbed during smear test
What are the risk factors for endocervical andenocarcinoma ?
- Higher Socioeconmic Class
- Later onset of sexual activity
- Smoking
- HPV again, particularly HPV18.
Which carries the worse prognosis - adenocarcinoma or squamous carcinoma of the cervix?
Adenocarcinoma as often caught later
What type of cervical carcinoma is shown here ?
Squamous cell carcinoma of the cervix, its characterisitcs include:
- normal features of cancer but also better differentiated ones may have kertain perals seen (the swirlls of pink)
- Compared to adenocarcinoma, have more irregular cellular and nuclear shapes, more cytoplasmic density, more chromatin granularity, more hyperchromasia
What type of cervical cancer is shown
Adenocarcinoma
Increased number of glands plus normal malignant features
Define what lichen sclerosus is and where is commonly affects
- It is an inflammatory condition which usually affects the genitalia and is more common in elderly females.
- Lichen sclerosus leads to atrophy of the epidermis with white plaques forming
Describe the appearance of vulval lichen sclerosus
- Ivory or porcleain-white, shiny lesions
- Commonly associated with areas of purpura
