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Obstetrics and Gynaecology > The cervix and it's disorders > Flashcards

The cervix and it's disorders Flashcards

1
Q

What is cervical ectropion?

A

When the columnar epithelium of the endocervix is visible as a red area around the os on the surface of the cervix

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2
Q

What causes a cervical ectropion?

A

It is due to eversion

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3
Q

Are cervical ectropions normal?

A

Elevated oestrogen levels

They are normal in pregnant women, particularly those who are pregnant or taking the ‘pill’

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4
Q

What are the symptoms of cervical ectropion?

A

Normally asymptomatic, ectropians occasionally cause vaginal discharge or postcoital bleeding.

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5
Q

How do you treat cervical ectropions?

A

It can be treated by freezing (cryotherapy) without anaesthetic, but only after a smear, and ideally colposcopy to exclude carcinoma

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6
Q

What is chronic cervicitis?

A

Chronic inflammation or infection, often of an ectropion.

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7
Q

What symptoms does chronic cervicitis cause?

A

It is a common cause of vaginal discharge

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8
Q

How do you treat chronic cervicitis?

A

Cryotherapy is used, with or without antibiotics, depending upon bacterial culture

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9
Q

What are cervical polyps?

A

Benign tumours of the endocervical epithelium.

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10
Q

What age are cervical polyps most common?

A

Most common in women above the age of 40 years

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11
Q

What are the symptoms of cervical polyps?

A

They may be asymptomatic or cause intermenstrual bleeding or postcoital bleeding

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12
Q

What is cervical intraepithelial neoplasia (CIN)?

A

CIN, or cervical dysplasia, is the presence of atypical cells within the squamous epithelium

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13
Q

What are the cells that are atypical in CIN?

A

The atypical cells are dyskaryotic, exhibiting larger nuclei with frequent mitoses.

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14
Q

How is CIN graded?

A

Depending on the extent to which these cells are found in the epithelium (histologically)

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15
Q

What is CIN 1?

A

Mild dysplasia - atypical cells are found only in the lower third of the epithelium

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16
Q

What is CIN 2?

A

Moderate dysplasia - atypical cells are found in the lower 2/3of the epithelium

17
Q

What is CIN 3?

A

Severe dysplasia - atypical cells occupy the full thickness of the epithelium - carcinoma in situ - malignant lesion but no invasion

18
Q

How many women will get cervical cancer if CIN 2/3 is untreated?

A

About 1/3 women within 10 years

19
Q

Can CIN 1 regress?

A

Yes, it can regress spontaneously

20
Q

What age is CIN most common?

A

90% of CIN 3 cases are in women under 45, with peak incidence in this 25-29 years of age

21
Q

What is the histological change that occurs during CIN?

A

Columnar epithelium to squamous epithelium

22
Q

What is the treatment for CIN 2 or 3?

A

Cutting diathermy under local anaesthetic - ‘LLETZ- Large Loop Excision of the Transformation Zone’

23
Q

What age in cervical cancer most common?

A

The disease can occur at any age after first intercourse but has two peaks of incidence, in her 30s and 80s. The majority of cases occur in women aged 25-49 years.

24
Q

What is the pathology of cervical cancer?

A

90% are squamous cell carcinoma, 10% are adenocarcinoma

25
Q

What type of cervical cancer has the worst prognosis?

A

Adenocarcinomas have a worse prognosis and are increasing in proportion as smear programme prevents proportionally more squamous cell carcinoma

26
Q

What can accelerate CIN to cervical cancer?

A

Immunosuppression

27
Q

What are the symptoms of cervical cancer?

A

Postcoital bleeding, offensive vaginal bleeding, intermenstrual bleeding or postmenopausal bleeding are common. Pain is a late feature.

28
Q

Is nodal spread common in cervical cancer?

A

Lymphatic spread to the pelvic nodes is an early feature but blood borne spread occurs late

29
Q

How is cervical cancer staged?

A

FIGO - clinical from examination

30
Q

List 2 causes of inadquate smears.

A
  1. masking of epithelial cell detail by pus

2. insufficient epithelial cells being present for accurate assessment

31
Q

What are the risk factors for cervical cancer?

A

Human papillomavirus (HPV), particularly serotypes 16,18 and 33 is by far the most important factor in the development of cervical cancer. Other risk factors include:
smoking
human immunodeficiency virus
early first intercourse, many sexual partners
high parity
lower socioeconomic status
combined oral contraceptive pill*

32
Q

Mechanism of HPV causing cervical cancer

A

HPV 16 and 18 produces the oncogenes E6 and E7 genes respectively
E6 inhibits the p53 tumour suppressor gene
E7 inhibits RB suppressor gene

Obstetrics and Gynaecology (27 decks)

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