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Year 2 RE > The Cervix in Health and Disease > Flashcards

The Cervix in Health and Disease Flashcards

1
Q

What is the cervix?

A
  • begins a the isthmus of uterus with internal OS
  • first part is called endocervix containing columnar epithelial cells
  • at the external OS it becomes the ectocervix containing stratified squamous epithelial cells
  • then vagina begins
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2
Q

Label the key parts of the cervix using the labels below”

external os
internal os
uterine part of endocervix
vaginal part of endocervix
isthmus
A 
1 - isthmus
2 - external os
3 - uterine part of endocervix
4 - vaginal part of endocervix
5 - internal os
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3
Q

Generally where is the location of the cervix in the pelvis?

A
  • midline
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4
Q

Using the labels below, label the organisation of the female reproductive system:

fundus
body of uterus
vagina
cervix
isthmus
A 
fundus
body of uterus
isthmus
cervix
vagina
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5
Q

The internal and external os are the openings between what and the cervix?

A
  • internal os = begins at isthmus

- external os = where cervix meets the vagina

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6
Q

What is the endocervix and ectocervix?

A
  • endocervix = start of cervix lined with columnar epithelial cells
  • ectocervix = end of cervix where it meets the vagina lined with stratified squamous epithelial cells
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7
Q

What cells line the endocervix and what do they secrete?

A
  • columnar epithelial cells

- produce mucus

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8
Q

What cells line the ectocervix and what do they secrete?

A
  • stratified squamous epithelial cells
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9
Q

What is the squamocolumnar junction?

A
  • junction where columnar (endocervix) and squamous (ectocervix) cells meet
  • this is contained within the transformation zone between the endo and ectocervix
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10
Q

What is the transformation zone?

A
  • between the endo and ectocervix
  • where columnar and squamous cells meet
  • sub columnar cells multiply and differentiate into immature squamous epithelium through a process called metaplasia
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11
Q

What is metaplasia?

A
  • replacement of one differentiated somatic cell type with another differentiated somatic cell type in the same tissue
  • in cervix this is columnar to squamous cells
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12
Q

What are 3 basic things that can affect the shape of the cervix?

1 - age, hormonal state, parity (previous babies)
2 - age, hormone state, medication
3 - age, medication, parity
4 - hormonal state, parity, medication

A

1 - age, hormonal state, parity (previous babies)

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13
Q

Parity is defined as the number of times that a woman has given birth to a fetus with a gestational age of 24 weeks or more, regardless of whether the child was born alive or was stillborn. In the image below which image shows nulliporous (not have given birth previously) and multiporous (several pregnancies)?

A
  • top is nulliporous (barrel shaped with small external os)

- bottom is multiporous (bulky and external os appears slit like)

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14
Q

What are the 4 main functions of the cervix?

1 - barrier, pregnancy stability, birth, contraception
2 - mucus production, barrier, pregnancy stability, birth
3 - mucus production, contraception, pregnancy stability
4 - mucus production, barrier, contraception, birth

A

2 - mucus production, barrier, pregnancy stability, birth

  • produces mucus to facilitate sperm migration
  • acts as a barrier to ascending infection
  • holds a developing pregnancy in place
  • effaces and dilates to enable vaginal birth
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15
Q

The cervix effaces during birth. What does this mean?

A
  • stretches and gets thinner

- works alongside dilation

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16
Q

During pregnancy does the cervix hypertrophy or atrophy?

A
  • hypertrophy

- becomes softer though which is important for effacation (stretches and gets thinner) and dilation

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17
Q

During pregnancy what happens to the blood supply to the cervix?

A
  • increases in vascularity

- venous congestion occurs

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18
Q

During pregnancy the glands of the cervix distend with mucus, forming what?

A
  • mucus plug

- important to ensure no infection can get to the foetus

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19
Q

During pregnancy the cervical canal elongates and the cells of the endocervix migrate outside of the cervix into the ectocervix of the vagina, called glandular cells. What is this process called?

1 - cervical dysplasia
2 - cervical ectropion
3 - cervical metaplasia
4 - cervical hypertrophy

A

1 - cervical ectropion

- driven by estrogen

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20
Q

During pregnancy the cervical canal elongates and the cells of the endocervix migrate outside of the cervix into the ectocervix of the vagina, called glandular cells in a process called cervical ectropion, which is driven by estrogen. Why is this important?

A
  • cells that grow on the outside of the cervix are more sensitive
  • increased sensitivity can cause pain, bleeding and discharge
  • this can happen post-coitally (post sex)
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21
Q

During pregnancy the cervical canal grows onto the outside of the cervix, called glandular cells in a process called cervical ectropion, which is driven by estrogen. This is important because cells that grow on the outside of the cervix are more sensitive and can cause pain, bleeding and discharge. Is this generally treated?

