Cervix - Pathoma Flashcards
What are the two divisions of the cervix?
Endocervix = columnar epithelium
Exocervix = squamous epithelium
What is the most important infection of the cervix?
HPV:
Low risk = 6, 11
High risk = 16, 18, 31, 33 => dysplasia => carcinoma
What area of the female reproductive tract does HPV infect?
Infects the lower genital tract, especially the cervix in the “transformation zone”
Persistant infection of HPV leads to an increased risk for what?
CIN = Cervix intraepithelial
What two proteins make high-risk HPV high risk?
E6: increases destruction of p53 (regulates G1-S phase)
E7: increases destruction of Rb (regulates E2F => promotes S-phase transition)
What three morphological changes characterize CIN?
- Koilocytic change
- Nuclear atypia
- Increased mitotic activity
How do you distinguish dysplasia from carcinoma? Key feature?
Reversibility
What are the grades of CIN based on the extent of immature, dysplastic cells?
CIN I = first 1/3 of cells
CIN II = first 2/3 of cells
CIN III = almost all layers
CIS = all layers, carcinoma in situ
What is the reversibility of the CIN grades?
CIN I = 66% reversibility
CIN II = 33% reversibility
CIN III = rarely reverses
CIS = NOT REVERSIBLE
How does CIN progress?
Progresses stepwise (I => II => III => CIS => invasive carcinoma)
Not inevitable, May regress
What is the key feature of Cervical Carcinoma that distinguishes it from carcinoma in situ?
Invades through the basement membrane and into the surrounding tissues
What is the patient population most commonly affected by Cervical Carcinoma?
Middle-aged women (40-50 years old)
How does Cervical Carcinoma typically present?
abnormal vaginal bleeding, post-coital bleeding (bleeding after intercourse)
What are the key risk factors for Cervical Carcinoma?
***Primary: High-risk HPV infection
Secondary: smoking, immunodeficiency
What are the two potential types of Cervical Carcinoma?
Sqaumous cell and Adenocarcinoma
***Both types are related to HPV
Where does Cervical Carcinoma metastasize to?
Often doesn’t metastasize until very late!
If it does => invades through the anterior uterine wall and into the BLADDER
What is the clinical finding when Cervical Carcinoma has metastasized to the bladder?
Hydronephrosis => due to blockage of the ureters
What is the most common cause of death in Cervical Carcinoma?
Renal failure
How do we help patients avoid Cervical Carcinoma?
Screening! => catch dysplasia before it develops into carcinoma
Pap smear = gold standard
What tests are done after an abnormal pap smear?
Confirmatory colposcopy with biopsy
What are the limitations of the pap smear?
- Inadequate sampling of the transformation zone resulting in false negative screening
- Limited efficacy in screening for adenocarcinoma
What is the current way of preventing HPV infection?
Immunization!!!
- quadrivalent vaccine covers 6, 11, 16, and 18
- protection lasts for five years
- pap smears are still necessary
