Cervix pathology

Question 1

Symptoms of advanced cervical cancer

Answer 1

Post-coital bleeding

Foul smelling discharge

Intermenstrual bleeding

Advanced weight loss

Question 2

Majority of cervical cancer types

Answer 2

Squamous cell carcinoma

• More differentiated= more keratin production
• Correlated with how closely it resembles cell of origin

Question 3

Sources of oestrogen

Answer 3

Ovaries

Adrenal glands

Subcutaneous fat

Question 4

Follicular phase of ovary

Answer 4

Proliferative phase of the endothelium
- Approx 7 days

Tubular glands, mitotic activity

Dense stroma (differentiated)

Question 5

Secretory phase of endothelium

Answer 5

Early phase, Day 15-16

• Presence of corpus luteum
• Subnuclear vacuolation

Late phase
- Long, cork-screw glands

Question 6

Indications for hysterectomy

Answer 6

Fibroid uterus

Early cervical carcinoma

Endometrium carcinoma

Ovarian cancer

Uterine prolapse

Dysfunctional uterine bleeding.

Question 7

Best time to sample endometrium for infertility investigation

Answer 7

Luteal phase- Day 16 onwards

- After ovulation, when you can tell if ovulation has occurred.

Question 8

Dysfunctional uterine bleeding

Answer 8

Bleeding without mechanical cause

Examples

• Menorrhagia
• Intermenstrual bleeding
• Polymenorrhoea
• Metrorrhagia

Question 9

Fibroid uterus

Answer 9

Most common tumour of the uterus
- Leiomyoma (benign)

Malignant- leiomyosarcoma

Question 10

Leiomyoma clinical presentation

Answer 10

Abnormal uterine bleeding (Metrorrhagia)

Pain (dysmenorrhoea)

Urinary symptoms (pressure effects)

Impaired infertility (recurrent miscarriage)

Pregnancy

• Preterm labour
• Obstructed labour

Question 11

Mirena and DUB

Answer 11

Secretion of progesterone–> Suppresses endometrial proliferation–> Less bleeding

Question 12

Subserosal fibroid complications in pregnancy

Answer 12

Preterm labour

Obstructing/ complicated labour

Acute abdomen (severe pain) from infarction

Question 13

Investigations for carcinoma of the endometrium

Answer 13

Hysteroscopy + biopsy

Ultrasound- assess thickness

MRI -local spread

CT- Local and distant spread

Question 14

Poorly differentiated cancers

Answer 14

Have poorer prognosis

• High rate of proliferation
• increased propensity to invade blood vessels and lymphatics

Question 15

Lower uterine segment and C-section

Answer 15

Used because

• Thinner and easier to suture
• Easier to control bleeding
• Reduced risk of rupture

Question 16

Post-partum haemorrhage causes

Answer 16

Uterine atony

• Does not close off intra-myometrial vessels
• Usually due to prolonged labour

Retained products of conception

Clotting abnormalities