Cervix and its disorders

Question 1

What type of epithelium lines the endocervix?

Answer 1

The canal is lined with columnar epithelium.

Question 2

What type of epithelium lines the ectocervix?

Answer 2

Squamous epithelium.

Question 3

Where does cervical carcinoma originate from?

Answer 3

Transitional zone between columnar and squamous epithelia.

Question 4

What is a cervical ectropion? Is it normal?

Answer 4

Columnar epithelium visible on the surface of the cervix.

Yes, its normal in young women, especially if pregnant or taking oral contraception.

Question 5

What problems may an ectropion cause? How is this treated?

Answer 5

Discharge and bleeding.

Smear to exclude carcinoma and then local cryotherapy.

Question 6

What is a nabothian follicle?

Answer 6

Squamous epithelium has formed over endocervical cells, this traps secretions forming retention cysts.

Question 7

How would you treat a cervical polyp?

Answer 7

Avulsion.

Question 8

What abnormalities are seen in cervical intraepithelial neoplasia?

Answer 8

Atypical cells within the squamous epithelium. They exhibit large nuclei and frequent mitoses.

Question 9

What are the grades of CIN? What do they mean?

Answer 9

CIN 1-3. How many thirds of the squamous epithelium are dyskariotic cells.

1 = mild, lower third only

2 = moderate, lower 2/3

3 = severe, full thickness. This is carcinoma in situ.

Question 10

What is the prognosis in untreated CIN 2/3?

Answer 10

Cervical cancer within 10y.

Question 11

What is the most important risk factor for CIN? What are the others?

Answer 11

Most important = HPV 16, 18, 31, 33.

Other RF: Oral contraceptive use, smoking, immunocompromise.

Question 12

At what age and how often are cervical smears done?

Answer 12

From 25y, every 3y.

From 50-64 every 5y.

65 and above, only if not screened since 50, or recent abnormal test.

Question 13

What is the technique for using the Thinprep brush?

Answer 13

Stick it on the cervix and rotate clockwise 5 times.

Question 14

What are the next steps for an abnormal smear? (different for each grade)

Answer 14

Borderline / mild, HPV negative: back to routine follow up.

Borderline / mild, HPV positive: Colposcopy.

Moderate: Colposcopy.

Severe: Urgent colposcopy.

Cervical glandular intraepithelial neoplasia: Colposcopy.

Question 15

What solutions do you use in colposcopy to visualise the abnormal cells?

Answer 15

Acetic acid - dyskariotic cells stain white.

After this, use iodine - normal cells stain black, allows you to visualise the affected area.

Question 16

What treatment is given if abnormalities are found at colposcopy?

Answer 16

LLETZ - long loop excision of the transformation zone.

Question 17

What are the two most common cervical malignancies?

Answer 17

Squamous cell carcinoma - 90%.

Adenocarcinomas - 10%.

Question 18

What are the risk factors for cervical malignancy?

Answer 18

Same as CIN - HPV, OCP, smoking, immunosuppression.

Question 19

What is the clinical presentation of cervical carcinoma?

Answer 19

Postcoital bleeding.

Offensive discharge.

Irregular bleeding.

Postmenopausal bleeding.

Late features: pain, uraemia, haematuria, rectal bleeding.

Question 20

What investigations would you perform in cervical carcinoma?

Answer 20

To confirm diagnosis: biopsy.

To stage: vaginal and rectal exam, MRI.

To assess fitness for surgery: CXR, FBC, U&E.

Question 21

How do you treat cervical carcinoma? (stage1a, 1-2a, 2b and above)

Answer 21

Stage 1a: cone biopsy. Or hysterectomy in older women.

Stage 1 and 2a: radical hysterectomy or chemo-radio (if LN involvement)

Stage 2b or worse: chemo-radio