cervix, vulva, vagina Flashcards
normal ectocervixn- cell layers
exfoliating cells, superficial cells, intermediate cells, basement membrane
which part of the cervix can you feel in vaginal canal?
ectocervix
which part has hard squamous cells?
ectocervix
which part has soft columnar glandular cells?
endocervix
hard squamous becomes soft columnar glandular cells?
transition zone
the position of the tz alters throughout life. this is physiological. what is it a response to?
menarche, pregnancy, menopause
which part is the opening of the uterus?
endocervix
what is tz also known as?
squamo columnar junction
exposure of delicate endoecervical epithelium to acid environment of vagina leads to ?
physiological squamous metaplasia
what is a nathobian cyst
mucus filled cyst on the surface of the cervix. caused by squamous cells growing over columnar cells
what happenst to nathobian cysts?
usually disappear on their own
how can cervicitis lead to infertility?
can cause simultaneous silent fallopian tube damage
cervicitis can be? (4)
non specific, follicular, chlamydia, hsv infection
what kind of cells would you see in follicular cervicitis?
lymphoid follicles
cervical polyp - when can it cause bleeding? is it malignant?
it can cause bleeding but is not malignant
two main types of cervical cancer
squamous and aden squ ad
how does HPV infect the cervical cells
infects epithelial cells in the cervical mucosa. HPV DNA integrates into the cellular genome when causing cancer
within weeks you can get viral replication
90% heal within 2 years
over 10-30 years, how many will develop into an invasive cancer?
0.8%
why does having many sexual partners increase risk of cervical cancer?
increases likelihood and time exposed to high risk HPV
smoking increases risk of cervical cancer by?
3
age at first intercourse, long term use of oral contraceptive and non use of barrier contraception all increase risk of cervical cancer
immunosuppression also
in genital warts, koilocytosis is seen, how can this be picked up?
cervical smear
how long does it take to get from HPV infection to high grade CIN?
6 months - 3 years
high grade CIN - invasive cancer?
5-20 years
pre i invasive stage of cervical cancer, occurs at transformation zone, can involve large area, not visible to naked eye, asymptomatic, detectable by cervical screening
CIN
normal pathway of CIN?
normal epithelium - koilocytosis - CIN 1-2-3
in CIN, there is a delay of maturation/differentiation. which type of cells are occupying more of the epithelium?
immature basal
some of the nuclear abnormalities?
hyperchromasia, increased nucleocytoplasmic ratio, pleomorphism
there is excess mitotic activity situated above normal layers
CIN 1 - 1/3 basal occupied by abnormal cells
2 - abnormal cells in 2/3 and mitosis in middle third. ABNORMAL MITOTIC figures
in CIN3, abnormal cells occupy the full thickness of the epithelium
mitosis, often abnormal, in upper 1/3
what percentage of these progress to invasion
12%
y
what is the most common cervical carcinoma?
squamous
how does it develop?
from pre existing CIN
therefore why should it be preventable?
by screening
symptoms of invasive cervical carcinoma?
usually none, abnormal bleeding, (post coital, post menopausal, BROWNISH or BLOODSTAINED vaginal discharge, contact bleeding)
what sort of pain would you get>=?
pelvic pain
why would you get haematuria?
local spread to ureter
why would it lead to renal failure?
causes ureteric obstruction
how can it spread?
local, blood, lymph
CGIN - what is it?
cervical glandular intraeputhelial neoplasia
where is its origin?
endocervical epithelium
what is it a pre invasive phase of?
endovervical adenocarcinoma
CGIN PRADA, why is screening of adenocarcinoma les effective?
difficult to diagnose pre invasive adenocarcinoma of the endocervix
adenocarcinoma has an increased incidence in what age group?
young women
although overall it is less common
y
which has a better prognosis, squamous or aden?
squamous
what HPV is adenocarcinoma associated with?
18
what else is it associated with?
smoking
makes up what percentage of cervical cancer?
15-25%
commoner in young women of higher social class with later SA
y
vulval HPV, whats it like in young women?
multifocal/recurrent/persitent, causing tx problems
in older people, there is a greater risk of progression to invasive squamous carcinoma
y
vulvar invasive squamous carcinoma - usually which age group?
usually elderly with ulcer or exophytic mass
how can it arise?
from epithelium or VIN
what is the most important prognostic factor?
spread to the inguinal lymph nodes
treatment?
radical vulvectomy and lympadenectomy
vulvar pages disease?
crusting rash, tumour cells in the epidermis ,contain mucin
most of the time where does this arise from?
sweat gland in skin, mostly non underlying cancer
crusting rash on vulva, contains mucin, arises from sweat gland
vulvar pagets disease
what HOV involved in vulvar warts?
HPV 6 and 11
squamous carcinoma of the vagina, disease of the elderly
y
what is cervical ectropion?
increased oestrogen results in larger area of columnar epithelium in ectocervix. as its glandular, you get post coital bleeding and discharge
which fibres carry pain from annexe/uterus/vagina?
visceral afferents
from the perineum?
somatic sensory
the superior aspect of pelvic organs (touching peritoneum). visceral afferents run alongside?
sympathetic fibres
where do they enter the spinal cord?
T11-L2
what is pain from here perceived as?
suprapubic
inferior parts of pelvic organs (NOT TOUCHING PERITONEUM) run along side?
parasympathetic fibres
where is pain perceived?
perineum
what level does it go to?
S2, 3 and 4
above the elevator ani, visceral afferents..parasympathetic s2,3,4
below levator ani, somatic sensory, s2,3,4, pudendal nerve, localised pan within the perineum
when does the spinal cord become the caudal equine?
L2
epidural - where is anaesthetic injected?
l3-l5 region
what is epidural space made up of?
fat and veins
where do sympathetic nerves exit spinal chord?
t1-l2
what do all spinal nerves contain?
sympathetic fibres
what do sympathetic fibres supply?
all arterioles (sympathetic tone)
in spinal anaesthetic you get vasodilation
y
what physical signs would you see?
skin look flushed, warm lower limbs, reduced sweating
what are all these a sign of?
spinal anaesthetic is working
pudendal nerve is a branch of which plexus?
sacral
bloccking pudendal nerve affects?
majority of perineum
which ligament does the pudendal nerve cross
lateral aspect of sacrospinous ligament (ischial spine can be used as a landmark)
when would this be done?
painful delivery - during labour
if baby is rhesus positive, why would future pregnancies be at risk?
rhd antigens could enter mothers circulation at delivery, mother mounts attack against these. antibodies could cross placenta in future pregnancies and cause homeless in fetus
what is sensitisation?
when a rhd negative woman is exposed to rhd positive blood and has an immune response to it
what do anti d antibodies given do?
neutralise any rhd positive antibodies that may have entered mothers circulation
