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Reproduction > Pathology cervix and screening > Flashcards

Pathology cervix and screening Flashcards

1
Q

What is the transformation zone of the cervix?

A
  • squamo-columnar junction between ectocervical (squamous) and endocervical (columnar) epithelium
  • position of this alters during life
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2
Q

What is cervical erosion(ectropion)?

A

-exposure of delicate endocervix to acidic environ. of vagina leads to physiological squamous metaplasia

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3
Q

What is a nabothian follicle (nabothian cyst)

A

squamous epithelium grows over the columnar epithelium = mucus filled cyst on cervix surface

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4
Q

What is cervicitis?

  • caused by?
  • what pathology is seen?
  • clinical features?
A

Causes: chlamydia and herpes simplex

Pathology:

  • non-specific acute inflammation
  • follicular cervicitis: subepthelial reactive lymphoid fllicles present at cervix
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5
Q

Cervical polyp:

  • is this premalignant?
  • what can it cause?
  • what pathology is seen?
A

Not premalignant

  • cause of bleeding if ulcerated
  • localised inflammatory outgrowth
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6
Q

What 3 neoplastic conditions affect the cervix?

A

CIN: HPV 16, 18

Cancer:

  • squamous carcinoma
  • adenocarcinoma
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7
Q

What are the risk factors for CIN/cervical cancer?

A

persistence of high risk HPV (16,18):
-many sexual partners increases the risk

Vulnerability of transitional zone in early reproductive life:

  • early age at 1st sexual intercourse
  • long term use of oral contraceptives
  • non-use of barrier contraception
  • Smoking (X3 the risk)
  • immunosupression
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8
Q

What does HPV 6 and 11 cause?

A 
Condyloma acuminatum (genital warts)
-thickened papillomatous squamous epithelium with cytoplasmic vacuolation
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9
Q

What does HPV 16 and 18 cause? describe the epithelial changes? where does this take place?

A

CIN

  • infected epithelium remains flat but may show koilocytosis
  • occurs at the transformation zone of the cervix
  • squamous cell dysplasia
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10
Q

What does HPV infection lead to? how long does this take?

A

HPV leads to high grade CIN (6mths - 3yrs)

High grade CIN can lead to invasive squamous carcinoma (5-20 years)

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11
Q

Describe the histology seen with CIN?

A

Delay in maturation/differentiation:
-immature basal cells occupy

No clear abnormalities:

  • hyperchromasia
  • pleomorphism
  • increase in nuclear cytoplasmic ratio

Excess mitotic activity:

  • situated above basal layers
  • abnormal mitotic forms
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12
Q

Describe the morphology of CIN 1,2 and 3, what is the chance of progression to invasion?

A

CIN 1:

  • Basal 1/3 epithelium occupied by abnormal cells
  • raised no. of mitotic figures in lower 1/3
  • surface cells quite mature but nuclei slightly abnormal
  • 1% chance progression

CIN 2:

  • abnormal cells extend to middle 1/3
  • mitoses in middle 1/3
  • abnormal mitotic figures
  • 5% chance progression

CIN 3:

  • abnormal cells occupy full thickness of epithelium
  • mitoses, often abnormal, in upper 1/3
  • > 12% chance progression
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13
Q

Invasive squamous cell carcinoma cervix:

  • is this common?
  • does this affect younger women?
  • is this preventable?
A

75-95% of malignant cervical tumours
-2nd commonest female cancer worldwide

  • increasingly detected in younger women, often found in early stages but some are rapidly progressive tumours
  • preventable if develops from pre-exisiting CIN
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14
Q

What are the symptoms of squamous cell carcinoma cervix?

A

Asymptomatic: micro/ealry invasive (screening)

Abnormal bleeding: PCB/PMB/brownish-blood stained discharge/contact bleeding (friable epithelium)

Pelvic pain

Haematuria/UTI

Ureteric obstruction and renal failure

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15
Q

Where does squamous cell carcinoma cervix spread to?

A

Local: uterine body, vagina, bladder, uterus, rectum

Lymphatic: early = pelvic, paraortic nodes

Haemotogenous: late = liver/lungs/bone

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16
Q

Describe the staging of squamous cell carcinoma cervix?

