The cervix and its disorders Flashcards
What is cervical ectopy?
Columnar epithelium of the endocervix protrudes out through the external os due to eversion and undergoes squamous metaplasia, transforming into stratified squamous epithelium. It appears as a red area around the os on the surface of the cervix.
When is cervical ectopy, due to eversion commonly seen?
In younger women and those taking the COCP
Why does the cervical ectropion appear red?
Glandular cells are red
What symptoms do a cervical ectropion usually cause?
Vaginal discharge or post-coital bleeding
How can cervical ectropion be treated?
Freezing (cryotherapy) without anaesthetic but only after a smear and ideally colposcopy has excluded carcinoma.
What are cervical polyps?
They are benign tumours of the endocervical epithelium.
Who are cervical polyps most common in?
Women of 40 years of age
What are nabothian follicles?
They are squamous epithelium formed by metaplasia over endocervical cells and the columnar cell secretions are trapped forming retention cysts. NO SYMPTOMS normally
How is CIN 1 histologically described?
Mild dysplasia- with atypical cells found in the lower third of the epithelium
How is CIN 2 histologically described?
Moderate dysplasia- with atypical cells found in the lower two-thirds of the epithelium
How is CIN 3 histologically described?
Atypical cells which occupy the full thickness of the epithelium. They are similar in appearance to malignant lesions but there is no invasion.
How are malignant cells described?
Atypical cells which occupy full thickness of the epithelium and invade the basement membrane.
What percentage of women with CIN II/III will go on to develop cervical cancer?
About a third of women will develop cancer over the next 10 years.
Which age group and class is cervical cancer most prevanent in?
35-45 and in the lower socio-economic class
When does the peak incidence of cervical cancer occur?
25-29
What is the main aetiology associated with cervical cancer?
Number of sexual partners, especially at an early age.
Which factors increase the risk of cervical cancer slightly?
Smoking and OCP. Immunocompromised patients are obviously more at risk too
How often are women screened for cervical cancer?
Every 3 years from 25-49 and then every 5 years from 50-64
What is a pap smear?
This is usually carried out by a GP or nurse in primary care or can be in GUM clinic. The cervical cells are collected using a disposable spatula device.
What are the disadvantages of a pap smear?
Approx 8% are inadequate meaning women must re-attend causing anxiety and inconvenience. The presence of inflammatory cells, blood or mucous also obscure the sample.
How does liquid based cytology work (LBC)?
Samples are collected using a brush like device rather than a spatula and the head is broken off into a vial or preservative fluid.
What are the advantages of LBC?
Improved means of slide preparation, producing more homogenous samples than a pap. There is also increased sensitivity and specificity and there is improved efficiency of handling lab samples.
What are the current methods of LBC?
Sure path and Cytoscreen (manual method of sample prep)
How are the smear results evaluated, (according to what guidelines)?
Categorised using the british society for clinical cytologists (BSCC).
What are the categories of smear test results?
Negativem borderline, mild, moderate, severe, glandular neoplasia or adenocarcinoma in situ-15% cervical cancers
If results are borderline or mildly dyskaryotic, what happens?
Invited back to screen at 6 months and if still present then, colposcopy.
How many smears are required if the result is mildly dyskaryotic?
Maximum 2 smears
What happens if the results show moderate dyskaryosis?
Colposcopy
What happens if the results show severe dyskaryosis?
Urgent colposcopy
What is the results show CGIN (any grade)?
Colposcopy, hysteroscopy
What does colposcopy show?
The presence and grade of CIN
