cervix in health and disease

Question 1

Outline the histology of the normal cervix

Answer 1

The ectocervix is covered by non-keratinising, stratified squamous epithelium, either native or metaplastic.

the squamous epithelium is composed of multiple layers, the basal, paranasal, intermediate, superficial layer

the endocervix is covered by a simple columnar epithelium that secretes mucus

mucinous columnar epithelium lines the surface and the underlying glands.

Question 2

Describe the transformation zone

Answer 2

The place where the endocervix meets the ectocervix, a place of constantly dividing cells that are undergoing metaplasia and change.

Question 3

Describe the changes in the transformation zone post menopause

Answer 3

Relative deficiency in estrogen, so the SCJ recedes upwards into the canal so the transformation zone is located in the endocervix, this is due to a lack of estrogen.

Question 4

What are the functions of the cervix

Answer 4

• Produces mucus to facilitate sperm migration
• acts as a barrier to ascending infection
• holds a developing pregnancy in place
• effaces and dilates to enable vaginal birth.

Question 5

What are some physiological changes to the cervix during pregnancy

Answer 5

-Hypertrophies, but not as much as the uterus
-becomes softer, increased vascularity, glands
become distended with mucus, ‘mucus plug’
-prominent ectropion (migration of columnar epithelium onto the ectocervix)
-remains elongated until the onset of labour.

Question 6

What are some risk factors to HPV infection and related changes

Answer 6

• Smoking
• multiple sexual partners
• immune compromise
• low socio-economic status

Question 7

What are current treatments for cervical cancer

Answer 7

1a cone biopsy/ excision
1b radical hysterectomy/ radical trachelectomy
1b2 chemo-radiotherapy

Question 8

How do we investigate cervical cancer

Answer 8

Colposcopy
cytology
biopsy