Cervix and its disorders Flashcards
what are the two areas of the cervix
endo and ectocervix
what kind of epithelium covers the ectocervix
squamous epithelium
what kind of epithelium covers the endocervix
glandular epithelium
why is there two different types of cervix and why is it a high risk area for malignant change
partial eversion occurs in puberty exposing to the different pH of the vagina leading to squamous metaplasia which has a risk for cancerous change
what is the lymphatic drainage of the vagina/uterus
obturator and internal/external iliac nodes to common ilial and paraaortic
what is a cervical ectropion
erosion of the cervix revealing columnar epithelium, particularly common in younger people taking the pill/that are pregnant
what are the symptoms of a cervial ectropion
post-coital bleeding
vaginal discharge
how do you manage cervical ectropion
smear to exclude cancer
cryotherapy is curative
what is acute cervicitis and what are the clinical features
rare, complication of STIs, ulceration and infection with severe prolapse
what is chronic cervicitis and how do you treat it
most common form of vaginal discharge, usually from an ectropion, treat as an ectropion
what is a cervical polyp
benign tumours of endocervical epithelium
what is the most common age group for cervical polyps
> 40
what are symptoms of cervical polyps
post coital bleeding
vaginal discharge
how do you manage cervical polyps
smaller ones may be excised but any bleeding/large lesions may need to be investigated for cancer
what are nabothian follicles
squamous epitheloum growth over the columnar secretory epithelium, secretions get trapped under the epithelium forming cyst like structures - appearing like opaque like swelling on the ectocervix
what is cervical intraepithelial neoplasia
the presence of abnormal cells in the squamous epithelium
how are CIN cells described
dyskaryotic due to increased nuclear:cytoplasm ratio
what is the grading of CIN and how does that relate to the chance of cancerous progression in 5-15 years
CIN 1 = mild (abnormal cells only found in lower 1/3 of epithelium 20% chance of progressing to cervical cancer in 5-15 years
CIN 2 = moderate (abnormal cells in lower 2/3 of epithelium) 50% chance in 5-15 years
CIN 3 = full thickness atypical presentation
80% chance of progression in 5-15 years
What are the peak ages for CIN
25-29
95% are <49
what is the aetiology of CIN
HPV sexual contact at an early age smoking OCP immunocompromisation
what is the pathology of HPV in the context of CIN
Transformational zone metaplasia is interrupted by viral DNA incorporating itself into the cellular DNA, inactivating key tumour suppressor genes which pushes the cell into mitosis
Due to increased cellular turnover, mutations can accumulate
Viruses can also cause changes to avoid the immune system which is why immunocompromised patients are at risk
how do you diagnose CIN
CIN is asymptomatic so smears are the only way to catch it
what is the cervical smear screening regime
25-49 every 3 years
49-65 every 5 years
<25 not done
>65 only done if theyve had previous abnormal smears. or if theyre only been screened from 50
what is the role of colposcopy in cervical smears
normal/ borderline hpv -ve smears are not followed up
HPV +ve borderlines are followed up
moderate+ are followed up
how do you treat CIN
CIN2/3 = large loop excision of transformation zone via diathermy
what are the complications of CIN treatment
they’re rare
haemorrhage
preterm delivery in the future
what are the peak ages of cervical cancer
30s and 80s
what kind of cancer are cervical cancers usually
squamous cell carcinoma 90-95%
5-10% are adenocarcinomas originating from the columnar epithelium
what are clinical features of cervical cancers
post-coital discharge offensive vaginal discharge intermenstrual bleeding post-menopausal bleeding pain (late) uraemia (late) rectal bleeding (late) ulcer/mass visible to naked eye (late)
how does cervical cancer spread
locally to parametrium and vaginal wall lymphatic spread is early rarely there is ovarian spread blood-bourne spread is late staging is clinical
how do you stage cervical cancer
1a(i) + 1a(ii) are microscopic and differ by invasion lateral spread
1b(i) - clinically visible <4cm
1b(ii) = clinically visible >4cm
stage 2 = vaginal invasion but not pelvic side wall
2a (i) = <4cm with involvement of upper 2/3 of vagina
2a(ii) = >4cm
2b = invasion of parametrium
stage 3 = lower vaginal/pelvic side wall invasion
stage 4 = invasion of bladder or rectal mucosa, beyond true pelvis
how do you investigate suspected cervical cancer
biopsy
Vaginal and rectal examination is done under GA to determine local spread
Cystoscopy detects bladder involvement
MRI detects local spread and lymph node involvement
how do you treat cervical cancer
stage 1a(i) - cone biopsy as lymph node spread risk is very low (0.5%)
1a(ii)-2a - chemoradiotherapy or radical abdominal hysterectomy
2b+ - chemoradiotherapy with platinum agents, paliation for bone pain/haemorrhage done via radiotherapy
what are the complications for radical abdominal hysterectomy
Haemorrhage
Fistula
Ureteric and bladder damage
Voiding problems
Lymph accumulation
what is involved in a radical abdominal hysterectomy for cervical cancer
pelvic node clearance, hysterectomy , removal of parametrium and upper 1/3 of the vagina
ovaries are left in young women to prevent menopause
what is a radical trachelectomy
Conserves fertility
Laparoscopic pelvic lymphadenectomy first performed and biopsies are done, chemo-radiotherapy is performed if the biopsy is +ve
80% of cervix and upper vagina is removed, with cervical sutures put in place to prevent an increased risk of preterm delivery
what is the review programme for cervical cancer
3 months, 6 months and the every 6 months for 5 years
what are poor prognostic indicators for cervical cancer
lymph involvement advanced clinical stage large primary tumour poor differentiation early recurrence
what does death usually occur from in cervical cancer
uraemia due to ureteric obstruction
