The cervix & disorders Flashcards
where does cervical carcinoma commonly occur?
the transformation zone - squamocolumnar junction
the endocervix has which main cells?
columnar/gladular epithelium
the ectocervix has which main cells?
squamous epithelium
cervical carcinoma has which method of invasion?
local to eg vagina
lymphatic spread
what is the blood supply and lymph drainage of the cervix?
Upper vaginal branches
Uterine artery
lymph:
local - obturator and internal and external iliac nodes
and thence
distant - Common iliac and para-aortic nodes.
list some possible sx of cervical ectropion.
how is it ivx and rx?
Asymptomatic
Discharge
Post coiital bleed
Ivx: Smear , Colposcopy
Rx; Cryotherapy - freeze
what does an ‘inflammatory smear’ mean. treatment?
chronic cervicitis
rx: cryotherapy +- abx
how can cervial polyps present? rx?
Bleeding: PMB/PCB
rx: avulse, no anaesthetic
true/false cervical polyps orignate from ectocervix?
false
from endocervical epithelium
which CIN causes carcinoma in situ?
CIN III
what is the prognosis of CIN?
CIN I - goes by itself usually
CIN III - can become cervical carcinoma in 10 years
epidemiology of CIN?
peak incidence 25-29
why are hpv vaccines given to girls ar age 12?
want to vaccinate BEFORE 1st sexual contact
to prevent development of premalignant lesions
what is the risk factor for getting hpv?
number of sexual contacts: early age
risk factors of CIN?
Oral contraceptive
Smoking
HPV
HIV & Long term steroid ->. quicker malignancy
what is the cervical cancer screening programme?
Age 25
every 3 years until 49
every 5 years; 50-69
a 65 y/o comes in wanting cervical smear. her last screen was at age 55. what do you need to advise?
she has been screened since age 50
so doesnt need another one
true/false:
smears identify histological abnormalities?
false
cellular abnormalities only - ‘dyskaryosis’
a cervical smear report reads ‘CIN III’. what does this mean?
This does not mean that CIN III is present,
merely that a biopsy would be likely to find it.
what are the next steps after receiving smear results?
abnormal smear result:
CIN borderline/low grade identified:
- test for hpv
- high risk hpv found - coloscopy
- low risk hpv: back to routine screen
slightly different for CGIN
CIN and CGIN can progress to which types of cancers?
CIN - cervical squamous cell carcinoma
CGIN - adenocarcinoma
what happens if CGIN identified on smear?
colposcopy + endocervical curettage
-> exclude malignancy
hysteroscopy if unclear still
how is abnormality seen on colposcopy?
stain with acetic acid
BUT still need to take biopsy for a histological picture – which is diagnostic
how is CIN II/III treated?
complications?
LLETZ or diathermy loop excision - of transformation zone
under local anaesthetic
complicatoins - preteerm delivery! haemorrhage - rare.
what cancer could present with bleeding, offensive discharge
and lateer uraemia, haematuria, reectal bleeing, pain
cervical carcinoma
how is cervical cancer treated?
1a(i) Cone biopsy or simple hysterectomy
1a(ii)–1b(i) Laparoscopic lymphadenectomy and
radical trachelectomy
1a(ii)–2a Radical hysterectomy (if lymph nodes
negative) or chemo-radiotherapy
2b and above or lymph nodes positive -
Chemo-radiotherapy alone
difference between simple and radical hysterectomy?
radical: uterus + part of the cervix removed
simple: uterus
what usually kills patients with cervical cancer?
uraemia from ureteric obstruction
