Cervix Flashcards
List 5 problems with a population based cervical screening program
Cost Access False +ve results Acceptability Cultural and language barriers
What is required for a nationwide cervical screening program?
Nationwide database Skilled smear takers Low cost appointments Education programs System for notification of results Guidelines for referral Colposcopy services in all areas Skilled colposcopists Skilled labs MDT set up Guidelines for follow up Gynae-onc service availability
What are the indications for a cone biopsy?
- unsatisfactory colposcopy in woman with high grade squamous abnormality
- suspicion of early invasive cancer on cytology, biopsy or colposcopic assessment
- Mixed lesion (glandular abnormality + squamous abnormalities)
- Cytology suggests high grade lesion but not seen at colposcopy
- Concern about compliance with follow up
What conditions might be associated with ‘possible high grade squamous intra-epithelial lesion?’
- CIN1-3
- ASC-US
- ASC-H
- invasive cervical cancer
- Squamous metaplasia
- inflammation or infection
- decidualisation of cervical mucosa in pregnancy
How does pregnancy affect colposcopy assessment?
- increased vascularity
- genital oedema
- ectropion (wider TZ)
- Vaginal laxity
- patient concern for pregnancy
Describe the histogenesis of the transformation zone
Exposure of the sensitive columnar epithelium to the postpubertal acidic environment of the vagina results in squamous metaplasia.
The TZ forms between the endocervical columnar epithelium and the ectocervical squamous epithelium.
The TZ is made of squamous epithelium that used to be sensitive columnar epithelium.
What are the features of an unsatisfactory colposcopy assessment?
Inability to fully visualise the transformation zone
Inability to fully visualise the lesion
Give 6 descriptive factors associated with the surface contour of a high grade cervical lesion?
Micropapillary Microcondolomatous Hyerkeratosis Peeling Rolling edge Ulcerated
Give 3 descriptors of vascularity associated with a high grade cervical lesion?
- Punctation
- Coarse mosaicism
- Irregular vasculature
Give 2 descriptors for the topography of a high grade cervical lesion?
- raised lesions
- margins may be ill-define, irregular and variable
Describe the acetowhite reaction and iodine uptake of a high grade lesion?
- rapid and dense acetowhite uptake
- negative iodine uptake
What is the reason for the acetowhite reaction?!
acetowhite reaction occurs in the presence of cells with high nuclear density
(remember increased Nuclear:cytoplasmic ratio is a key feature of differentiation)
- In CINI the acetowhite has to penetrate to the bottom 1/3 of epithelium therefore takes longer and not as dense
What is the reason for the iodine use at colposcopy?
CIN and invasive cancer contain little glycogen
Iodine is glycophilic
Areas of good iodine uptake are reassuring
Areas with poor iodine uptake are concerning
List 4 cytological features of CINIII
Nuclear pleomorphism
High nuclear: cytoplasm ratio
Large irregular cells
Irregular chromatin formation with clumping
List 4 histological features of CINIII
- almost no differentiation
- Mitotic figures
- Cellular and nuclear hyperchromasia and pleomorphism
- involves entire thickness of epithelium but doesn’t breech basement membrane
