Lecture 7: Cervical Disorders Flashcards
makeup of cervix?
When does the transformation zone appear?
- what causes it? where?
Overall result?
fibrous/collagen tissue + small amt of smooth muscle
transformation zone appears during menarche
- acidification –> ectcoervix undergoes squamous metaplasia –> form columnar epithelium on inner cervix
Result (after menarche)
- endocervix = columnar epithelium
- ectocervix = sqaumous epithelium
4 types of benign cervical conditions?
- Ectropion
- Nabothian Cysts
- Cervical Polyps
- Cervical Stenosis
Other: cervical insuffic (not on obj)
Ectropion
- When is commonly seen? (2)
- What cells are on the surface of the cervix –> causing what presentation?
- What 3 things is cervix vulnerable to?
Ectropion
- occurs during pds of high estrogen
- Menarche
- Hyperestrogen states (OCPs, Preg) - COLUMNAR cells on surface of the cervix –> cervix looks rough, red + beefy
- Vul to: inf, trauma, friction
Nabothian Cysts
- When do they form?
- How to they form? result?
- Tx?
- Form during squamous metaplasia
- Squam epithelium entraps columnar cells–> mucus trapping –> blebs –> blisters (popping –> mucus leakage)
- No Tx, benign
Cervical Polyps
- definition
- Presentation (2)
- Normally removed (benign) but when are they not removed (2)
- hyperplastic endocervical folds of columnar epithelium
- presentation
- Post-coital bleeding but NO PAIN
- pink, fleshy, mobile mass protruding thru external cervical os - Not removed when pregnant or risk of bleeding
Cervical Stenosis
- What is it?
- What is it in response to? Ex?
- When is it MC?
- ACQUIRED scarring of cervical canal –> smaller/closed
- Response to trauma or HYPOestrogenism
- Ex: hematometra, infertility, recurrent/deep cervical Bx - MC in labor
What is the MC STI?
HPV
What is the biggest RF for HPV?
Which is more common: cytologic abn or genital warts?
Which type of HPV causes cervical CA? (MC type of CA)
Strongest RF = # of lifetime partners
More common = cytologic abn
High risk HPV types–> Cervical CA (MC = SCC)
Is an HPV more commonly:
- latent or expressed?
- transient or persistent?
HPV inf more commonly
- LATENT - most ppl clear
- TRANSIENT - most regress in 2 yrs
Why are pap smears not generally done annually anymore?
Take 5 yrs to progress to high grade dysplasia and longer tor Cervical CA
Current Pap Recommendations:
- What age does Pap testing start?
- What if person is HIV +? how often?
- How often to do if 21-29?
- How often Pap done alone and how often Pap + HPV testing done if 30-65?
- When is it okay to stop testing at age 65
- When is a pap of a vaginal cuff done annually? with what?
Current Pap Recommendations:
- Pap testing starts at age 21
- HIV + —> start at time of dx/sexually active (annually)
- Pap testing Q3 yrs for 21-29
- Pap + HPV done Q5 yrs and Pap alone Q3 yrs if 30-65
- stop testing at age 65 if: no hx of dysplasia/cervical CA
- pap of vaginal cuff (no uterus) done when Hx of dysplasia/cervical CA
- use spatula
When is colposcopy done (2)?
What is applied to perform it?
Colposcopy:
- Eval abn pap or persistent HPV infection
- apply acetic acid + Lugol’s iodine soln –> highlights abn
What are the 3 concerning results seen w/colscopy?
- acetowhite changes (brighter white)
- Abn staining w/Lugol’s (cells DONT take up iodine stain)
- Squamous changes that are most dense/intense at transformation zone
What are the 3 concerning results seen w/colscopy?
- acetowhite changes (brighter white)
- Abn staining w/Lugol’s (cells DONT take up iodine stain)
- Squamous changes that are most dense/intense at transformation zone
What is intraepithelial cervical dyplasia d/t, what is concern w/it?
Low risk type?
2 High risk types?
intraepithelial cervical dyplasia is HPV mediated abn growth that is potentially pre-malignant
Low risk = CIN-I
high risk = CIN-II, III
