Cervix Flashcards
What is the cervix?
Part of uterus below the internal os
What area of uterus is most predisposed to malignant change?
Transition zone
What is the transition zone?
Squamo-columnar junction between endocervical canal and vaginal cervix
Histology of vaginal cervix?
Squamous epithelium
Histology of endocervical canal?
Columnar epithelium
What is cervical ectropion/ erosion ?
Endocervical epithelium extends outside cervical canal to vaginal portion of cervix
What are nabothian cysts?
Mucus retention cysts on the cervix - harmless
What are cervical polyps?
Benign tumours of endocervical epithelium. May cause bleeding
Treatment of cervical polyps?
In young women - avulsed
In peri/postmenopausal women - TVS +/- hysterectomy
Consequence of cervicitis?
Infertility if Fallopian tube damage
Causes Of cervicitis?
Chlamydia
Gonococci
Herpes simplex
If chronic may be mixed infection
How often are HIV +ve smeared?
Every year
How often are age 25-50 year olds smeared?
Every 3 years
How often are aged 50-64years old smeared?
Every 5 years
If smear is normal, next action?
Repeat in 3 years
If smear shows inflammation, next actions?
Repeat in 6 months
Swabs
Colposcopy after 3 abnormal p
If smear borderline, next actions?
High risk HPV test - if positive refer for colposcopy. If negative repeat in 3 years
If smear shows mild dyskaryosis, next actions?
High risk HPV test - if positive refer for colposcopy. If negative repeat in 3 years
If smear shows moderate-severe dyskaryosis, next actions?
Refer to colposcopy
If smear shows suspected invasion, next action?
Urgent colposcopy
If smear shows abnormal glandular cells, next action?
Urgent colposcopy
What is CIN?
Cervical intraepithelial neoplasia.
Pre-invasive stage of cervical cancer
Features of CIN?
Dysplasia of squamous cells
Nuclear abnormalities - increased nucleocytoplasmic ratio
Excess mitotic activity
Where does CIN occur?
Transformation zone
Risk factors for CIN?
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
Changes in CIN I?
Abnormal cells in basal 1/3 of epithelium
Increased number of mitotic figures in lower 1/3
Surface cells quite mature but nuclei abnormal
Changes in CIN II?
Abnormal cells extend to middle 1/3
Mitosis in middle 1/3
Abnormal mitotic figures
Changes in CIN III?
Abnormal cells occupying full thickness of epithelium.
Mitosis, often abnormal, in upper 1/3
Management of CIN?
Colposcopy - punch biopsies taken to get histological diagnosis.
LLETZ
Management of CIN I?
May regress spontaneously
If HPV +ve, offer 6 monthly colposcopy and LLETZ if persistent
Treatment of CIN II and III?
Excision with LLETZ
What does cervical cancer have a strong association with?
HPV
Preexisting CIN
When does cervical cancer occur?
2 peaks:
- 30-39 years old
- > 70 years old
Symptoms and signs of cervical cancer?
On smear- invasion
Post-coital/ postmenopausal bleeding
Advanced disease - heavy vaginal bleeding, uteric obstruction, weight loss, bowel disturbance , pain
Investigations of cervical cancer?
FBC, U&Es, LFTs Punch biopsy for histology CT abdo and pelvis MRI pelvis Cystoscope, hysteroscopy, PR/PV exam
Cervical cancer on colposcopy?
Irregular cervical surface
Abnormal vessels
Dense uptake of acetic acid
Speculum exam of cervical cancer?
Irregular mass - often bleeds on contact
Cervical cancer on bimanual exam?
Cervix feels roughened and hard.
If advanced - loss of fornices and cervix fixed
Staging of cervical cancer?
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
Treatment of stage 1a1 cervical cancer?
Excision or hysterectomy
Treatment of stage 1a2 or 1b cervical cancer?
Lymphadenectomy and hysterectomy
Treatment of stage II or III cervical cancer?
Combined chemoradiotherapy
Treatment of stage IV cervical cancer?
Chemoradiotherapy, lymohadenectomy, wertheims hysterectomy
