Disorders of Cervix

Question 1

What are some disorders of the Uterine Cervix?

Answer 1

Acutre and Chronic Cervicits

Endocervical Polyps

Premalignant and Malignant Neoplasms (Cervical Intraepithelial Neoplasias, Cervical Cancer)

Question 2

Is cervicitis extremely common?

Answer 2

Yes

Question 3

Sources of Infection in Cervicitis?

Answer 3

C. Trachomatis

U. Urealyticum

T. Vaginalis

Candida spp

N. Gonorrheae

HSV-2 and HPV

Question 4

Types of Cervicitis?

Answer 4

Non Specific

Chronic

Acute

Question 5

Chronic Cervicitis

Answer 5

Epithelial Regeneration

Hyperplasia

Squamous Metaplasia

Question 6

Acute Cervicitis

Answer 6

Postpartum (rare)

Staphylococcus or Streptococcus

Question 7

Endocervical Polyps

Answer 7

Benign Lesion

Adult Women

Clinical Sign: VAGINAL BLEEDING OR SPOTTING

Mostly in the endocervical canal

Question 8

What is the link between HPV and Cervical Cancer?

Answer 8

HPV has a HIGH association with Cervical Cancer

Increases risk by 50-100x

Question 9

Factors that increase risk of HPV

Answer 9

Multiple sexual partners

Male partner with multiple previous/present sexual partner

Young age at first intercourse

High parity

Question 10

Oncogenic Risk of certain HPV infections?

Answer 10

Type 16 and 18– HIGH ONCOGENIC RISK

Types 6, 11, 42-44– LOW ONCOGENIC RISK

Question 11

Where does HPV infect?

Answer 11

the immature cells at the metaplastic squamo-columnar junction

Question 12

LOOK AT SLIDES FOR HPX INFECTION AND PREMALIGNANT LESION

Answer 12

LOOK AT SLIDES FOR HPX INFECTION AND PREMALIGNANT LESION

Question 13

Natural History of infection?

Answer 13

Normal–> Low grade SIL–> High grade SIL–> Invasive Cancer–> Local–> Regional–> Distant

Question 14

Consequences of HPV infection

Answer 14

Immune status is compromised and increased genetic vulnerability to development of cancer

Question 15

Factor that may promote progression to CaCx?

Answer 15

Immunosupression

Persistent Infection with viral integration into genome

Co-infection with other STDs

Hormanal Status (use of contraceptive pills)

Use of Nicotene

Certain HLA types

Mutation of tumor suppressor gene LKB I (recent)

Question 16

Low risk infections that only cause episomal infection?

Answer 16

HPV 6 and 11

Question 17

Management of persistem CIN1

Answer 17

Ablation

Question 18

Management of CIN 2 and CIN 3

Answer 18

Excision

(Loops electrosurgical excision procedure (LEEP), Colonization, Cryosurgery)

Question 19

Management of Invasive CA, depending on stage?

Answer 19

Hysterectomy

Radio and chemotherapy

Question 20

What are the types of CaCx

Answer 20

Grossly: Exophytic and Infiltrative

Microscopically: Keratinizing, non-keratinizing, microinvasion

Question 21

First sign of CaCx

Answer 21

Spotting after intercourse or douching

Question 22

Prevention of HPV?

Answer 22

VACCINES

Question 23

Vaccines used in HPV

Answer 23

GARDASIL

CERVARIX

Question 24

Age for vaccination?

Answer 24

ideally, before the age of sexual activity.

11 or 12 year old girls

Quadrivalent HPV vaccine: 11 or 12 year old boys, but may be given to 22-26 year old males.

Question 25

Other types of CaCx

Answer 25

Adenocarcinoma

Adenosquamous Carncinoma

Smal Cell Carcinoma

Question 26

Carcinoma from glandular epithelium of the endocervix

Answer 26

Adenocervix

Question 27

Carcinoma from admixture of malignant glandular and squamous epithelium

Answer 27

Adenosquamous carcinoma

Question 28

Neuroendocrine carcinoma

Answer 28

Small cell carcinoma

Question 29

Cells present in LSIL?

Answer 29

Koilocytes