A 
FIGO staging systems
¥	Stage 1a – microscopic
¥	Stage 1b visible lesion
¥	Stage 2 a – vaginal involvement
¥	2b parametrial involvement
¥	Stage 3 lower vagina or pelvic sidewall
¥	Stage 4 bladder/rectum or metastases
17
Q

What is cervical glandular intraepithelial neoplasia (CGIN)?

  • origin from?
  • what can this lead to?
  • is this picked up on smears?
  • is this assoc. CIN?
A
  • origin from endocervical epithelium
  • pre-invasive phase of endocervical adenocarcinoma
  • screening is less effective CIN
  • sometimes assoc. CIN
18
Q

Endocervical adenocarcinoma cervix:

  • is this common?
  • is the prognosis better or worse than squamous?
  • what is the epidemiology?
A

5-25% cervical cancer, increased incidence in younger women

Prognosis -worse than squamous

Epidemiology:

  • higher s.e. class
  • later onset sexual activity
  • smoking
  • HPV esp. 18
19
Q

Apart from CIN what other HPV driven disease exists?

A
  • Vulval intraepithelial neoplasia (VIN)
  • Vaginal intraepithelial neoplasia (VaIN)
  • Anal intraepithelial neoplasia (AIN)
20
Q

VIN:

  • which disease is this assoc. with?
  • is the pathology predictable or unpredictable?
  • what age does this affect?
  • what else is this usually synchronous with?
  • What can this lead to?
A

Pagets disease: small no. of those with PD of vulva may develop VIN

Unpredictable pathology (3 grades)

Age affected is bimodal:
Young women - often multifocal, recurrent or persistent causing treatment problems
Older women - greater risk of progression to invasive

Usually synchronous with CIN/VaIN

Can lead to vulval invasive squamous carcinoma

21
Q

What is vulval pagets disease?

A

Crusting rash

  • tumour cells in epidermis contain mucin (they arise from sweat glands in skin)
  • mostly no underlying cancer
22
Q

vulval invasive squamous carcinoma:

  • who does this affect?
  • what is seen macroscopically?
  • what is the usual pathology?
  • where does this spread?
  • treatment?
A

Affects elderly women

Macroscopically:
-ulcer or exophytic mass

Pathology:

  • can arise from normal epithelium or VIN
  • mostly are well differentiated

Spread:
-inguinal nodes

Treatment:
-surgical = radical vulvectomy and inguinal lymphadenectomy

23
Q

VaIN:

  • is this common?
  • who does this effect?
A

Less common than CIN/VIN

-elderly women

24
Q

Cervical screening:

What is done if CIN1 is detected?

A

-repeat smear in 6mths

25
Q

Cervical screening:

What is done if CIN2 is detected?

A
  • referred to colposcopy for LLETZ/laser ablation/cold coagulation
  • then retested every 6mths for CIN and HPV
  • if HPV -ve and normal smear go back to normal population
26
Q

What is done if CIN3 is detected?

A
  • referred to colposcopy for LLETZ/laser ablation/cold coagulation
  • then retested every 6mths for CIN and HPV
  • if HPV -ve and normal smear go back to normal population
27
Q

At what age is cervical screening done?

A

-25-64

28
Q

Describe the treatment options of cervical cancer

A

Surgery is for stage 1B2 or less
o Loop excision of transformation zone (LETS)
o Fertility sparing
o Wertheim

  • Radiotherapy – do this OR surgery
  • Chemotherapy – there is not much role for this but get it in combo with radio.
29
Q

Radiotherapy for cervical cancer: how is this done?

-what planning is needed?

A

¥ High energy x-rays
¥ Targeted to include tumour +/- nodes
¥ External Beam – for five weeks
¥ Brachytherapy – then get this ‘concentrated’ radiotherapy
(Intrauterine tube goes into cervix with ring applicator which is loaded with a radioisotope)

Planning:
¥ EUA (examination under anaesthetic) and marker seed insertion – this helps to indicate how extensive tumour is
¥ CT planned

30
Q

Describe how chemo is given for cervical cancer?

A

¥ Neoadjuvant
Concomittant – at same time as therapy

Palliative
Types:
• Cisplatin – 40mg/m2 weekly
• Carboplatin/paclitaxel

Reproduction (34 decks)

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