Premalignant disease of the cervix

Question 1

What is the epithelium of the vagina?

Answer 1

Squamous epithelium

Question 2

What is the epithelium of the cervix?

Answer 2

Columnar epithelium

Question 3

What is cervical intraepithelial neoplasia?

Answer 3

Pre malignant change in the cervical epithelium which has the potential to turn malignant without treatment

Question 4

Two major causes of CIN?

Answer 4

1. HPV infection

2. Smoking

Question 5

Explain the pathophysiology of CIN

Answer 5

1. Under the influence of oestrogen;
2. Cervical glandular epithelium is pushed down into the ectocervix
3. Exposed to low PH and undergoes Squamous metaplasia (Transformational zone)
4. Infection of transformational zone can lead to cervical cancer

Question 6

Grading of CIN ( 3 stages )

Answer 6

CIN 1 - Mild dyskaryosis
CIN 2 - Moderate dyskaryosis
CIN 3 - Severe dyskaryosis

Question 7

What does mild dyskaryosis mean?

Answer 7

Abnormal nucleus occupies less than half of the area of the cell

Question 8

What does moderate dyskaryosis mean?

Answer 8

Nucleus occupies 1/2 to 2/3 of the cell

Question 9

What does severe dyskaryosis mean?

Answer 9

Nucleus fill 2/ 3 or more of the cell

Question 10

Mx of Borderline or mild dyskaryosis

Answer 10

The original sample is tested for HPV*
if negative the patient goes back to routine recall
if positive the patient is referred for colposcopy

Question 11

Moderate dyskaryosis

Answer 11

Consistent with CIN II. Refer for urgent colposcopy (within 2 weeks)

Question 12

Severe dyskaryosis

Answer 12

Consistent with CIN III. Refer for urgent colposcopy (within 2 weeks**)

Question 13

Suspected invasive cancer

Answer 13

Refer for urgent colposcopy (within 2 weeks)

Question 14

Why may some women be invited back after treatment?

Answer 14

Women who have been treated for CIN1, CIN2, or CIN3 should be invited 6 months after treatment for ‘test of cure’ repeat cytology in the community.