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Gynaecology > The cervix and its disorders > Flashcards

The cervix and its disorders Flashcards

1
Q

Cervix to sacrum

A

uterosacral ligaments

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2
Q

Cervix to pelvic wall

A

Cardinal ligaments

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3
Q

squamocolumnar junction

A

endocervix- columnar
ectocervix- squamous
Boundary

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4
Q

Transformation zone

A

Low vaginal pH causing metaplasia of columnar to squamous- vulnerable to metaplasia

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5
Q

Upper cervix supplied by and drains into

A

uterine artery, external iliac-paraaortic

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6
Q

Lower cervix supplied by and drains into

A

upper vaginal arteries, internal iliac- common iliac

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7
Q

Cervical ectropion is…

A

benign eversion of cervix relvealing columnar epithelium of endocervix as red area

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8
Q

Cervical ectropion age and RF

A

young on OCP or pregnant

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9
Q

Treating cervical ectropion

A

Cryotherapy only after ruling out cancer by colposcopy

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10
Q

Acute cervicitis is rare and occurs mainly due to

A

STDs

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11
Q

Chronic cervicitis is and presents as

A

Chronic inflammation/infection of the ectropion

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12
Q

Treatment for chronic cervicitis

A

Cryotherapy +/- Antibiotics

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13
Q

Cervical polyps are derived from what tissue

A

benign polyps of the endocervical epithelium

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14
Q

How do Cervical polyps present?

A

Aysmptomatic or IMB/PCB in women over 40 and smaller than 1cm.

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15
Q

Treatment for cervical polyps?

A

Avulsion without anaesthetic

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16
Q

What are nabothian follicles?

A

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.

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17
Q

Define CIN

A

Presence of atypical cells within the squamous epithelium

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18
Q

CIN cell histology

A

Dyskaryotic with large nulei and frequent mitoses

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19
Q

CIN grading

A

CIN I- lower 1/3, CIN II- lower 2/3, CIN III- carcinoma in situ full thickness of epithelium

20
Q

CIN–>malignancy

A

Invades the basement membrane. 1/3 of women over the next 10 years

21
Q

CIN I prognosis

A

Has no malignant potential, progresses to CINII/II or can regress spontaneously

22
Q

CIN epidemiology- what % under 45? Peak incidence at?

A

90%. 25-29

23
Q

HPV causes dysplastic changes to metaplastic cells. What is the most important factor in getting HPV ?

A

Number of sexual partners at a young age, unknown in virgins

24
Q

Which HPV strains are most commonly associated with cervial cancer?

A

16, 18, 31, 33

25
Q

HPV Vaccine targets what demographic and which viruses?

A

16 and 18, women before first sexual contact

26
Q

Who are at risk of CIN?

A

OCP, Smoking, Immunocompromise (HIV/Steroids)

27
Q

CIN screening is done by what and for who?

A

Smear test, ages 25-49 every 3 years, ages 50-64 every 5 years.

28
Q

What method of microscopy is used for smear results?

A

Liquid based cytology- more adequate sampling and high risk HPV strains detected

29
Q

What happens to Smear results- Normal, Borderline or mild dyskaryosis +/- HPV, moderate, severe, cervical glandular intraepithelial neoplasia

A

repeat every 3 years(5), back to routine recall if HPV -, colposcopy if HPV +, colposcopy, urgent colposcopy, colposcopy if normal hysteroscopy

30
Q

Treatment of CIN

A

LLETZ or DLE- CIN I, II

31
Q

What do you tell a woman with CIN III smear?

A

Without treatment you have a 30% chance of developoing cancer over 8-15 years.

32
Q

Two peak ages for cervical carcinoma

A

30’s and 80s

33
Q

What is the histopathology of cervical cancer?

A

90% squamous cell carcinomas, 10% Adenocarcinomas, worse prognosis.

34
Q

How does cervical cancer present?

A

PCB, IMB, Pain is a late feature, obstructive and invasion into ureters, bladder, rectum, nerves can cause- uraemia, haematuria, rectal bleeds and pain.

35
Q

Staging of cervical carcinoma

A

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

36
Q

How would you investigate cervical malignancy

A

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

37
Q

How would you treat microinvasive stage 1ai cervical cancer

A

Cone biopsy or simple hysterectomy

38
Q

How would you treat stage 1 and 2a cervical cancer

A

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

39
Q

What is Wertheims hysterectomy?

A

Pelvic node clearance, hysterectomy, removal of parametrium, and upper 1/4 vagina.

40
Q

What is Radical Trachelectomy?

A

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.

41
Q

Stage 2b cervical Ca or worse with positive lymph nodes.

A

Radio + platinum chemo.

42
Q

Specific complications to Wertheims hysterectomy? (5)

A

haemorrhage, uteteric and bladder damage and fistulae, voiding problems, lymphocysts

43
Q

What is pelvic exenteration and when is it used?

A

Used for recurrent tumours. Involves removal of vagina, bladder, rectum. 50% cure rate. Tried in young fit women.

44
Q

Poor prognostic indicators for cervical ca?

A 
Lymph node involvement
Advanced clinical disease
large primary tumour
poorly differentiated
early recurrence
45
Q

How do people die with Cervical Ca?

A

Uraemia due to ureteric obstruction

Gynaecology (11 decks)

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