Cervix Flashcards
What is the cervix?
Part of the uterus below the internal os
What is the endocervical canal lined with?
Mucous columnar epithelium
The transition zone is also known as the —– - ——- junction
Squamo-columnar junction
The position of the transitional zone changes during life as a response to which 3 events?
Menarche
Pregnancy
Menopause
(also using COCP)
What is the most common cancer in females <35
Cervical
What are the 6 Wilson and Jugner Criteria
Important Health problem Treatment available Recognisable latent or early symptomatic phase Suitable screening test available Natural history of condition understood Cost effective
Why do cervical screening?
Screening can identify cell changes which may develop to be pre-cancerous
How many lives are saved per year in the UK due to cervical screening?
5,000
What is the best protection against cervical cancer?
Screening (even if you have been immunised with HPV)
TRUE/FALSE If you develop symptoms this should be picked up on screening test as usual
Meh
If symptoms then diagnostic testing NOT screening
Screening is for which two strains of HPV?
Strain 16 and 18
What percentage of cancers does screening pick up?
75%
What age range do you have to fall within in order to be eligible for cervical cancer screening?
25-64
What is the algorithm for determining coverage?
Screened population/ eligible population x 100
What is the algorithm for determining uptake?
Screened population/ Invited population x 100
TRUE/FALSE You can do a smear even if they are bleeding?
Kinda
Difficult to do a smear when bleeding
If persistent then examination of cervix and/or considered for endometrial biopsy
What do smears collect?
Cervical cells for microscopy
With smears what correlates to the severity?
Degree of dyskaryosis
What is the pre-invasive phase of cervical cancer called?
Cervical intra-epithelial neoplasia (CIN)
What strains of HPV is CIN associated with?
16, 18, 31, 33
TRUE/FALSE
Once CIN has spread down the endocervical crypts it is cancer
FLASE
It does not mean cancer- it is just the path of least resistance
What are the RF for CIN?
Persistent high risk HPV infection Multiple partners Smoking Immunocompromise OCP Lack of barrier contraception Young age for first intercourse
What does koilocytosis indicate is present?
HPV infection
How much of the epithelium does CIN I affect?
Lower basal 1/3 epithelium
With CIN III what percentage regress and what percentage progress to infection?
30% regress
10% progress to invasion
What type of carcinoma are 75-95% of malignant cervical tumours?
Squamous carcinoma
Why should squamous carcinoma of the cervix be preventable?
As it develops from pre-existing CIN therefore it should be preventable by screening
What are some symptoms of cervical cancer?
- Usually none at early invasive stage
- Abnormal bleeding
- Brownish/blood stained discharge
- Pelvic pain
- Haematuria/urinary infections
- Ureteric obstruction/renal failure
What are the 3 types of spread fo cervical cancer?
Local
Haematogenous
Lymphatic
In stage 3 cervical cancer there is involvement of the
Pelvic wall
What type of glands does adenocarcinoma form in?
Mucous secreting glands
TRUE/FALSE Squamous carcinoma of the cervix has a better prognosis than adenocarcinoma
FALSE
Adenocarcinoma has a worse prognosis
In which age group is adenocarcinoma of the cervix increasing?
Young
What is the epidemiology of adenocarcinoma of the cervix?
Higher S.E class
Later onset of sexual activity
Smoking
HPV (esp HPV 18)
What is the preinvasive phase of endocervical adenocarcinoma?
Cervical Glandular Intraepithelial neoplasia (CGIN)
If you think someone may have cervical cancer the first line is colposcopy TRUE/FALSE
FALSE
Colposcopy is part of the screening for asymptomatic pre-cancer
If you think cancer then need to do internal examination
What are the 4 types of surgery for cervical cancer
LLTEZ- up to stage 1a1
Cone biopsy- up to stage 1a2
Trachelectomy- up to stage 1b
Radical hysterectomy if confined to cervix
If you use cisplatin why does there need to be good hydration?
It is excreted by the kidneys
Which chemotherapy agent causes lots of neurological SE e.g. tinnitus, pins and needles?
Cisplatin
What is the risk that you warn all patients about who are undergoing chemotherapy?
Neutropenia
If they are going to what is the period that they will be neutropenic after chemo?
5-12 days period
Of the 80 types of HPV identified how many are known to cause infection int eh genital tract?
40
What is the shape of the DNA in HPV?
Circular, double stranded DNA, protected by capsid proteins
What does HPV 6 and 11 cause?
Genital warts
What is the period of time from HPV infection to High grade CIN?
6 months- 3 years
What is the period of time from high grade CIN to invasive cancer?
5 years - 20 years
Which age groups is vulval intraepithelial neoplasia common in?
Bimodal
- Young women
- Older women
What is the most important prognostic indicator in vulvar invasive squamous carcinoma?
Spread to inguinal lymph nodes
What is the treatment for vulvar intraepithelial neoplasia?
Radical vulvectomy
Inguinal Lymphadenopathy
What are the three things that ectropians are prone to?
Bleeding
Excess mucous production
Infection
Why do ectropians extend during puberty, with the COCP and during pregnancy?
Hormonal influence
Treatment of cervical ectropian
None if asymptomatic/pregnant/pubertal
If taking hormonal contraceptive- consider change to non-hormonal
Cautery with diathermy if the patient wishes
What is an ectropion?
A red ring around the os as endocervical epithelium extended its territory over the paler epithelium of the ectocervix
What is another name for mucous retention cysts?
Nabothian cysts
What are cervical polyps?
Pedunculated benign tumours of endocervical epithelium, localised inflammatory outgrowth
Cervical polyps are premalignant TRUE/FALSE
FALSE
Treatment of cervical polyps
Young women–> avulsion
Old women–> avulsion + TVS +- hysteroscopy
What are the two risks with cervicitis?
- Can lead to infertility
2. May mask neoplasia on a smear
What is the cause of 50% of cervicitis?
Chlamydia
Squamous carcinoma of the vagina is a disease of what age group?
The elderly
