Conditions Of The Cervix Flashcards
What are the risk factors for cervical cancer?
> HPV infection
early age 1st sexual encounter
poor screening uptake
multiple sexual partners
high risk male partner
smoking
immunodeficiency
HIV infected
What is the pathophysiology of cervical cancer?
Ectocervix = squamous epithelium
Endocervix = columnar epithelium
During puberty -> increase oestrogen causes eversion of a single layer of columnar epi = metaplasia to squamous epithelium (making new squamocolumnar junction)
Area between old and new squamocolumnar junctions = transformation zone
Transformation zone = area sensitive to carcinogens and dysplasia
How do you prevent cervical cancer?
1) PRIMARY PREVENTION
>HPV vaccination
>education on safe sex practices
2) SECONDARY PREVENTION
>screening
>Pap smear (cytology)
>HPV (molecular)
>visual inspection with acetic acid and iodine
3) TERTIARY PREVENTION (detect it early)
>vaginal and speculum exam in primary setting
>raise awareness, improve early Diagnosis
What classification is used in Pap smear results?
Bethesda classification
1) normal +-infection changes
2) atypical cells of unknown significance
3) squamous atypia
4) LSIL
>CIN I (lower 1/3 of epithelium involved)
HSIL
>CIN II (lower 2/3 of epithelium involved)
>CIN III (full thickness of epithelium affected)
5) abnormal glandular cells of unknown significance
6) adeno carcinoma in situ
7) invasive squamous / adeno carcinoma
What makes an adequate colposcopy?
The entire transitional zone must be visualised
What are the indications for a cone biopsy?
> where you can’t visualise endocervical component on colposcopy
cytology = LSIL and no colposcopy available
unsatisfactory colposcopy
Biopsy shows lower grade than cytology
directed biopsy shows microinvasive ca
suspected endocervical adeno ca
How do you treat HSIL?
Colposcopy and LLETZ
What do you do when you get the pap results back?
LSIL = repeat pap in 3-9 months (NB screen for HPV to determine risk)
>/=2 paps positive = refer for colposcopy
HSIL = schedule for colposcopy and LLETZ (diagnostic and therapeutic)
Biopsy results direct management
>LLETZ
>hysterectomy
Etc
What are the symptoms of cervical cancer/how would a patient present?
Asymptomatic
>found on screening Pap smear
>+/- discharge, post-coital bleeding/AUB
Symptomatic (late presentation = cx of cancer)
>ABNORMAL VAGINAL BLEEDING»_space;> contact bleeding, post menopausal, post coital
>pain
>bowel and urinary symptoms
>appears normal on speculum exam
>inguinal lymphadenopathy
>weight loss
>swollen legs
>palpable mass on digital exam
How do you identify signs of cervical cancer malignancy on examination?
> abnormal blood vessels
fungating mass/loss of epithelium/raised borders
iodine/acetic acid staining reveals abnormalities (acetowhite lesions)
mosaicism
bleed on contact
More advanced
>exophytic (SCC)
>ulcerated
>endophytic (adenoCa)
How do you DIAGNOSE cervical cancer?
1) LLETZ (diagnostic excision)
2) cone biopsy (adeno suspected)
3) colposcopy and staining
4) endocervical curettage if entire lesion not visible
What is the name of the staging used to stage cervical cancer? Give an overview of how it is staged
FIGO staging
Stage 1: confined to cervix
>A = microscopic
1: <3mm
2: 3-5mm
>B = macroscopic
1: 5mm-2cm
2: 2-4cm
3: >4cm
Stage 2: extension from cervix
>A = extension into upper 2/3 vagina
1: <4cm
2: >4cm
>B = extension to parametria
Stage 3:
>A = lower 1/3 vagina involved
>B = pelvic side wall (ureters, hydronephrosis, renal dysfunction)
>C = involvement of pelvic and paraaortic lymph nodes irrespective of tumor size
1: pelvic nodes
2: paraaortic nodes
R = radiological
P = pathology
Stage 4: Metastasis
>A = bladder/rectum
>B = distant mets
How do you manage cervical cancer?
Stage 1 - 2A = surgery
Stage 2B - 3 = radical radiotherapy with concomitant Cisplatin chemotherapy (6-7 weeks)
Stage 4 = palliation
Stage 1A1: LLETZ/trachectomy/simple hysterectomy
Stage 1A2: simple abdo/vag hysterectomy
Stage 1B: Radical hysterectomy with pelvic LN dissection (risk LN mets)
Stage 2A: radical hysterectomy with pelvic LN dissection (risk LN mets)
What is a trachelectomy and why is it performed?
Used for fertility sparing
Removal of cervix
Radical trachelectomy = removal of
1)upper vagina
2)cervix
3)paracervical ligament tissue
4)pelvic LN
Vagina anastomosed to isthmus of uterus
What does the cervix look like with adeno carcinoma?
Barrel shaped cervix
