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Repro > Pathology of the Cervix, Vulva and Vagina > Flashcards

Pathology of the Cervix, Vulva and Vagina Flashcards

1
Q

What is the Transformation zone (TZ)?

A

Squamo-columnar junction between ectocervical (squamous) and endocervical (columnar) epithelia

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2
Q

What physiological things can alter the position of the TZ?

A

Menarche
Pregnancy
Menopause

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3
Q

What is cervical erosion?

A

Exposure to delicate endocervical epithelium to acid environment of the vagina which leads to physiological squamous metaplasia

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4
Q

What is Cervicitis?

A

Often asymptomatic

Can lead to infertility due to simultaneous silent fallopian tube damage

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5
Q

What is follicular cervicitis?

A

Sub. epithelial reactive lymphoid follicles present in cervix

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6
Q

What is Chlamydia trachomatis?

A

STI

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7
Q

What is a Cervical polyp?

A

Localised inflam outgrowth
Cause of bleeding if ulcerated
Not premalignant

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8
Q

What are types of cervical cancer?

A

Squamous carcinoma
Adenocarcinoma
Cervical Intraepithelial Neoplasia

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9
Q

What are risk factors for CIN/cervical cancer?

A 
HPV
Age at first intercourse
Long term oral contraceptive
Non-use of barrier contraception
Smoking
Immunosuppresion
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10
Q

What HPV cause genital warts?

A

6 and 11

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11
Q

What are genital warts?

A

Condyloma acuminatum: thickened papilomatous squamous epithelium with cytoplasmic vacuolation (koilocytosis)

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12
Q

What HPV causes CIN?

A

16 and 18

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13
Q

WHat is CIN?

A

Infected epithelium remains flat, but may show koilocytosis, which can be detected in cervical smears

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14
Q

What is cervical cancer?

A

Invasive squamous carcinoma: virus integrated into host DNA

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15
Q

Describe CIN?

A 
Pre-invasive stage of cervical cancer
Occurs at the TZ
Can involve large areas
Dysplasia of squamous cells
Not visible to naked eye
Asymptomatic
Detectable on cervical smear
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16
Q

Describe CIN I

A

basal 1/3 of epithelium occupied by abnormal cells
Raised numbers of mitotic figures in lower 1/3
Surface cells quite mature, but nuclei slightly abnormal

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17
Q

Describe CIN II

A

Abnormal cells extend to middle 1/3
Mitoses in middle 1/3
Abnormal mitotic figures

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18
Q

Describe CIN III

A

Abnormal cells occupy full thickness of epithelium

Mitoses, often abnormal, in upper 1/3

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19
Q

Describe Invasive Squamous Carcinoma (ISC)

A

75-95% of malignant cervical tumours
2nd commonest female cancer
Develop from pre-existing CIN so should be preventable by screening

20
Q

What is the 5 year survival rate for cervical cancer in Scotland?

A

70.1%

21
Q

What is stage 1A1 ISC?

A

depth up to 3mm, width up to 7mm

22
Q

What is stage 1A2 ISC?

A

depth up to 5mm
width up to 7mm
Low risk of metastases

23
Q

What is stage 1B ISC?

A

Confined to the cervix

24
Q

What is stage 2 ISC?

A

Spread to adjacent organs (vagina, uterus etc.)

25
Q

What is stage 3 ISC?

A

Involvement of pelvic wall

26
Q

What is stage 4 ISC?

A

Distant metastases or involvement of rectum or bladder

27
Q

What are symptoms of invasive carcinoma?

A 
usually none at microinvasive and early invasive stages (detected at screening)
Abnormal bleeding
Pelvic plain
Haematuria/Urinary infections
Ureteric obstruction/Renal failire
28
Q

Describe the bleeding seen in invasive carcinoma?

A

Post coital
Post-menopausal
Brownish or blood stained vaginal discharge
Contact bleeding - friable epithelium

29
Q

Where does squamous carcinoma metastasise to via local spread?

A 
Uterine body
Vagina
Bladder
Ureters
Rectum
30
Q

Where does squamous carcinoma metastasise to via lymphatic spread? (early)

A

Pelvic

para-aortic nodes

31
Q

Where does squamous carcinoma metastasise to via haematogenous spread? (late)

A

Liver
Lungs
Bone

32
Q

How is squamous carcinoma graded?

A

Well differentiated
Moderately differentiated
Poorly differentiated
Undifferentiated / anaplastic

33
Q

What is CGIN?

A

Cervical Glandular Intraepithelial Neoplasm

34
Q

Describe Cervical Glandular Intraepithelial Neoplasm

A

Origin from endocervical epithelium
Preinvasive phase of endocervical adenocarcinoma
Screening less effective
Can be assoc. with CIN

35
Q

What has a worse prognosis; Squamous carcinoma or Endocervical adenocarcinoma?

A

Endocervical adenocarcinoma

36
Q

What are risk factors for Adenocarcinoma?

A

Higher S.E. class
Later onset sexual activity
Smoking
HPV, esp. 18

37
Q

Name 3 other HPV driven diseases

A

Vulvar Intraepithelial Neoplasia (VIN)
Vaginal Intraepithelial Neoplasia (VaIN)
Anal Intraepithelial Neoplasia (AIN)

38
Q

What does Vulvar Intraepithelial Neoplasia have an association with?

A

Paget’s disease

39
Q

Describe VIN in young women?

A

Often multifocal

Recurrent or persistent causing treatment problems

40
Q

Describe VIN in older women?

A

Greater risk of progression to invasive squamous carcinoma

41
Q

What is VIN often synchronous with?

A

Cervical and vaginal neoplasia (CIN and VaIN)

42
Q

Describe Vulvular Invasive Squamous carcinoma

A

Usually elderly women
Ulcer or exophytic mass
Can arise from normal epithelium or VIN

43
Q

Where does Vulvular Invasive Squamous carcinoma spread to?

A

Inguinal lymph nodes

44
Q

What is the treatment of Vulvular Invasive Squamous carcinoma?

A

Surgical - radical vulvectomy and inguinal lymphadecnectomy

45
Q

What is the 5 year survival of Vulvular Invasive Squamous carcinoma for node +ve and node -ve?

A

Node +ve = <60%

Node -ve = 90%

46
Q

Describe Vulvar Paget’s disease

A

Crusting rash
Tumour cells in epidermis, contain mucin
Mostly no underlying cancer, tumour arises from sweat gland in skin

Repro (46 decks)

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