T3 L5 Cervix in health and disease

Question 1

When does the development of the female genital system start?

Answer 1

Week 8

Question 2

Describe the development of the female genital system

Answer 2

Paramesonephros tube joins in midline and then with sinovaginal bulb to form a solid vaginal plate which later canalises to form the vagina

Question 3

What is agenesis of the cervix?

Answer 3

Complete absence of the cervix?

Question 4

What is partial agenesis of the cervix?

Answer 4

Obstructed cervix

Question 5

What is dysgenesis of the cervix?

Answer 5

Abnormal development and growth of the cervix

Question 6

What is the endocervix?

Answer 6

Inner part of the cervix

Question 7

What is the ectocervix?

Answer 7

Portio vaginalis and external os

Question 8

What is the transformation zone?

Answer 8

Area between original SCJ and new SCJ

Question 9

Describe the cervix in a nulliparous female

Answer 9

Cervix is barrel shaped

External os is small and circular at the centre of the cervix

Question 10

Describe the cervix in a parous female

Answer 10

Cervix is bulky

External os becomes slit-like

Question 11

Describe the stroma of the cervix?

Answer 11

Collagenous connective tissue

15% smooth muscle fibre

Question 12

Why does the cervix often bleed when you take a biopsy?

Answer 12

Lack of muscle fibres meaning vasoconstriction is limited

Question 13

What can be used to stop bleeding during a biopsy of the cervix?

Answer 13

Silver nitrate

Question 14

What is the blood supply to the cervix?

Answer 14

Descending branch of uterine artery

Venous drainage follows the arteries

Question 15

What is the lymphatic drainage of the cervix?

Answer 15

Parametrium nodes to obturator nodes into internal and external iliacs to the common iliacs

Question 16

What is the nerve supply of the cervix?

Answer 16

Pain fibres with parasympathetic to S2, S3, S4

Uterine to T11 and T12

Question 17

What is the histology of the ectocervix?

Answer 17

Non-keratinising stratified squamous epithelium

Native of metaplastic in continuity with vaginal epithelium

Question 18

What are the multiple layers of squamous epithelium of the ectocervix?

Answer 18

Basal
Parabasal
Intermediate
Superficial

Question 19

What is the histology of the endocervix?

Answer 19

Simple columnar epithelium that secretes mucus

Mucinous columnar epithelium lines the surface and the underlying glands

Question 20

What are the functions of the cervix?

Answer 20

Produces mucus to facilitate sperm migration
Barrier to ascending infection
Holds developing pregnancy in place
Effaces and dilates to enable vaginal birth

Question 21

What are the physiological changes of the cervix in pregnancy?

Answer 21

Hypertrophies
Softens
Increased vascularity / venous congestion
Glands become distended with mucus
Prominent ectropion
Remains elongated until onset of labour

Question 22

What causes cervical ectopy ‘‘erosion’’?

Answer 22

Effect of oestrogen

Question 23

What causes atrophic cervicitis?

Answer 23

Lack of oestrogen

Question 24

What is atrophic vaginitis?

Answer 24

Inflammation of the vagina due to tissue thinning caused by a lack of oestrogen

Question 25

What are some examples of cervical infections?

Answer 25

``` Chlamydia Gonorrhoea Trichomonas vaginalis HPV Thrush Genital warts ```

Question 26

What does the cervix look like in trichomonas vaginalis?

Answer 26

Ulcers on the cervix (leopard cervix)

Question 27

How many cases of cervical cancer are there each year?

Answer 27

430,000

Question 28

What does the cervix look like in CIN III?

Answer 28

Increased vascularisation Contact bleeding Sharp, white edges Spots with halo around them (HPV)

Question 29

What are the predisposing factors of cervical cancer from HPV?

Answer 29

Smoking Multiple sexual partners Immune compromise Low socio-economic status

Question 30

How is HPV transmitted?

Answer 30

Through close sexual contact not via bodily fluids

Question 31

What percentage of sexually active women will be infected with HPV?

Answer 31

95%

Question 32

Why aren't condoms fully protective against HPV?

Answer 32

Don't cover all areas of the genitals | Close sexual contact may occur before condom is put on

Question 33

How often are women invited for cytology?

Answer 33

Every 3 years if aged between 25 and 49 years | Every 5 years if aged between 50 and 65 years

Question 34

What are the normal findings in a cytology test?

Answer 34

Endocervical cells Squamous cells Metaplastic cells from transformation zone

Question 35

What are the dyskaryosis findings in a cytology?

Answer 35

Nucleus is larger Increased nucleoli Nuclear cytoplasm is reduced Looks more purple

Question 36

Why is acetic acid added in a colposcopy?

Answer 36

Makes abnormal cells more white

Question 37

Why is iodine added in a colposcopy?

Answer 37

Pre-cancerous / cancerous cells will look yellow instead of dark brown.

Question 38

How is cervical cancer treated?

Answer 38

Ablation or excision

Question 39

What is the treatment in stage 1a?

Answer 39

Cone biopsy / loop excision

Question 40

What is the treatment in 1b?

Answer 40

Radical hysterectomy / trachelectomy

Question 41

What is the treatment in 2a?

Answer 41

Chemo-radiotherapy