Disorder of Cervix Flashcards
Cervicitis:
- causes
- sx
- PE findings
Cause; -STI (which may be asymptmatic) -local trauma -malignancy, radiation therapy, chemical irritation, systemic inflamm dz (behcets) -idiopathic -use of pessiary, diaphragm, douches (gonorrhea, chlamydia, trichomonas, HSV)
sx:
- purulent vaginal discharge, postcoital bleeding, vaginal spotting, deep pain
- dysuria or urinary frequency
- vulvovaginal irritation
- constitutional sx: fever, chills, malaise
PE:
- purulent discharge on surface and/or exuding from canal
- minor trauma from insertion from a cotton swab= bleeding
- vesicular lesions suggesting HSV
- punctate hemorrhages consistent with trichomonas
- cervical motion tenderness = coexisting PID.
Cervicitis; treatment of STIs:
- Gonorrhea?
- Chlamydia?
Gonorrhea: 250mg IM Rocephin
Chlamydia: 1g Azithro PO
*make sure you always treat for both infections because they are almost always concurrent.
Cervicitis:
- dx
- tx
Dx:
- may require gonorrhea, chlamydia, and HSV testing
- HIV testing and counseling
Tx:
- if persists after intial round of abx then repeat testing w/ most sensitive dx test
- re-examine possible exposure to chemical irritants
- have sex partners tested for STI
Cervical polyps:
- what are these?
- cause
- found MC in who?
- sx
What: benign, pedunculated growths of varying size that extend from the ectocervix or endocervical canal. May be single or multiple
Cause: unknown, believed to result from chronic inflammation, may be associated with hyperestrogen states
Found MC in multiparous women in their 30-40s.
Sx:
- usually asymptomatic
- thick leukorrhea
- postcoital bleeding
- intermenstrual bleeding
- menorrhagia
- post-menopausal bleeding
- mucopurulent or blood-tinged vaginal discharge.
Cervical Polyps:
- PE findings
- tx
PE:
- single or multiple pear-shaped growths may protrude from cervix into vaginal canal
- smooth, soft, reddish purple to cherry red in color
- may bleed when touched
- may be small or large.
Tx:
- tie at base and twist off at base with forceps
- may need to cauterize
Nabothian Cysts:
- what is this?
- cause
- tx
What: harmless mucous filled cyst on the surface of the cervix
Cause:
-stratified squamous epithelium of the ectocervix grows over the simple columnar epithelium of the endocervix
Tx:
- resolve on own
- may be removed via electrocautery or cryotherapy
Cervical Cancer:
- pathologic types
- sx
- risk factors
Pathologic types:
- squamous cell (69%)
- adenocarcinoma
- adenosquamous
Sx:
- frequently asymptomatic
- abnormal vaginal bleeding
- postcoital spotting
- vaginal discharge–can be watery, mucoid, or purulent and malodorous
Risk factors:
- early onset of intercouse (less then 18YO)
- three or more sexual partners
- male partner who has had other partners or is uncircumcised
- Hx of STI
- 1st child before 20YO & multiparity
- cigarette smoking
- oral contraceptive use
- low SES
- daughter of mother who took DES
Cervical CA:
- protective factors
- which infection has a huge role in cervical cancer?
protective:
- virginity
- long term celibacy
- life-long mutual monogamy
- long term use of condoms
- obtaining regular pap smears
Role:
- HPV!!! most HPV infections are transient and are cleared on their own.
- HPV can be detected in 99.7% of all cervical CA!
- takes about 15yrs from time of infection to presentation of Cervical CA.
HPV & its role in Cervical Cancer:
- how is this neoplastic?
- which HPV subtypes?
neoplastic:
- HPV integrates into the human genome and can result in abnormal high grade lesions and cancer.
HPV 16 & 18 cause cervical cancer.
Dx of Genital HPV
Prevention of HPV
Pap smear
Prevention: vaccination!!!! Gardasil; for men and women ages 9-26YO.
–3 separate IM injections at 0, 2, 6 MO
What part of the cervix is the most likely site of dysplasia?
Definition of a satisfactory pap?
Results of PAP
Squamo-columnar junction
Satisfactory pap:
- proper amount of squamous cells
- proper labeling
- endocervical cells present***
PAP results:
-normal: no abnormal cells seen.
- abnormal: atypical cells of undetermined significance, low grade squamous intraepithelial lesions or cervical intraepithelial neoplasia (CIN) 1. [these are mild, subtle cell changes, and most go away without tx]
- high grade squamous intraepithelial lesions (HSIL) or CIN 2 or 3. [moderate and severe cell changes which require further testing or tx]
- carcinoma
**cervical CA may present at ANY POINT in the spectrum, depending upon the associated HPV type and other host factors.
Tx of Cervical CA
tx is according to staging system
Early stage: surgery or chemo-radiation
Locally advanced dz: chemo-radiation
disease w/ distant mets: chemo, palliative care with radiation and chemo possibly
Cervical CA Screening
- when do you start?
- screening intervals
- when do you stop?
begin at age 21; earlier screening may result in over-dz of cervical lesions, these usually regress spontaneously but may lead to inappropriate intervention.
Screening intervals:
- q3years from 21-30 pap smear
- Over 30YO; q3years pap or q5yrs pap and HPV test
Stop: age 65 as long as woman had 2 consecutive tests negative prior to stopping
Management of abnormal pap
for low grade lesions: give periodic pap tests until abnormality resolves or colposcopy referral for persistent lesions
for higher grade lesions: refer for colposcopy
- HPV is very common
- the longer HPV is present and the older the pt the greater the risk of CIN
- vast majority clear the virus or suppress it
What type of f/u is required if:
-pap normal, HPV positive?
repeat pap and HPV testing in 12mo, then colposcopy if either is positive.
