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A - ObsNGynae > The cervix & disorders > Flashcards

The cervix & disorders Flashcards

1
Q

where does cervical carcinoma commonly occur?

A

the transformation zone - squamocolumnar junction

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2
Q

the endocervix has which main cells?

A

columnar/gladular epithelium

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3
Q

the ectocervix has which main cells?

A

squamous epithelium

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4
Q

cervical carcinoma has which method of invasion?

A

local to eg vagina

lymphatic spread

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5
Q

what is the blood supply and lymph drainage of the cervix?

A

Upper vaginal branches
Uterine artery

lymph:
local - obturator and internal and external iliac nodes
and thence
distant - Common iliac and para-aortic nodes.

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6
Q

list some possible sx of cervical ectropion.

how is it ivx and rx?

A

Asymptomatic
Discharge
Post coiital bleed

Ivx: Smear , Colposcopy
Rx; Cryotherapy - freeze

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7
Q

what does an ‘inflammatory smear’ mean. treatment?

A

chronic cervicitis

rx: cryotherapy +- abx

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8
Q

how can cervial polyps present? rx?

A

Bleeding: PMB/PCB

rx: avulse, no anaesthetic

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9
Q

true/false cervical polyps orignate from ectocervix?

A

false

from endocervical epithelium

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10
Q

which CIN causes carcinoma in situ?

A

CIN III

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11
Q

what is the prognosis of CIN?

A

CIN I - goes by itself usually

CIN III - can become cervical carcinoma in 10 years

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12
Q

epidemiology of CIN?

A

peak incidence 25-29

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13
Q

why are hpv vaccines given to girls ar age 12?

A

want to vaccinate BEFORE 1st sexual contact

to prevent development of premalignant lesions

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14
Q

what is the risk factor for getting hpv?

A

number of sexual contacts: early age

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15
Q

risk factors of CIN?

A

Oral contraceptive
Smoking
HPV

HIV & Long term steroid ->. quicker malignancy

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16
Q

what is the cervical cancer screening programme?

A

Age 25

every 3 years until 49

every 5 years; 50-69

17
Q

a 65 y/o comes in wanting cervical smear. her last screen was at age 55. what do you need to advise?

A

she has been screened since age 50

so doesnt need another one

18
Q

true/false:

smears identify histological abnormalities?

A

false

cellular abnormalities only - ‘dyskaryosis’

19
Q

a cervical smear report reads ‘CIN III’. what does this mean?

A

This does not mean that CIN III is present,

merely that a biopsy would be likely to find it.

20
Q

what are the next steps after receiving smear results?

A

abnormal smear result:

CIN borderline/low grade identified:

  1. test for hpv
  2. high risk hpv found - coloscopy
    • low risk hpv: back to routine screen

slightly different for CGIN

21
Q

CIN and CGIN can progress to which types of cancers?

A

CIN - cervical squamous cell carcinoma

CGIN - adenocarcinoma

22
Q

what happens if CGIN identified on smear?

A

colposcopy + endocervical curettage
-> exclude malignancy

hysteroscopy if unclear still

23
Q

how is abnormality seen on colposcopy?

A

stain with acetic acid

BUT still need to take biopsy for a histological picture – which is diagnostic

24
Q

how is CIN II/III treated?

complications?

A

LLETZ or diathermy loop excision - of transformation zone

under local anaesthetic

complicatoins - preteerm delivery! haemorrhage - rare.

25
Q

what cancer could present with bleeding, offensive discharge

and lateer uraemia, haematuria, reectal bleeing, pain

A

cervical carcinoma

26
Q

how is cervical cancer treated?

A

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

27
Q

difference between simple and radical hysterectomy?

A

radical: uterus + part of the cervix removed
simple: uterus

28
Q

what usually kills patients with cervical cancer?

A

uraemia from ureteric obstruction

A - ObsNGynae (37 decks)

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