Conditions of cervix, vulva and vagina Flashcards
epithelium of endocervix
columnar mucosal
epithelium of ectocervix
squamous
name of the area between ecto and endocervix
transition zone
what alter position of transition zone
menarche
pregnancy
menopause
what is the transition zone predisposed to
malignant change
what is cervical erosion
exposure of endocervical mucosal cells to acid environment of vagina causing squamous metaplasia
what are nabothian cysts
mucous retention cysts found on cervix - benign and physiological
infection of cervix
cervicitis
organisms causing cervicitis
chlamydia
herpes
gonococci
pathology of cervicitis
sub-epithelial reactive lymphoid follicles present in cervix
what can cervicitis lead to
fallopian tube damage
how does cervicitis usually present
usually asymptomatic may have discharge
what are cervical polyps
localised inflammatory outgrowth - may be ulcerated
cervical polyps are pre-malignant/benign
benign
presentation of cervical polyps
post-coital bleeding
discharge
management of cervical polyps
pre-menopause - nothing
post-menopause - TVS and hysteroscopy to exclude uterine polyps
what is the pre-invasive phase of cervical cancer
cervical intraepithelial neoplasia
what are the 2 high risk viruses associated with cervical disease
HPV 16 and 18
risk factors for CIN
many sexual partners (increased HPV exposure)
vulnerability of SC junction in early reproductive life
long term use of oral contraceptives
non-use of barrier methods
smoking
immunosuppression
what histological change is present in CIN
koilocytosis - presence of koilocytes (abnormal squamous cells)
immature basal cells
nuclear abnormalities
excess mitotic activity
how can koilocytes be detected
smear
where does CIN occur
transition zone
CNI histology
basal 1/3 of epithelium occupied by abnormal cells
CNII histology
abnormal cells extend to middle 1/3
CNIII histology
abnormal cells occupy full thickness of epithelium
most common cervical cancer
squamous
age group affected by squamous cervical cancer
younger women
what does squamous carcinoma develop from
CIN (most cases are preventable by screening )
stage 1A1
depth <3mm, width <7mm
stage 1A2
depth <5mm, width <7mm
stage 1B
confined to cefvix
stage 2
spread to adjacent organs (vagina, uterus etc)
stage 3
involvement with pelvic wall
stage 4
distant metastases/bladder/bowel involvement
presentation of cervical cancer
none at early stages abnormal bleeding (post coital, post menopausal) brown/blood stained mucosal discharge contact bleeding pelvic pain haematuria UTI
what lymph nodes do cervical cancers spread to
pelvic
para-aortic
lymph node spread is early/late
early
haematogenous spread is early/late
late
distant sites of metastasis
liver
lungs
bone
pre-invasive form of endocervical adenocarcinoma
cervical glandular intraepithelial neoplasia
what has worse prognosis, squamous or adenocarcinoma of cervix
adenocarcinoma
what are other HPV associated neoplastic diseases
vulvar intraepithelial neoplasia (VIN)
vaginal intraepithelial neoplasia (VaIN)
anal intraepithelial neoplasia (AIN)
VIN has greater risk of progression in younger/older women
older
who gets vulvar invasive squamous carcinoma
elderly women
how does vulvar carcinoma present
ulcer
exophytic mass
where does vulvar carcinoma spread to
inguinal lymph nodes
treatment for vulval cancer
radical vulvectomy
inguinal lymphadenectomy
crusting vulvar rash
vulvar paget’s disease
what is pagets disease of vulva
tumour cells in epidermis (containing mucin)
tumour arising from sweat gland in skin
who gets vaginal cancer
elderly
