T3 L5 Cervix in health and disease Flashcards
When does the development of the female genital system start?
Week 8
Describe the development of the female genital system
Paramesonephros tube joins in midline and then with sinovaginal bulb to form a solid vaginal plate which later canalises to form the vagina
What is agenesis of the cervix?
Complete absence of the cervix?
What is partial agenesis of the cervix?
Obstructed cervix
What is dysgenesis of the cervix?
Abnormal development and growth of the cervix
What is the endocervix?
Inner part of the cervix
What is the ectocervix?
Portio vaginalis and external os
What is the transformation zone?
Area between original SCJ and new SCJ
Describe the cervix in a nulliparous female
Cervix is barrel shaped
External os is small and circular at the centre of the cervix
Describe the cervix in a parous female
Cervix is bulky
External os becomes slit-like
Describe the stroma of the cervix?
Collagenous connective tissue
15% smooth muscle fibre
Why does the cervix often bleed when you take a biopsy?
Lack of muscle fibres meaning vasoconstriction is limited
What can be used to stop bleeding during a biopsy of the cervix?
Silver nitrate
What is the blood supply to the cervix?
Descending branch of uterine artery
Venous drainage follows the arteries
What is the lymphatic drainage of the cervix?
Parametrium nodes to obturator nodes into internal and external iliacs to the common iliacs
What is the nerve supply of the cervix?
Pain fibres with parasympathetic to S2, S3, S4
Uterine to T11 and T12
What is the histology of the ectocervix?
Non-keratinising stratified squamous epithelium
Native of metaplastic in continuity with vaginal epithelium
What are the multiple layers of squamous epithelium of the ectocervix?
Basal
Parabasal
Intermediate
Superficial
What is the histology of the endocervix?
Simple columnar epithelium that secretes mucus
Mucinous columnar epithelium lines the surface and the underlying glands
What are the functions of the cervix?
Produces mucus to facilitate sperm migration
Barrier to ascending infection
Holds developing pregnancy in place
Effaces and dilates to enable vaginal birth
What are the physiological changes of the cervix in pregnancy?
Hypertrophies Softens Increased vascularity / venous congestion Glands become distended with mucus Prominent ectropion Remains elongated until onset of labour
What causes cervical ectopy ‘‘erosion’’?
Effect of oestrogen
What causes atrophic cervicitis?
Lack of oestrogen
What is atrophic vaginitis?
Inflammation of the vagina due to tissue thinning caused by a lack of oestrogen
What are some examples of cervical infections?
Chlamydia Gonorrhoea Trichomonas vaginalis HPV Thrush Genital warts
What does the cervix look like in trichomonas vaginalis?
Ulcers on the cervix (leopard cervix)
How many cases of cervical cancer are there each year?
430,000
What does the cervix look like in CIN III?
Increased vascularisation
Contact bleeding
Sharp, white edges
Spots with halo around them (HPV)
What are the predisposing factors of cervical cancer from HPV?
Smoking
Multiple sexual partners
Immune compromise
Low socio-economic status
How is HPV transmitted?
Through close sexual contact not via bodily fluids
What percentage of sexually active women will be infected with HPV?
95%
Why aren’t condoms fully protective against HPV?
Don’t cover all areas of the genitals
Close sexual contact may occur before condom is put on
How often are women invited for cytology?
Every 3 years if aged between 25 and 49 years
Every 5 years if aged between 50 and 65 years
What are the normal findings in a cytology test?
Endocervical cells
Squamous cells
Metaplastic cells from transformation zone
What are the dyskaryosis findings in a cytology?
Nucleus is larger
Increased nucleoli
Nuclear cytoplasm is reduced
Looks more purple
Why is acetic acid added in a colposcopy?
Makes abnormal cells more white
Why is iodine added in a colposcopy?
Pre-cancerous / cancerous cells will look yellow instead of dark brown.
How is cervical cancer treated?
Ablation or excision
What is the treatment in stage 1a?
Cone biopsy / loop excision
What is the treatment in 1b?
Radical hysterectomy / trachelectomy
What is the treatment in 2a?
Chemo-radiotherapy
