Disorders of the Cervix Flashcards
Inflammation of the cervix
This is most often caused by an infection that is caught during sexual
activity
Very common – affects more than half of all women at some people during their adult life
Cervicitis
What are the risk factors for cervicitis?
High-risk sexual behavior
History of STIs
Multiple sexual partners
Sex at an early age
Sexual partners who have engaged in high-risk sexual behavior or have had an STI
List some STIs that can cause cervicitis
Chlamydia
Gonorrhea
Trichomoniasis
Herpes virus
HPV
Infection of the upper genital tract after initial infection of the cervix
Pelvic Inflammatory Disease
What are the main organisms that can cause pelvic inflammatory disease?
C. trachomatis
N. gonorrhea
What can result from scarring and damaged fallopian tubes (PID complications)
Infertility
What is the greatest risk factor for PID?
prior PID
What are some risk factors for PID?
Adolescence
Multiple sex partners
Previous PID
IUD use
Post abortion
Post-op pelvic surgery
What are some complications of PID?
Tubo-ovarian abscess
Fitz-Hugh-Curtis syndrome
Infertility
Ectopic Pregnancies
Repeated infections
Adhesions (Chronic pelvic pain, dysparenunia)
Adhesions between the liver and diaphragm
Fitz-Hugh-Curtis syndrome
Rupture of a tubo-ovarian abscess with septic shock is a life-threatening complication with mortality approaching what percentage?
10%
Extremely common infection, occurring in up to 80% of sexually active women by age 50
Transmission by contact with infected genital skin, mucous membranes or body fluids (partner may have subclinical infection)
Unlike most STDs, sequelae of infection may take years to develop
HPV Infection
What is present in 99.7% of invasive cervical cancers?
HPV
Persistent HPV infection, especially high viral loads have a higher likelihood of what?
CIN and cervical cancer
Which HPV type is the most persistent?
HPV 16
Most HPV infections are transient, and what percentage of immunocompetent women will have a spontaneous resolution over a two year period
90%
What are some cofactors with HPV in pathology detectable CIN?
Immunosuppression
Smoking
Multiple sex partners
With patients with HPV, which percentage will have pathology detectable CIN?
5%
What are the two types of HPV associated with genital condyloma and low grade lesions (CIN 1)?
6
11
What are the four types of HPV associated with high grade lesions and invasive cancer?
16
18
31
33
Which two HPV subtypes account for 2/3 of cervical cancer cases?
16 and 18
What risk factor is associated with a 3.5 fold increase in the risk of
developing cervical cancer?
Cigarette smoking
On pap smears, you should not do what testing prior to age 30?
HPV-DNA
What is the biggest mistake in primary care?
The biggest mistake in primary care is getting an abnormal pap
without HPV testing
You can do this type of cervical cancer screening when patient is on their period
Thin prep
Disordered growth and development of the epithelial lining of the
cervix
Called cervical intraepithelial neoplasm (CIN)
Formerly known as “dysplasia”
CIN is most commonly detected in women of what age range?
women in their 20s
CIN Classification:
Disordered growth or abnormal maturation of the lower 1/3 of the epithelial lining
CIN I: mild dysplasia, LSIL
CIN Classification:
Disordered growth or abnormal maturation of the lower 2/3 of the epithelial lining
CIN II: moderate dysplasia, HSIL
CIN Classification:
Disordered growth or abnormal maturation in more than the lower 2/3 of the epithelial lining
CIN III: severe dysplasia, HSIL
CIN Classification:
Full thickness
Carcinoma in Situ: CIS
Management of Abnormal Pap Smear:
Often the next step following an abnormal pap smear
Used to direct biopsies of abnormal areas
Colposcopy
Management of Abnormal Pap Smear:
Office procedure in which nitrous oxide or carbon dioxide is used as a refrigerant to super-cool a probe
ectocervix only
Cryotherapy
Cure rate for CIN I is about what percentage with cryotherapy?
90%
Management of Abnormal Pap Smear:
Rarely used these days
Ectocervix only
Requires special training and attention to safety as well as local or general anesthesia
Can be used for ablation of abnormal tissue or as a cutting instrument for a cone biopsy
CO2 laser
Management of Abnormal Pap Smear:
Provides additional histological examination – most effective diagnostic test
Most popular – can do in office under paracervical block
Procedure of choice for CIN II and CIN III
Loop Electrosurgical Excision Procedure (LEEP) - (Cone-Shaped Excision)
Management of Abnormal Pap Smear:
For very advanced forms
Excision of a cone-shaped portion of the cervix using a scalpel - provides additional histological examination
Results in a specimen without thermal artifact
An endocervical curettage is performed following the procedure to assess the remaining endocervical canal
Done in OR under local or general anesthesia
Cold Knife (Cone-Shaped Excision)
List the complications of a Cold Knife (Cone-Shaped Excision) procedure
bleeding
infection
cervical stenosis
cervical incompetence
Which abnormal pap procedure is not performed in pregnancy due to risk of infection or abortion?
Loop Electrosurgical Excision Procedure
Management of Abnormal Pap Smear in pregnancy:
What are the indications for the colposcopy?
Colposcopy is performed using the same indications in non-pregnancy
Management of Abnormal Pap Smear in pregnancy:
What are limited unless colpo reveals signs suggestive of
carcinoma in situ or invasive disease
biopsies
Management of Abnormal Pap Smear in pregnancy:
If dysplasia is found, repeat colpo and pap smear how often?
each trimester
Management of Abnormal Pap Smear in pregnancy:
The LEEP procedure is only indicated in pregnancy when?
in suspected invasive disease
What percentage of CIN I will spontaneously regress without treatment?
~60%
If CIN I persists for how long before then treat
two years
What is the 3rd most common gynecological cancer?
cervical cancer
Cervical cancer etiology is from what cause 90% of the time?
HPV
Cancer is preceded by an identifiable precursor lesions (CIN) that may
progress to cancer
cervical cancer
List some risk factors for cervical cancer
Early age at first coitus
Multiple sex partners
History of HPV infection in patient or partner (HPV types 16, 18, 31, 33, 35)
Personal history of cervical dysplasia
Immunocompromised (HIV)
smoking
What are some methods to help prevent cervical cancer?
Sexual abstinence
Barrier protection
Regular exams and cytology screening
HPV vaccines
