The cervix and its disorders

Question 1

What is cervical ectopy?

Answer 1

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.

Question 2

When is cervical ectopy, due to eversion commonly seen?

Answer 2

In younger women and those taking the COCP

Question 3

Why does the cervical ectropion appear red?

Answer 3

Glandular cells are red

Question 4

What symptoms do a cervical ectropion usually cause?

Answer 4

Vaginal discharge or post-coital bleeding

Question 5

How can cervical ectropion be treated?

Answer 5

Freezing (cryotherapy) without anaesthetic but only after a smear and ideally colposcopy has excluded carcinoma.

Question 6

What are cervical polyps?

Answer 6

They are benign tumours of the endocervical epithelium.

Question 7

Who are cervical polyps most common in?

Answer 7

Women of 40 years of age

Question 8

What are nabothian follicles?

Answer 8

They are squamous epithelium formed by metaplasia over endocervical cells and the columnar cell secretions are trapped forming retention cysts. NO SYMPTOMS normally

Question 9

How is CIN 1 histologically described?

Answer 9

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

Question 10

How is CIN 2 histologically described?

Answer 10

Moderate dysplasia- with atypical cells found in the lower two-thirds of the epithelium

Question 11

How is CIN 3 histologically described?

Answer 11

Atypical cells which occupy the full thickness of the epithelium. They are similar in appearance to malignant lesions but there is no invasion.

Question 12

How are malignant cells described?

Answer 12

Atypical cells which occupy full thickness of the epithelium and invade the basement membrane.

Question 13

What percentage of women with CIN II/III will go on to develop cervical cancer?

Answer 13

About a third of women will develop cancer over the next 10 years.

Question 14

Which age group and class is cervical cancer most prevanent in?

Answer 14

35-45 and in the lower socio-economic class

Question 15

When does the peak incidence of cervical cancer occur?

Answer 15

25-29

Question 16

What is the main aetiology associated with cervical cancer?

Answer 16

Number of sexual partners, especially at an early age.

Question 17

Which factors increase the risk of cervical cancer slightly?

Answer 17

Smoking and OCP. Immunocompromised patients are obviously more at risk too

Question 18

How often are women screened for cervical cancer?

Answer 18

Every 3 years from 25-49 and then every 5 years from 50-64

Question 19

What is a pap smear?

Answer 19

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.

Question 20

What are the disadvantages of a pap smear?

Answer 20

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.

Question 21

How does liquid based cytology work (LBC)?

Answer 21

Samples are collected using a brush like device rather than a spatula and the head is broken off into a vial or preservative fluid.

Question 22

What are the advantages of LBC?

Answer 22

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.

Question 23

What are the current methods of LBC?

Answer 23

Sure path and Cytoscreen (manual method of sample prep)

Question 24

How are the smear results evaluated, (according to what guidelines)?

Answer 24

Categorised using the british society for clinical cytologists (BSCC).

Question 25

What are the categories of smear test results?

Answer 25

Negativem borderline, mild, moderate, severe, glandular neoplasia or adenocarcinoma in situ-15% cervical cancers

Question 26

If results are borderline or mildly dyskaryotic, what happens?

Answer 26

Invited back to screen at 6 months and if still present then, colposcopy.

Question 27

How many smears are required if the result is mildly dyskaryotic?

Answer 27

Maximum 2 smears

Question 28

What happens if the results show moderate dyskaryosis?

Answer 28

Colposcopy

Question 29

What happens if the results show severe dyskaryosis?

Answer 29

Urgent colposcopy

Question 30

What is the results show CGIN (any grade)?

Answer 30

Colposcopy, hysteroscopy

Question 31

What does colposcopy show?

Answer 31

The presence and grade of CIN