L7 - Cervix in health and disease

Question 1

EMBRYOLOGY

i) which epithelium does the cervix originate from?
ii) which ducts fuse to make the cervix? what three other structures develop with the cervix?

Answer 1

i) coelemic epithelium
ii) fusion of paramesonephric ducts > cervix, vagina, uterus and cranial end of fallopian tube

Question 2

CONGENITAL ABNORMALITIES OF THE CERVIX

i) what are the two main congen abnormalities?
ii) what is the condition where there is no connection between the cervix and the vagina
iii) what condition is where only part of cervix is formed or there are two cavities of uterus divided by a septum?
iv) what weak does the septum usually disspear

Answer 2

i) cervical agenesis and dysgenesis
ii) agenesis
iii) dysgenesis
iv) week 20

Question 3

ANATOMY OF CERVIX

i) what canal is found between the internal and external os?
ii) how does the cervix look in a nulliparous women? how does it look in parous women?
iii) what type of epithelia covers the ectocervix?
iv) what type of epithelia lines the endocervix? what do these cells produce?
v) what type of epithelia lines the surface of the underlying glands?

Answer 3

i) endocervical canal

ii) nulliparous = barrel shaped with small circular ext os
parous - bulk and ext os is slit like (smiley face)

iii) ectocervix = non keratinising straified squamous epithelia

iv) endocervix = simple columnar epithelia
- mucus secreting

v) mucinous columnar epithelia lines surface of underlying glands

Question 4

THE TRANSFORMATION ZONE

i) what process happens in the TZ? what causes this?
ii) what happens to the TZ after menopause? why does this happen?
iii) which procedure may be difficult post menopause

Answer 4

i) squamous metaplasia (columnar > squamous) due to acidic pH

ii) after menopause the squamo columnar junction receeds into the endocervical canal therefore the TZ is inside
- happens due to oestrogen deficiency

iii) colposcopy because transformation zone isnt external

Question 5

STRUCTURE OF CERVIX

I) what type of tissues makes up most of the cervical stroma? what makes up around 15% of it?

ii) what is the main arterial supply? what is this a branch of? which vein drains it?
iii) where does lymphatic drainage start? which LNs does it go through before it reaches the aorta?
iv) which fibres supply the cervix? which two others supply the uterus?
v) in what situation may these nerve fibres be stimulated leading to shock and fainting

Answer 5

i) most is collagenous connective tissue
- smooth muscle fibres make up 15%

ii) supply by uterine artery (branch of int iliac)
drained by uterine vein

iii) lymph drainage starts in the parametrium LNs > obturator> int iliac > ext iliac> common iliac > aorta

iv) parasympathetic S2,3,4
- uterine also psym to T11 and T12

v) misscariage > dilates cervix and stim nerve fibres = pain

Question 6

FUNCTIONS OF THE CERVIX

i) what does it produce to help sperm migration?
ii) what does it act as a barrier to?
iii) what does it do during pregnancy? what happens to it in labour (2)

Answer 6

i) produces mucus
ii) barrier to infection

iii) holds pregnancy in place
- labour > effaces and dilates to allow birth

Question 7

PHYSIOLOGICAL CHANGES OF CERVIX IN PREGNANCY

i) what happens to the size/cells
ii) what makes it softer? why does it get a purple tinge?
iii) what are glands distended with?
iv) what can be visualised that is also see in women in COCP
v) how does it remain until onset of labour? what happens at labour?

Answer 7

i) hypertrophies (but not as much as uterus)

ii) increased vascularity makes it softer
- purple tinge due to venous congestion

iii) glands distended with mucus - mucus plug
iv) cervical ectropion
v) remains elongated then onset of labour it thins (effacement) and dilates

Question 8

PHYSIOLOGICAL CHANGES TO CERVIX THROUGH LIFE

i) what is cervical ectropion? what can cause it?
ii) what is atrophic cervicitis? what can cause it? when may this be seen
iii) what may be seen under the sq epithelia in atrophic cervicitis?

Answer 8

i) growth of columnar epithelia on the ectocervix
- changes due to oestrogen

ii) inflammed cervix
- changes due to lack of oestrogen > menopause

iii) may see blood vessels under sq ep

Question 9

CERVICAL INFECTIONS

i) what is the main type of infection seen?
ii) name four
iii) which infection may give excess discharge on cervix
iv) which gives the appearance of ‘strawberry cervix’ what is this due to?
v) which may cause warts on vulva or surface of cervix?

Answer 9

i) STIs
ii) chalmidya, gonorrhea, trichomonas vaginalis, HPV
iii) gonorrhea
iv) TV - due to erosion of sq epithelia from TV pathogen
v) HPV

Question 10

HPV INFECTION

i) give three predisposing factors for HPV
ii) name two ways it can be transmitted
iii) what % of women will have been infected with HPV at some point
iv) what can reduce risk?
v) what type of cancers have been increasing due to HPV? (4)

Answer 10

i) smoking, multiple sexual partners, low SE status
ii) sexual and close skin to skin contact
iii) 95%
iv) condoms
v) oropharyngeal, tonsilar, tongue, anal

Question 11

CERVICAL SCREENING

i) how often do women beteween 25-49yrs have screening? how often for 50-65yrs?
ii) name three types of cell that need to be collected on smear test?
iii) how may a dyskaryotic cell appear on cytology? (2)

Answer 11

i) 25-49 = 3 yearly
50-65 = 5 yearly

ii) squamous, columnar, metaplastic
iii) big nuc and little cytoplasm

Question 12

COLPOSCOPY

i) what can be used to visualised abnormal cells on cervix? why does this work?
ii) what would be seen in high and low grade changes?
iii) how does iodine highlight dyskaryotic cells? why?

Answer 12

i) acetic acid
- denatures proteins in dyskaryotic cells which makes them look white

ii) low grade > slight white change
high grade > opaque white change

iii) iodine stains normal cells brown and dysaryotic cells stain lighter as they are dividing

Question 13

EPIDEMIOLOGY OF CERVICAL CANCER

i) what % of cervical cancer occurs in low SE countries?
ii) how has incidence of cervical cancer changed after the intro of screening in the UK?

Answer 13

i) 80%
ii) static

Question 14

TREATMENT FOR CERVICAL CANCER

i) what is the treatment for stage 1a?
ii) what is treatment for tumour less than 4cm? (1b)
iii) what is the treatment for 1b if woman wants to preserve fertility? how does this work?
iv) what is treatment for stage 1b2 >4cm tumour?

Answer 14

i) cone biopsy/excision - cells around ext os are removed
ii) <4cm = radical hysterectomy

iii) to preserve fertility - radical tachelectomy
- remove cervix and attach body of uterus to vagina
- good collateral circulation allows maintenance of fertility

iv) chemo/RT