Cervix - Pathoma

Question 1

What are the two divisions of the cervix?

Answer 1

Endocervix = columnar epithelium

Exocervix = squamous epithelium

Question 2

What is the most important infection of the cervix?

Answer 2

HPV:

Low risk = 6, 11

High risk = 16, 18, 31, 33 => dysplasia => carcinoma

Question 3

What area of the female reproductive tract does HPV infect?

Answer 3

Infects the lower genital tract, especially the cervix in the “transformation zone”

Question 4

Persistant infection of HPV leads to an increased risk for what?

Answer 4

CIN = Cervix intraepithelial

Question 5

What two proteins make high-risk HPV high risk?

Answer 5

E6: increases destruction of p53 (regulates G1-S phase)

E7: increases destruction of Rb (regulates E2F => promotes S-phase transition)

Question 6

What three morphological changes characterize CIN?

Answer 6

1. Koilocytic change
2. Nuclear atypia
3. Increased mitotic activity

Question 7

How do you distinguish dysplasia from carcinoma? Key feature?

Answer 7

Reversibility

Question 8

What are the grades of CIN based on the extent of immature, dysplastic cells?

Answer 8

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

Question 9

What is the reversibility of the CIN grades?

Answer 9

CIN I = 66% reversibility
CIN II = 33% reversibility
CIN III = rarely reverses
CIS = NOT REVERSIBLE

Question 10

How does CIN progress?

Answer 10

Progresses stepwise (I => II => III => CIS => invasive carcinoma)

Not inevitable, May regress

Question 11

What is the key feature of Cervical Carcinoma that distinguishes it from carcinoma in situ?

Answer 11

Invades through the basement membrane and into the surrounding tissues

Question 12

What is the patient population most commonly affected by Cervical Carcinoma?

Answer 12

Middle-aged women (40-50 years old)

Question 13

How does Cervical Carcinoma typically present?

Answer 13

abnormal vaginal bleeding, post-coital bleeding (bleeding after intercourse)

Question 14

What are the key risk factors for Cervical Carcinoma?

Answer 14

***Primary: High-risk HPV infection

Secondary: smoking, immunodeficiency

Question 15

What are the two potential types of Cervical Carcinoma?

Answer 15

Sqaumous cell and Adenocarcinoma

***Both types are related to HPV

Question 16

Where does Cervical Carcinoma metastasize to?

Answer 16

Often doesn’t metastasize until very late!

If it does => invades through the anterior uterine wall and into the BLADDER

Question 17

What is the clinical finding when Cervical Carcinoma has metastasized to the bladder?

Answer 17

Hydronephrosis => due to blockage of the ureters

Question 18

What is the most common cause of death in Cervical Carcinoma?

Answer 18

Renal failure

Question 19

How do we help patients avoid Cervical Carcinoma?

Answer 19

Screening! => catch dysplasia before it develops into carcinoma

Pap smear = gold standard

Question 20

What tests are done after an abnormal pap smear?

Answer 20

Confirmatory colposcopy with biopsy

Question 21

What are the limitations of the pap smear?

Answer 21

• Inadequate sampling of the transformation zone resulting in false negative screening
• Limited efficacy in screening for adenocarcinoma

Question 22

What is the current way of preventing HPV infection?

Answer 22

Immunization!!!

• quadrivalent vaccine covers 6, 11, 16, and 18
• protection lasts for five years
• pap smears are still necessary