CERVIX Flashcards
This inflammatory condition is characterised by loads of lymphocytes in the sub-epithelial tissue (sub-epithelial reactive lymphoid follicles)
Follicular cervicitis
When might a cervical polyp cause bleeding?
If it becomes ulcerated
The squamo-columnar junction is very vulnerable in early life, what could influence this
- age at first intercourse
- long term use of OCP
- non-use of barrier contraception
Effect of smoking on cervical cancer risk
Increases risk times THREE
Cervical intraepithelial neoplasia is caused by which types of HPV?
HPV 16 and 18
How long does it take for HPV infection to transform to high grade CIN?
6 months - 3 years
How long does it take for high grade CIN to transform into invasive cancer?
5-20 years
What is the pre-invasive stage of cervical cancer?
Cervical intraepithelial neoplasia
Where does cervical intraepithelial neoplasia occur? What type of cells?
- Occurs in the transformation zone
- dysplasia of squamous cells
- detectable by cervical screening
Percentage of CIN1 that progress to invasion?
1%
Percentage of CIN2 that progress to invasion
5%
Percentage of CIN3 that progress to
> 12%
Stage 1 cervical cancer
Confined to cervix
Stage 2 cervical cancer
Spread to adjacent organs (vagina, uterus etc)
Stage 3 cervical cancer
Involvement of pelvic wall
Stage 4 cervical cancer
Distant metastases or involvement of rectum or bladder
Symptoms of invasive cervical carcinoma
Abnormal bleeding:
- post coital
- post menopause
- brownish or blood stained vaginal discharge
- contact bleeding - friable epithelium
Pelvic pain
Haematuria/urinary infections
Ureteric obstruction / renal failure
Spread of squamous carcinoma
Local - uterine body, vagina, bladder, ureters, rectum
Lymphatic - EARLY, pelvic, para-aortic nodes
Haematogenous - LATE, liver, lungs, bone
Lymphatic spread of cervical carcinoma
This spread is EARLY
-pelivc, para-aortic nodes
Haematogenous spread of cervical carcinoma
This spread is LATE
-liver, lungs, bone
What is CGIN?
Cervical glandular intraepithelial neoplasia (CGIN)
CGIN is the preinvasive phase of which type of cancer
Endocervical adenocarcinoma
What is the preinvasive phase of ednocervical adenocarcinoma?
CGIN
Which HPV is associated with cervical adenocarcinoma
HPV 18
Which age groups get vulval intraepithelial neoplasia?
Bimodal incidence:
Young women and older women
Can present as an ulcer of an exophytic mass
Often but not always HPV related
Crusting rash
Vulvar pagets disease
Where does vulvar pagets disease arise from?
Tumour cells in epidermis (CONTAIN MUCIN !!) - cancer arises from the sweat glands in the skin
What do the tumour cells contain in vulvar paget’s disease?
Tumour cells contain mucin !!
How does vulvar invasive squamous carcinoma present?
In elderly women, as an ulcer or as an exophytic mass
Melanoma of the vagina?
This is vary rare, but may present as a polyp
What type of cells will you see in cervicitis?
Subeptihelial reactive lymphoid follicles
How might vulval carcinoma present?
Very itchy
May present as a nodule (this could then ulcerate) or may present as a cauliflower growth
-burning, tingling
-sex may be sore
Smoking effect on cervical cancer
3x risk
Condyloma Acuminatum: thickened “papillomatous” squamous epithelium with cytoplasmic vacuolation (“koilocytosis”)
HPV
Which cells are affected in CIN?
Dysplasia of squamous cells
Stage 1A1
Depth up to 3mm
Width up to 7mm
Stage 1A2
Depth up to 5mm
Width up to 7mm
Stage 1B
Confined to cervix
Stage 2A
Spread to adjacent organs (vagina, uterus etc)
Stage 3
Involvement of pelvic wall
Stage 4
Distant metastases or involvement of rectum or bladder
Lymphatic spread of squamous carcinoma?
Lymphatic spread it early to pelvic and para-aortic nodes
Haematogenous spread is late to liver, lungs and bone
Which nodes does vulvar invasive squamous carcinoma spread to and why is this important?
Spreads to inguinal nodes
-important prognostic factor
Crusting rash.
Tumour cells in epidermis, contain mucin
Pagets disease
Arises from sweat glands
What is it about HPV that increases risk of cervical cancer?
PERSISTENCE increases risk of disease
Mild karyotosis management
Check HPV status
if negative, patient goes back to routine recall
If HPV positive –> patient is referred for colposcopy
Moderate karyotosis management
This is consistent with CIN II - refer for coloposcopy
Severe dyskaryosis management
This is consistent with CIN III - refer for colposcopy
Suspected invasive cancer management
Refer for urgent colposcopy (within 2 weeks)
Results from smear are inadequate, what should you do?
Repeat smear - if persistent (3 inadequate samples - assess by colposcopy)
Histology findings of CIN
- the cells take longer to mature (so you’ll see lots more immature cells, like me lol)
- Nuclear abnormalities (hyperchromasia, increased nucleocytoplasmic ratio, pleomorphism)
- Excess mitotic activity
What does koilocytosis indicate?
Indicates HPV infection
This cancer is associated with a higher SE class
Adenocarcinoma
This cancer is associated with a later onset of sexual activity
Adenocarcinoma
