Disorders of the Cervix

Question 1

what are the disorders of the cervix?

Answer 1

• Cervical intraepithelial neoplasia
• Cervical cancer

Question 2

what is this?

Answer 2

normal cervix

Question 3

what is this?

Answer 3

normal endo and exocervix

Question 4

what is the purpose of the Cervix?

what are its 2 portions?

Answer 4

connects the uterus to the vagina.

1. exocervix: part that protrudes into the vagina, covered in squamous epithelium
2. endocervix: canal that leads to endometrial cavity and is line with mucus secreting columnar cells

Question 5

what part of the cervix can cancer develop?

where is that?

what cancer develops here?

what procedure is done to check here for cancer?

Answer 5

T (transformation) zone, area that undergoes squamous metaplasia, its where edocervical epithelium meets the acid pH of vagina

squamous dysplasia

pap smear

Question 6

what is this?

Answer 6

koilocytosis in squamous cells

Question 7

what is Cervical intraepithelial neoplasia (CIN)?

what part of the epithelium does it involve mainly?

how do you notice neoplasia?

where do changes happen?

Answer 7

• disordered growth of cervical epithelium
• squamo-columnar junction
• disordered growth (loss of polarity) and nuclear hyperchromatism
• changes begin at the basal layer and extend outward.

Question 8

what is this?

Answer 8

carcinoma in situ (intact bas. membrane)

Question 9

Majority of cases of Cervical intraepithelial neoplasia (CIN) are associated with what?

Answer 9

HPV types 16, 18, 31, 33

Question 10

CIN is classified into 3 types depending on extent of epithelial involvement, what are these?

Answer 10

1. CIN 1: Mild dysplasia of lower third of epithelium.
2. CIN 2: Moderate dysplasia in lower two thirds of the epithelium
3. CIN 3: Severe dysplasia to carcinoma in situ of entire thickness of epithelium

Question 11

what is this?

Answer 11

squamous cell carcinoma of the cervix

Question 12

what is this?

Answer 12

cervical cancer producing hydronephrosis

Question 13

what is this?

Answer 13

exophytic ulcerated squamous cell carcinoma

Question 14

what is this?

Answer 14

keratin pearls found in squamous cell carcinoma of cervix

Question 15

what are the risk factors for CIN?

how do you screen?

Answer 15

early age sexual activity

multiple high risk partners

high risk HPV types

pap smear

Question 16

what are the Clinical Findings for Cervical intraepithelial neoplasia?

Answer 16

• Dysplasia is not usually visible to naked eyes
  
  • 1% acetic acid wash applied to cervix, dehydrates cells and reveals “acetowhite” areas that correspond to dysplasia

Question 17

what are the Cervical Carcinomas?

Answer 17

1. Squamous cell carcinoma*******
2. Adenocarcinoma

Question 18

what is this?

Answer 18

Question 20

what is the third most common cancer of lower female genital tract?

what are its risks?

Answer 20

cervical carcinoma

• early age sexual activity, especially with high risk partners
• HPV

Question 21

what are the high risk HPV serotypes for Cervical carcinoma?

what proteins of the serotypes are important in cervical cancer?

Answer 21

16, 18, 31, 33

protein E6 (binds to p53) and E7 (binds to Rb)

Question 22

what are the symptoms found in cervical cancer?

Answer 22

• Postcoital vaginal bleeding
• Dyspareunia
• Malodorous discharge

Question 23

what are the signs of cervical cancer?

Answer 23

Friable, raised, reddened or ulcerated area visible on cervix

Question 24

how do you diagnose cervical cancer?

how do you prevent it?

Answer 24

pap smear

colonoscopy

hpv vaccine: gardasil (hpv 6,11, 16,18

cervarix (hpv 16, 18)

Question 25

how does cervical cancer spread?

Answer 25

extends into the vagina, to the lateral wall of the cervix and infiltrates bladder wall, obstructing the ureter (azotemia in labs)