The cervix and it's disorders Flashcards
What is cervical ectropion?
When the columnar epithelium of the endocervix is visible as a red area around the os on the surface of the cervix
What causes a cervical ectropion?
It is due to eversion
Are cervical ectropions normal?
Elevated oestrogen levels
They are normal in pregnant women, particularly those who are pregnant or taking the ‘pill’
What are the symptoms of cervical ectropion?
Normally asymptomatic, ectropians occasionally cause vaginal discharge or postcoital bleeding.
How do you treat cervical ectropions?
It can be treated by freezing (cryotherapy) without anaesthetic, but only after a smear, and ideally colposcopy to exclude carcinoma
What is chronic cervicitis?
Chronic inflammation or infection, often of an ectropion.
What symptoms does chronic cervicitis cause?
It is a common cause of vaginal discharge
How do you treat chronic cervicitis?
Cryotherapy is used, with or without antibiotics, depending upon bacterial culture
What are cervical polyps?
Benign tumours of the endocervical epithelium.
What age are cervical polyps most common?
Most common in women above the age of 40 years
What are the symptoms of cervical polyps?
They may be asymptomatic or cause intermenstrual bleeding or postcoital bleeding
What is cervical intraepithelial neoplasia (CIN)?
CIN, or cervical dysplasia, is the presence of atypical cells within the squamous epithelium
What are the cells that are atypical in CIN?
The atypical cells are dyskaryotic, exhibiting larger nuclei with frequent mitoses.
How is CIN graded?
Depending on the extent to which these cells are found in the epithelium (histologically)
What is CIN 1?
Mild dysplasia - atypical cells are found only in the lower third of the epithelium
What is CIN 2?
Moderate dysplasia - atypical cells are found in the lower 2/3of the epithelium
What is CIN 3?
Severe dysplasia - atypical cells occupy the full thickness of the epithelium - carcinoma in situ - malignant lesion but no invasion
How many women will get cervical cancer if CIN 2/3 is untreated?
About 1/3 women within 10 years
Can CIN 1 regress?
Yes, it can regress spontaneously
What age is CIN most common?
90% of CIN 3 cases are in women under 45, with peak incidence in this 25-29 years of age
What is the histological change that occurs during CIN?
Columnar epithelium to squamous epithelium
What is the treatment for CIN 2 or 3?
Cutting diathermy under local anaesthetic - ‘LLETZ- Large Loop Excision of the Transformation Zone’
What age in cervical cancer most common?
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.
What is the pathology of cervical cancer?
90% are squamous cell carcinoma, 10% are adenocarcinoma
What type of cervical cancer has the worst prognosis?
Adenocarcinomas have a worse prognosis and are increasing in proportion as smear programme prevents proportionally more squamous cell carcinoma
What can accelerate CIN to cervical cancer?
Immunosuppression
What are the symptoms of cervical cancer?
Postcoital bleeding, offensive vaginal bleeding, intermenstrual bleeding or postmenopausal bleeding are common. Pain is a late feature.
Is nodal spread common in cervical cancer?
Lymphatic spread to the pelvic nodes is an early feature but blood borne spread occurs late
How is cervical cancer staged?
FIGO - clinical from examination
List 2 causes of inadquate smears.
- masking of epithelial cell detail by pus
2. insufficient epithelial cells being present for accurate assessment
What are the risk factors for cervical cancer?
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*
Mechanism of HPV causing cervical cancer
HPV 16 and 18 produces the oncogenes E6 and E7 genes respectively
E6 inhibits the p53 tumour suppressor gene
E7 inhibits RB suppressor gene
