Cervix conditions Flashcards
What is Cervicitis? What causes it (4)? RF?
Inflammation of the cervix. Complications: PID
Causes:
- STI: gonorrhoea, chlamydia, herpes, trichomoniasis, HPV
- BV
- Allergy: spermicides, contraceptives, douches
- Irritation: tampons, pessaries, diaphragm
RF:
- 15-25y, high risk sex behaviour (UPSI, multiple partners etc), sexual intercourse at an early age, Hx of STIs
Clinical features of Cervicitis
Dx is made clinically
- PV purulent discharge (most common syx)
- Abnormal bleeding: IMB, PCB
- Dypareunia
- Other syx: dysuria, lower abdo pain, vulvar or vaginal irritation
Investigations of Cervicitis (6)
(1. ) Pelvic ex + speculum: check for discharge, swelling, tenderness, bleeding
- Vesicles = herpes, strawberry cervix = trichomoniasis
(2. ) Pregnancy test
(3. ) Swab: easily induced bleeding indicates cervicitis
(4. ) Microscopy: Wet mount examination of cervical discharge
(5. ) NAAT of vaginal discharge for dx of gonorrhoea or chlamydia
(6. ) OSOM trichomonas rapid test allows for detection of trichomonas
Management of Cervicitis
- If allergy/irritation: avoid triggers
- Abx if STI/BV. Important to finish Rx before having sex again. Sexual partners to be treated too
BV = PO metronidazole for 5-7d
Chlamydia = doxycycline for 7d
Gonorrhoea = azithromycin after NAAT/swab
What is cervical ectropion + RF?
- It is where the columnar epithelium of the endocervix (usually lines cervical canal) extends out to the ectocervix (outer area of cervix).
- These cells are more fragile and are more likely to bleed, mucus production, infection.
- Not associated with cervical cancer
RF:
- younger women, COCP, pregnancy
Clinical features of cervical ectropion
- Asyx, usually found incidentally on speculum ex
- PV bleeding, PCB
- Dyspareunia
- PV discharge
o/e
- Speculum = well-demarcated border (transformation zone)
Management of cervical ectropion
(1. ) No Rx if asyx.
- Typically resolves when pt older, not pregnant, not on COCP
(2. ) Colposcopy + cauterisation with silver nitrate or cold coagulation
- Stops problematic bleeding
What is Cervical Dysplasia?
- Pre-cancerous condition in which abnormal cell growth occurs on the surface of the lining of the cervix or endocervical canal.
- Dysplasia is graded using CIN
- This does not mean it is cancer h/e if not treatment it may develop into cancer
What is Cervical Intraepithelial Neoplasia (CIN)?
- Grading system to assess level of DYSPLASIA within cervix.
- CIN/dysplasia is dx with a BIOPSY at colposcopy (note: dyskaryosis is on smear results)
Grades are:
- CIN I = mild, likely to return to normal without Rx
- CIN II = moderate, likely to progress to cancer if untreated
- CIN III = severe, very likely to progress to cancer if untreated
Who and when is cervical screening offered?
- Sexually active women 25-64
- 3 yearly for 25-50y
- 5 yearly for 50-64y
- Annually for HIV
How is cervical smear assessed?
- Smear shows if +ve or -ve HPV
- +ve HPV are investigated further to see if there are any cell changes (dyskaryosis)
- if cell changes present, pt is sent for colposcopy and biopsy (dysplasia).
Management of smear results
- Inadequate sample - repeat smear after 3m
- HPV negative = routine call (3y/5y)
- HPV positive + normal cytology = repeat at 12m
- HPV positive + abnormal cytology = refer for colposcopy
What is the most common type of cervical cancer?
squamous cell carcinoma (80%)
Causes + RF of cervical cancer
- Most commonly caused by HPV (strains 16 + 18), it is a STI
RF:
- Inc risk of catching HPV (multiple partners, early sexual activity, not using condoms etc)
- Non-engagement with screening
- Smoking
- HIV (HIV pts offered yearly smears)
- Inc number of full-term pregnancies
- FH
CLinical features of cervical cancer
- Asyx
- Abnormal PV bleeding i.e. IMB, PCB, PMB
- PV discharge
- Pelvic pain
- Dyspareunia
Ix of cervical ca
(1. ) Pelvic exam + speculum
- Abnormal cervix appearance = ulceration, inflammation, bleeding, visible tumour
- Urgent referral for colposcopy if abnormal appearance
(2. ) Smear
(3. ) Colposcopy +/- biopsy
Mx of cervical ca
Based on FIGO staging
(1. ) CIN/early ca = LLETZ or Cone biopsy/trachelectomy
- LLETZ: large loop excision of the transformation zone
- Cone biopsy: cone-shaped piece of cervix removed using scalpel and sent to histology
(2. ) Stage 1B-2A = Radical hysterectomy, chemotherapy, radiotherapy
(3. ) Stage 2B-4A: Chemotherapy and radiotherapy
(4. ) Stage 4B: Management may involve a combination of surgery, radiotherapy, chemotherapy and palliative care
What is Cervical cyst? RF? Clinical features?
- AKA nabothian cysts/follicles /mucinous retention cysts
- Mucus retention fluid-filled cysts often seen on surface of cervix. Unrelated to cervical cancer.
- Columnar epithelium of endocervix (the canal) produces cervical mucus.
- When the squamous epithelium of the ectocervix slightly covers the mucus-secreting columnar epithelium, the mucus becomes trapped and forms a cyst.
- RF: after childbirth, minor trauma, cervicitis
Clinical features
- Fluid filled cyst on cervix
- Usually <1cm in size
- Harmless
Mx of Cervical cyst?
- Reassure, no Rx necessary, resolves spontaneously
- Colposcopy + excision/biopsy if dx uncertainty
What is Cervical Incompetent/ insufficiency
- Weak cervical tissue causes or contribute to premature birth or miscarriage due to absence of uterine contractions or labour (painless cervical dilatation), owing to a functional or structural defect.
- Normally, cervix dilates only when labor starts, in response to contractions of the uterus.
- However, in some women, tissues of the cervix are weak. - As a result, the cervix may dilate long before baby is due, and baby may be delivered too early.
- Usually occurs in 2nd or 3rd trimester
Causes of Cervical Incompetent/ insufficiency
- Defect of Mullerian ducts
- Ehlers-Danlos syndrome or Marfans syndrome
- Trauma = during childbirth, surgical procedures
Clinical features of Cervical Incompetent/ insufficiency
Usually dx in context of miscarriage occurring after 12-14w or in premature labour. It is not identified till a women delivers.
- Painless dilatation of the cervix
- Second trimester deliveries
Ix for Cervical Incompetent/ insufficiency
(1. ) TV USS – assess length of cervix, check if membranes are protruding through cervix
(2. ) Pelvic exam – amniotic fluid protruding through
Mx for Cervical Incompetent/ insufficiency
(1. ) Promoting full term pregnancies:
- Regular prenatal care
- Healthy diet
- Manage weight
- Avoid smoking + alcohol
(2.) Cervical stitch (cerclage) - ribbon tied around cervix
