Lecture 7 - Cervical Disorders

Question 1

Transitional area

Answer 1

endocervix –> endometrium

Question 2

Endocervix

Answer 2

canal portion of cervix

columnar epithelium

Question 3

Ectocervix

Answer 3

protrudes into vagina

nonkeratinizing squamous epithelium

Question 4

How long is the cervix?

Answer 4

2-4cm

Question 5

What is happening to the cervix during menarche?

Answer 5

acidification –> ectocervix undergoes squamous transformation –> metaplastic change radiates inward from original squamocolumnar junction to new SCJ –> creates transfomration zone

Question 6

Ectropion

Answer 6

seen during periods of higher estrogen like during puberty or OCPs

this is a normal and benign variant to the cervix

Question 7

Nabothian cysts

Answer 7

a normal benign variant of the cervix

form during squamous metaplasia –mucus trapping

we don’t treat these –they might pop on their own but might come back

Question 8

Cervical polyps

Answer 8

MC benign cervical neoplasma

hyperplastic endocervical folds of columnar epithelium

pts complain of postcoital bleeding –> this is why we typically remove them

however if the pt presents with these post menopausal we excise and biopsy

Question 9

Cervical insufficiency

Answer 9

aka incompetence

painless premature dilation (the fact that it is painless sets it apart from preterm labor)

intrinsic or acquired (commonly from prior surgical procedures)

pregnancy loss or preterm delivery

Question 10

Cervical stenosis

Answer 10

rare
acquired scarring of the cervical canal in response to trauma or hypoestrogenism

we typically don’t know about the stenosis until time for dilation in labor, it either wont dilate or it will dilate slowly and then all at once (like it popped)

Question 11

What is the most common STI?

Answer 11

HPV

strongest risk factor = number of sexual partners

15 strains are high risk

squamous cell (rarely adenocarcinoma) –slow growing

Question 12

Why don’t we start screening for HPV until 30s?

Answer 12

because we assume that everyone in their 20s having sex has HPV, but they are clearing these infections
once they get older they’re unable to clear these infections and thus can lead to worse effects

Question 13

What are the current pap smear guidelines?

Answer 13

start at 21 (regardless of when pt first had sex)
every 3 years until 29
add HPV co-testing at 30, every 5 years until 64
discontinue after 65 if negative screening in past 10 years

Question 14

What are the exceptions to the pap smear guidelines?

Answer 14

for people who have HIV
if they were born with it they have to get a pap smear every year starting when they have sex

if they acquired it they have to get it at time of dx and every eyar following

Question 15

Colposcopy

Answer 15

microscope on wheels to look at cervix

acetic acid or Lugol’s stain to identify abnormal cells that need to be biopsied post abnormal pap smear results

Question 16

CIN 1-3

Answer 16

CIN 1 = low risk
CIN 2,3 = high risk

for cervical cancer

treatment recommended for high risk dysplasia

Question 17

What is the treatment for high risk dysplasia (CIN 2 and 3)?

Answer 17

excisional methods:
LEEP
Cold knife cone (done in OR)

ablation is almost never done anymore d/t risk of not getting all of the cancer cells

Question 18

What are the sxs of cervical cancer?

Answer 18

abnormal bleeding
watery discharge
postcoital bleeding
venous/lymphatic/ureteral compression

Question 19

How is cervical cancer staged?

Answer 19

BEFORE surgery so you know if surgery is the appropriate option