Disorders of the Cervix Flashcards
What is a normal nonpatholagical darker red portion of the cervix located in the center of the cervical os
Squamocolumnar Junction or ectropion
How does the cervix change during pregnancy. What is the name for these changes
It becomes engorged, red, and softer w/ more white secretions. May also take on grayish blue tint = Chadwick sign
3 parts of diagnosis of cervicitis
1) mucopurulent discharge
2) wet mount w/ > 10 wbc
3) cervix often friable
What pathogens cause cervicitis
Chlamydia, GC, Herpes, Mycoplasma, Ureaplasma, …
White milky discharge with foul smelling fishy order
Bacterial Vaginosis (BV): anaerobic microbes
How should cervicitis be treated if no organism can be identified?
Doxycycline 100mg PO BID x 7 days
What is a Nabothian cysts
Common findings
Asymptomatic
Retention cyst -squamous mucosa covering a gland
No treatment needed
What is a Myoma?
Smooth, firm mass
Usually solitary
Usually small and asymptomatic
Can excise if large and causing symptoms
A congenital or acquired narrowing of the cervix that may be asymptomatic or cause dysmenorrhea, or infertility.
Cervical Stenosis
Cervical cancer is most frequently what type of cancer? Who gets it? Why?
Squamous cell carcinoma
Sexually active women (esp never been screened or > 5 yr)
HPV: 16 - 18
Risk factors for Cervical Cancer
Young age at 1st coitus (<20 years) Multiple sexual partners Sexual partner with multiple sexual partners Immunosuppression Smoking (4-fold increased risk)
What HPV genotypes does guardasil cover
6-11-16-18
What type of test is a Pap Smear
Screening test
What tests are indicated after positive Pap Smear finding?
Colposcopy, +/- HPV testing
Pap Smear Guidlines
Begin at 21 yo
Annual screening until 3 consecutive negative paps, then
Avg risk: every 3 years or every 5 years w/ HPV co-testing.
High risk: every year for 20 years after treatment
every year for HIV+/ immunocompromised
Discontinue at 65yo if adequate prior screening/ not high risk (3x consecutive neg cytology/ 2 neg HPV w/in 10 yr)
What is an ASC-US vs ASC-H
atypical squamous cells of undetermined significance vs “Cannot exclude High grade SIL (HSIL :High grade Squamous Intraepithelial Lesion)
What is a system for reporting cervical or vaginal cytologic diagnoses, used for reporting Pap smear results.
The Bethesda system
How are Cervical Intraepithelial Neoplasia (CIN) ‘s rated
CIN 1 – disorder growth in lower 1/3 of epithelium
CIN 2 – disordered growth in lower 2/3 of epithelium
CIN 3 – disordered growth > 2/3 of epithelium
Invasive – full thickness dysmaturity
Procedures to Treat Cervical Dysplasia and Cancer
Ablation Techniques: Cryotherapy, Laser
Excisional Techniques:LEEP :Loop Electrosurgical Excision Procedure, Laser conization, Cold-knife conization
What level of Dysplasia/Cancer get hysterectomy?
Used to treat CIN 3 in patients who have completed childbearing
Not appropriate as first-line treatment for CIN-2 or 3 except in special circumstances
Never appropriate as first-line treatment of CIN-1
Monitoring for ASC-US (undetermined significance) or LSIL on Pap?
For women 21-24 years of age – Consider HPV testing (if negative can continue routine screening)
If HPV positive or unknown, repeat Pap smear every 12 months for 2 years - Any increase refer!
For women 25 years of age and older –
If HPV testing is positive, refer for colposcopy with directed cervical biopsies, and sampling of the endocervical canal
If HPV testing is negative, repeat pap smear and HPV co-testing in 3 years
If Preggers and + LSIL = Colposcopy
HSIL management
refer for colposcopy
What does postcoital (post sexual intercourse) bleeding suggest?
Cervical cancer, which must be ruled out.
