The cervix and its disorders Flashcards
Cervix to sacrum
uterosacral ligaments
Cervix to pelvic wall
Cardinal ligaments
squamocolumnar junction
endocervix- columnar
ectocervix- squamous
Boundary
Transformation zone
Low vaginal pH causing metaplasia of columnar to squamous- vulnerable to metaplasia
Upper cervix supplied by and drains into
uterine artery, external iliac-paraaortic
Lower cervix supplied by and drains into
upper vaginal arteries, internal iliac- common iliac
Cervical ectropion is…
benign eversion of cervix relvealing columnar epithelium of endocervix as red area
Cervical ectropion age and RF
young on OCP or pregnant
Treating cervical ectropion
Cryotherapy only after ruling out cancer by colposcopy
Acute cervicitis is rare and occurs mainly due to
STDs
Chronic cervicitis is and presents as
Chronic inflammation/infection of the ectropion
Treatment for chronic cervicitis
Cryotherapy +/- Antibiotics
Cervical polyps are derived from what tissue
benign polyps of the endocervical epithelium
How do Cervical polyps present?
Aysmptomatic or IMB/PCB in women over 40 and smaller than 1cm.
Treatment for cervical polyps?
Avulsion without anaesthetic
What are nabothian follicles?
Endocervical cells have changed by metaplasia into squamous epithelium and columnar cell secretions are trapped and form retention cysts- white opaque swellings on the ectocervix. Rare, benign.
Define CIN
Presence of atypical cells within the squamous epithelium
CIN cell histology
Dyskaryotic with large nulei and frequent mitoses
CIN grading
CIN I- lower 1/3, CIN II- lower 2/3, CIN III- carcinoma in situ full thickness of epithelium
CIN–>malignancy
Invades the basement membrane. 1/3 of women over the next 10 years
CIN I prognosis
Has no malignant potential, progresses to CINII/II or can regress spontaneously
CIN epidemiology- what % under 45? Peak incidence at?
90%. 25-29
HPV causes dysplastic changes to metaplastic cells. What is the most important factor in getting HPV ?
Number of sexual partners at a young age, unknown in virgins
Which HPV strains are most commonly associated with cervial cancer?
16, 18, 31, 33
HPV Vaccine targets what demographic and which viruses?
16 and 18, women before first sexual contact
Who are at risk of CIN?
OCP, Smoking, Immunocompromise (HIV/Steroids)
CIN screening is done by what and for who?
Smear test, ages 25-49 every 3 years, ages 50-64 every 5 years.
What method of microscopy is used for smear results?
Liquid based cytology- more adequate sampling and high risk HPV strains detected
What happens to Smear results- Normal, Borderline or mild dyskaryosis +/- HPV, moderate, severe, cervical glandular intraepithelial neoplasia
repeat every 3 years(5), back to routine recall if HPV -, colposcopy if HPV +, colposcopy, urgent colposcopy, colposcopy if normal hysteroscopy
Treatment of CIN
LLETZ or DLE- CIN I, II
What do you tell a woman with CIN III smear?
Without treatment you have a 30% chance of developoing cancer over 8-15 years.
Two peak ages for cervical carcinoma
30’s and 80s
What is the histopathology of cervical cancer?
90% squamous cell carcinomas, 10% Adenocarcinomas, worse prognosis.
How does cervical cancer present?
PCB, IMB, Pain is a late feature, obstructive and invasion into ureters, bladder, rectum, nerves can cause- uraemia, haematuria, rectal bleeds and pain.
Staging of cervical carcinoma
Stage 1- Confined to cervix
Stage 2- into vagina but not pelvic side wall
Stage 3- Invasion of lower vagina or pelvic wall or causing ureteric obstruction
Stage 4- Invasion of bladder or rectal mucosa, or beyond true pelvis
How would you investigate cervical malignancy
Biopsy tumour to confirm diagnosis, VE and PR to assess size of lesion/parametrial/rectal invasion.
EUA-Examination under anaesthetic
Cystoscopy- bladder involvement
MRI-size spread lymph nodes
How would you treat microinvasive stage 1ai cervical cancer
Cone biopsy or simple hysterectomy
How would you treat stage 1 and 2a cervical cancer
Surgery or chemo therapy.
Chemo is preferred with lymph node enlargement. MRI/node sampling to confirm. Lymph nodes dissected lap- Radical abdominal hysterectomy/Wertheim’s clearance/ radical trachelectomy
What is Wertheims hysterectomy?
Pelvic node clearance, hysterectomy, removal of parametrium, and upper 1/4 vagina.
What is Radical Trachelectomy?
Procedure to conserve fertility- lap pelvic lymphacdenectomy. +ve nodes=chemo-radio instead of surgery if Negative- 80% cervix removed and upper vagina. Cervical suture to prevent preterm delivery.
Stage 2b cervical Ca or worse with positive lymph nodes.
Radio + platinum chemo.
Specific complications to Wertheims hysterectomy? (5)
haemorrhage, uteteric and bladder damage and fistulae, voiding problems, lymphocysts
What is pelvic exenteration and when is it used?
Used for recurrent tumours. Involves removal of vagina, bladder, rectum. 50% cure rate. Tried in young fit women.
Poor prognostic indicators for cervical ca?
Lymph node involvement Advanced clinical disease large primary tumour poorly differentiated early recurrence
How do people die with Cervical Ca?
Uraemia due to ureteric obstruction
