Pathology of cervix, vagina and vulva Flashcards
The cervix
- before puberty, ectocervix is covered in . __________ _____ _______ _______
and the endocervix is covered by ________ (g______) epithelium - After pubertal growth the squamo-columnar junction is everted into the ______
- The columnar epithelium is constantly changing to squamous at the transformation zone as it adapts to the vaginal environment - the area this happens is called the ‘_________ ____’
- changes are reversed at _________
- zone of unstable differentiation is where most cervical neoplasia develop
The cervix
- before puberty, ectocervix is covered in non-keratinised stratified squamous epithelium
and the endocervix is covered by columnar (glandular) epithelium - After pubertal growth the squamo-columnar junction is everted into the vagina
- The columnar epithelium is constantly changing to squamous as it adapts to the vaginal environment - the area this happens is called the ‘transformation zone’
- changes are reversed at menopause
- zone of unstable differentiation is where most cervical neoplasia develop
Human Papilloma Virus (HPV)
- infection with oncogenic strain of HPV is a necessary cause of ______ ____
- HPV 16, 18 are prevalent oncogenic strains in Glasgow
Cervical cancer
Cervical cytology / cervical screening
- sample of cells taken from _________ ___
- used to detect ___ changes and cervical intraepithelial neoplasia (___)
- presence of _______ (nuclear abnormalities) suggests CIN
- CIN has no symptoms
Cervical cytology / cervical screening
- sample of cells taken from transformation zone
- used to detect HPV changes and cervical intraepithelial neoplasia (CIN)
- presence of dyskaryosis (nuclear abnormalities) suggests CIN
- CIN has no symptoms
Cervical screening
- age __-__, every _ years
- age __-__, every _ years
Cervical screening
- age 25-50, every 3 years
- age 50-65, every 5 years
Types of cells checked on a cervical smear/pap test:
http://www.slh.wisc.edu/clinical/cytology/resources-for-health-care-professionals/gynecologic-cytology-101/normal-cytology/
Also descriptions in pics of some of the cells tested for abnormalities.
Smear reporting:
- if negative, repeat in ___
- borderline nuclear abnormality, repeat in _ _____
- low grade dyskaryosis (nuclear abnormality), ______
- high grade dyskaryosis (moderate), _______
- high grade dyskaryosis (severe), _______
- glandular abnormality, ___________
- invasive features = _____ refer to colposcopy
Colposcopy = procedure for a detailed look at cervix
Smear reporting:
- if negative, repeat in 3yrs
- borderline nuclear abnormality, repeat in 6 month
- low grade dyskaryosis (nuclear abnormality), refer to colposcopy
- high grade dyskaryosis (moderate), refer to colposcopy
- high grade dyskaryosis (severe), refer to colposcopy
- glandular abnormality, refer to colposcopy
- invasive features = urgent refer to colposcopy
Colposcopy = looking at cervix using speculum
HPV vaccination
- started 2008
- aimed at 12/13 year old girls
- catch up programme for older girls
- Scotland uses quadrivalent vaccine - covers HPV 6,11,16,18
HPV testing?
- only HPV testing done in Scotland is ‘test of cure’
- in 2020 HPV testing will be used for primary screening
- most HPV infection does not progress to CIN or cancer, there are other risk factors
Colposcopy
- cervix visualised
- washed with _____ ____
- application of _____
- _____ light filter
- abnormal area can be biopsied or treated at time
Colposcopy
- cervix visualised
- washed with acetic acid
- application of iodine
- green light filter
- abnormal area can be biopsied or treated at time
HPV and the cervix
- __% cervical carcinomas associated with HPV
- early HPV genes (__-__) help virus use ___ ________ _______
- late HPV genes (__,__) encode ______ (virus shell) proteins, disrupts cell cycle and causes oncogenic mutations
HPV and the cervix
- 99% cervical carcinomas associated with HPV
- early HPV genes (E1-E7) help virus use cell proliferation machinery
- late HPV genes (L1,L2) encode capsid (virus shell) proteins, disrupts cell cycle and causes oncogenic mutations
LETZ stands for __ ______ __ _______ ___
LETZ is different but similar to colposcopy-directed biopsy.
LETZ stands for Loop Excision of Transformation Zone.
LETZ is different but similar to colposcopy-directed biopsy.
Cold Coagulation.
Explain what it is.
And think of complications.
Cold Coagulation is the destroying of abnormal cervical cells using a heated probe.
Pic in folder of post cold coagulation.
Complications: immed. - pain - haemorrhage delayed. - infection - cervical stenosis
What cervical screening looks for:
- looks for squamous lesions
- endocervical glandular epithelium also undergoes premalignant change - ___ ____ ___ ___ (cGIN)
- Malignant change from glandular epithelium is called __________
Pics of abnormal glandular epithelium in folder.
What cervical screening looks for:
- looks for squamous lesions
- endocervical glandular epithelium also undergoes premalignant change - Cervical Glandular Intraepithelial Neoplasia (cGIN)
- Malignant change from glandular epithelium is adenocarcinoma
Pics of abnormal glandular epithelium in folder.
What should always be done about post menopausal bleeding?
Refer to gynaecology for endometrial biopsy.
Cervical cancer symptoms:
name 4.
- post coital bleeding (after sex)
- intermenstrual bleeding
- irregular vaginal bleeding
- pain
- none
Invasive squamous carcinoma of the cervix
–> almost always develops from pre-existing ___
‘low grade’ squamous intraepithelial lesion = CIN 1
‘high grade’ squamous intraepithelial lesion = CIN 2, CIN 3
Invasive squamous carcinoma of the cervix
–> almost always develops from pre-existing CIN
‘low grade’ squamous intraepithelial lesion = CIN 1
‘high grade’ squamous intraepithelial lesion = CIN 2, CIN 3
