Cervix Flashcards
When does cervical screening happen?
Women aged 25-65.
25-50: every 3 years.
50-65: every 5 years.
How does the SCJ form?
After puberty, the cervix grows and the junction between ecto and endo cervix is everted into the vagina. This gives a zone of unstable differentiation.
What does cervical screening involve?
Taking cells from the transformation zone to detect dyskaryosis.
How does HPV cause cervical cancer?
Persistent HPV infection with types 16/18 infects the transformation zone cells, leading to CIN.
What increases risk of HPV causing cancer?
Smoking
What is CIN?
A potentially premalignant change in squamous cells at the SCJ caused by HPV infection.
How is CIN classified?
CIN1: lower 1/3 of epithelium
CIN2: lower 2/3 epithelium
CIN3: full thickness epithelium with invasion into glands
CIN2 and 3 are high grade and are treated.
What is dyskaryosis?
Abnormal nuclear changes in a cell compared to the cytoplasm e.g. multinuclear, in squamous epithelial cells.
The higher the grade, the more likely to progress to squamous cell carcinoma.
What is a koilocyte?
A sign of viral infection in the squamous cervical mucosa.
What is colposcopy?
Involves cervix being washed with acetic acid and then taking a biopsy of an abnormal area which was reported on smear.
When should people be referred to colposcopy?
If 3 borderline nuclear abnormalities
If any dyskaryosis (if severe, refer urgently)
What changes are seen in dyskaryosis?
Low grade: cytoplasm condensation
Moderate: increased nucleus size. Possibly CIN.
Severe: increased nucleus to cytoplasm ratio, inflammatory cells. Likely CIN 2 or 2.
Invasive SCC: necrosis, inflammation, BM is breached.
What treatments are there for cervical screening abnormalities?
LETZ: done at colposcopy. Can be for diagnosis or treatment.
Thermal ablation: burn away cells.
Cone biopsy
Cryotherapy: for minor cell changes.
Hysterectomy.
What are symptoms of cervical cancer?
Pain, bleeding e.g. post-coital, irregular.
What is cGIN?
Cervical glandular intraepithelial neoplasia. Premalignant changes in the glandular epithelium which can lead to adenocarcincoma.
