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Repro > Cervix > Flashcards

Cervix Flashcards

1
Q

What is the cervix?

A

Part of uterus below the internal os

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2
Q

What area of uterus is most predisposed to malignant change?

A

Transition zone

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3
Q

What is the transition zone?

A

Squamo-columnar junction between endocervical canal and vaginal cervix

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4
Q

Histology of vaginal cervix?

A

Squamous epithelium

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5
Q

Histology of endocervical canal?

A

Columnar epithelium

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6
Q

What is cervical ectropion/ erosion ?

A

Endocervical epithelium extends outside cervical canal to vaginal portion of cervix

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7
Q

What are nabothian cysts?

A

Mucus retention cysts on the cervix - harmless

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8
Q

What are cervical polyps?

A

Benign tumours of endocervical epithelium. May cause bleeding

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9
Q

Treatment of cervical polyps?

A

In young women - avulsed

In peri/postmenopausal women - TVS +/- hysterectomy

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10
Q

Consequence of cervicitis?

A

Infertility if Fallopian tube damage

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11
Q

Causes Of cervicitis?

A

Chlamydia
Gonococci
Herpes simplex
If chronic may be mixed infection

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12
Q

How often are HIV +ve smeared?

A

Every year

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13
Q

How often are age 25-50 year olds smeared?

A

Every 3 years

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14
Q

How often are aged 50-64years old smeared?

A

Every 5 years

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15
Q

If smear is normal, next action?

A

Repeat in 3 years

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16
Q

If smear shows inflammation, next actions?

A

Repeat in 6 months
Swabs
Colposcopy after 3 abnormal p

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17
Q

If smear borderline, next actions?

A

High risk HPV test - if positive refer for colposcopy. If negative repeat in 3 years

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18
Q

If smear shows mild dyskaryosis, next actions?

A

High risk HPV test - if positive refer for colposcopy. If negative repeat in 3 years

19
Q

If smear shows moderate-severe dyskaryosis, next actions?

A

Refer to colposcopy

20
Q

If smear shows suspected invasion, next action?

A

Urgent colposcopy

21
Q

If smear shows abnormal glandular cells, next action?

A

Urgent colposcopy

22
Q

What is CIN?

A

Cervical intraepithelial neoplasia.

Pre-invasive stage of cervical cancer

23
Q

Features of CIN?

A

Dysplasia of squamous cells
Nuclear abnormalities - increased nucleocytoplasmic ratio
Excess mitotic activity

24
Q

Where does CIN occur?

A

Transformation zone

25
Q

Risk factors for CIN?

A

Persistent high risk HPV infection (16,18)
Exposure to HPV by having multiple partners
Smoking
Immunocompromised
Decreased use of barrier contraceptives and increased use of oral contraceptives

26
Q

Changes in CIN I?

A

Abnormal cells in basal 1/3 of epithelium
Increased number of mitotic figures in lower 1/3
Surface cells quite mature but nuclei abnormal

27
Q

Changes in CIN II?

A

Abnormal cells extend to middle 1/3
Mitosis in middle 1/3
Abnormal mitotic figures

28
Q

Changes in CIN III?

A

Abnormal cells occupying full thickness of epithelium.

Mitosis, often abnormal, in upper 1/3

29
Q

Management of CIN?

A

Colposcopy - punch biopsies taken to get histological diagnosis.
LLETZ

30
Q

Management of CIN I?

A

May regress spontaneously

If HPV +ve, offer 6 monthly colposcopy and LLETZ if persistent

31
Q

Treatment of CIN II and III?

A

Excision with LLETZ

32
Q

What does cervical cancer have a strong association with?

A

HPV

Preexisting CIN

33
Q

When does cervical cancer occur?

A

2 peaks:

  • 30-39 years old
  • > 70 years old
34
Q

Symptoms and signs of cervical cancer?

A

On smear- invasion
Post-coital/ postmenopausal bleeding
Advanced disease - heavy vaginal bleeding, uteric obstruction, weight loss, bowel disturbance , pain

35
Q

Investigations of cervical cancer?

A 
FBC, U&Es, LFTs
Punch biopsy for histology
CT abdo and pelvis
MRI pelvis
Cystoscope, hysteroscopy, PR/PV exam
36
Q

Cervical cancer on colposcopy?

A

Irregular cervical surface
Abnormal vessels
Dense uptake of acetic acid

37
Q

Speculum exam of cervical cancer?

A

Irregular mass - often bleeds on contact

38
Q

Cervical cancer on bimanual exam?

A

Cervix feels roughened and hard.

If advanced - loss of fornices and cervix fixed

39
Q

Staging of cervical cancer?

A 
1a1 - <3mm depth, <7mm width
1a2 - <5mm depth, <7 mm width 
1b - confined to cervix 
II - spread to adjacent organs 
III - involvement of pelvis wall
IV - distant mets/ involvement of rectum / bladder
40
Q

Treatment of stage 1a1 cervical cancer?

A

Excision or hysterectomy

41
Q

Treatment of stage 1a2 or 1b cervical cancer?

A

Lymphadenectomy and hysterectomy

42
Q

Treatment of stage II or III cervical cancer?

A

Combined chemoradiotherapy

43
Q

Treatment of stage IV cervical cancer?

A

Chemoradiotherapy, lymohadenectomy, wertheims hysterectomy

Repro (39 decks)

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