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.
What vagina infections can be picked up on smear testing?
Bacterial vaginosis
Thrush
Trichomonas vaginalis
What is lichen sclerosis et atrophicus associated with?
Vulval squamous carcinoma.
What SCC vulval cancer occurs in under 60s?
Associated with vulval intraepithelial neoplasia; associated with CIN and HPV.
What SCC vulval cancer occurs in over 60s?
Associated with dermatoses. Well differentiated keratinising tumours, lichen sclerosis is common.
