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Gynaecology > Cervix and its disorders > Flashcards

Cervix and its disorders Flashcards

1
Q

what are the two areas of the cervix

A

endo and ectocervix

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2
Q

what kind of epithelium covers the ectocervix

A

squamous epithelium

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3
Q

what kind of epithelium covers the endocervix

A

glandular epithelium

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4
Q

why is there two different types of cervix and why is it a high risk area for malignant change

A

partial eversion occurs in puberty exposing to the different pH of the vagina leading to squamous metaplasia which has a risk for cancerous change

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5
Q

what is the lymphatic drainage of the vagina/uterus

A

obturator and internal/external iliac nodes to common ilial and paraaortic

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6
Q

what is a cervical ectropion

A

erosion of the cervix revealing columnar epithelium, particularly common in younger people taking the pill/that are pregnant

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7
Q

what are the symptoms of a cervial ectropion

A

post-coital bleeding

vaginal discharge

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8
Q

how do you manage cervical ectropion

A

smear to exclude cancer

cryotherapy is curative

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9
Q

what is acute cervicitis and what are the clinical features

A

rare, complication of STIs, ulceration and infection with severe prolapse

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10
Q

what is chronic cervicitis and how do you treat it

A

most common form of vaginal discharge, usually from an ectropion, treat as an ectropion

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11
Q

what is a cervical polyp

A

benign tumours of endocervical epithelium

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12
Q

what is the most common age group for cervical polyps

A

> 40

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13
Q

what are symptoms of cervical polyps

A

post coital bleeding

vaginal discharge

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14
Q

how do you manage cervical polyps

A

smaller ones may be excised but any bleeding/large lesions may need to be investigated for cancer

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15
Q

what are nabothian follicles

A

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

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16
Q

what is cervical intraepithelial neoplasia

A

the presence of abnormal cells in the squamous epithelium

17
Q

how are CIN cells described

A

dyskaryotic due to increased nuclear:cytoplasm ratio

18
Q

what is the grading of CIN and how does that relate to the chance of cancerous progression in 5-15 years

A

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

19
Q

What are the peak ages for CIN

A

25-29

95% are <49

20
Q

what is the aetiology of CIN

A 
HPV
sexual contact at an early age 
smoking
OCP
immunocompromisation
21
Q

what is the pathology of HPV in the context of CIN

A

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

22
Q

how do you diagnose CIN

A

CIN is asymptomatic so smears are the only way to catch it

23
Q

what is the cervical smear screening regime

A

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

24
Q

what is the role of colposcopy in cervical smears

A

normal/ borderline hpv -ve smears are not followed up
HPV +ve borderlines are followed up
moderate+ are followed up

25
Q

how do you treat CIN

A

CIN2/3 = large loop excision of transformation zone via diathermy

26
Q

what are the complications of CIN treatment

A

they’re rare

haemorrhage
preterm delivery in the future

27
Q

what are the peak ages of cervical cancer

A

30s and 80s

28
Q

what kind of cancer are cervical cancers usually

A

squamous cell carcinoma 90-95%

5-10% are adenocarcinomas originating from the columnar epithelium

29
Q

what are clinical features of cervical cancers

A 
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)
30
Q

how does cervical cancer spread

A 
locally to parametrium and vaginal wall 
lymphatic spread is early 
rarely there is ovarian spread 
blood-bourne spread is late 
staging is clinical
31
Q

how do you stage cervical cancer

A

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

32
Q

how do you investigate suspected cervical cancer

A

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

33
Q

how do you treat cervical cancer

A

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

34
Q

what are the complications for radical abdominal hysterectomy

A

Haemorrhage

Fistula

Ureteric and bladder damage

Voiding problems

Lymph accumulation

35
Q

what is involved in a radical abdominal hysterectomy for cervical cancer

A

pelvic node clearance, hysterectomy , removal of parametrium and upper 1/3 of the vagina

ovaries are left in young women to prevent menopause

36
Q

what is a radical trachelectomy

A

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

37
Q

what is the review programme for cervical cancer

A

3 months, 6 months and the every 6 months for 5 years

38
Q

what are poor prognostic indicators for cervical cancer

A 
lymph involvement 
advanced clinical stage 
large primary tumour
poor differentiation 
early recurrence
39
Q

what does death usually occur from in cervical cancer

A

uraemia due to ureteric obstruction

Gynaecology (14 decks)

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