A
  • no

- usually disappears in 3-6 months

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22
Q

Cervical diseases are one of the most common pathologies in women of different ages. Inflammatory cervical disease also called cervicitis is a common pathology and can be associated with symptoms such as purulent discharge. Cervicitis is inflammation of the cervix and can be divided into what 2 categories?

1 - infectious and hyperpasticicty
2 - infectious and metaplasticity
3 - infectious and non-infectious
4 - non-infectious and metaplasticity

A

3 - infectious and non-infectious

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23
Q

Cervical diseases are one of the most common pathologies in women of different ages. Inflammatory cervical disease, also called cervicitis can be divided into 2 categories, infectious and non-infectious. What are the 5 most common microorganisms that can cause infection through sexual transmission?

A 
1 - Chlamydia trachomatis
2 - Ureaplasma urealyticum
3 - T. vaginalis, 
4 - Neisseria gonorrhoeae
5 - HumanPapillomaVirus (HPV)
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24
Q

What are cervical polps?

1 - malignant growths of the cervix
2 - benign growth of the cervix appearing at the ectocervix
3 - benign growth of the cervix not visible as they are located on the endocervix
4 - malignant growth of the ectocervix

A

2 - benign growth of the cervix appearing at the ectocervix

- generally cherry-red to reddish-purple or grayish-white

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25
Q

What is the cervical condyloma and what causes it?

1 - malignant genital warts linked with HPV
2 - malignant mass on extocervix linked with HPV
3 - benign genital warts caused by the HPV
4 - benign growth of endometrium

HPV = human papillomavirus

A

3 - benign genital warts caused by the HPV

- latin for round tumour that can grow on cervix and vagina

26
Q

What is dysplasia?

A
  • development of abnormal cells
  • if replication continues faster than the body needs
  • causes abnormal number and shape of cells
27
Q

Dysplasia is when mature growth cells enter the cell cycle and undergo mitosis creating 2 identical daughter cells, but replication continues faster than the body needs them is called dysplasia. Why is dysplasia important?

A
  • precursor for cancer
28
Q

What are the 5 most common causes of cervical pathologies?

A 
1 - hormonal disorders
2 - injury to cervix
3 - infectious diseases
4 - viral diseases, including human papillomavirus (HPV)
5 - weak immune system
29
Q

When trying to diagnose cervical pathologies, why is a urogenital swab taken?

1 - identify cell types to screen for cancer
2 - identify if dysplasia is occurring
3 - assess microflora for presence of pathological bacteria
4 - assess for cervical ectropion

A

3 - assess microflora for presence of pathological bacteria

30
Q

When trying to diagnose cervical pathologies, why is a cytology performed?

1 - identify cell types to screen for cancer
2 - identify if dysplasia is occurring
3 - assess microflora for presence of pathological bacteria
4 - assess for cervical ectropion

A

1 - identify cell types to screen for cancer

31
Q

When trying to diagnose cervical pathologies, why might colposcopy be performed?

1 - identify cell types to screen for cancer
2 - identify if dysplasia is occurring
3 - assess microflora for presence of pathological bacteria
4 - more detailed look at cervix

A

4 - more detailed look at cervix

32
Q

Some basic cervical pathologies which can be treated such as erosion and inflammatory process are generally not dangerous. But left untreated, what can they develop into?

A
  • cervical cancer
33
Q

In the cervix where do tumours most commonly arise from?

1 - transformation zone
2 - endocervix
3 - ectocervix
4 - squamocolumnar junction

A

1 - transformation zone

34
Q

What is the most common cause of pre-cancer and cervical cancer?

1 - Smoking
2 - Multiple sexual partners
3 - Male partner with multiple
4 - Human papillomavirus (HPV)

A

4 - Human papillomavirus (HPV)

- transmitted through sex

35
Q

What are the 5 most common predisposing risk factors of pre-cancer and cervical cancer?

A
  • smoking
  • multiple sexual partners
  • male partner with multiple previous sexual partners
  • immuno compromise (HIV, organ transplant)
  • low socio-economic status
36
Q

What is the human papillomavirus (HPV)?

A
  • group of non-enveloped DNA viruses

- specifically infect human epithelial cells

37
Q

The human papillomavirus (HPV) has the ability to infect different cellular types ultimately to produce a successful infection. What is this ability called?

A
  • viral tropism

- HPV has viral tropism for immature squamous epithelial cells

38
Q

The human papillomavirus (HPV) has the ability to infect different cellular types ultimately to produce a successful infection. What is this ability called?

A
  • viral tropism

- HPV has viral tropism for immature squamous epithelial cells

39
Q

The human papillomavirus (HPV) has the ability to infect different cellular types ultimately to produce a successful infection. This ability is called viral tropism, where the HPV has viral tropism for immature squamous epithelial cells. Do HPV infections always lead to cancer?

A
  • no

- can be transient and eliminated by the host

40
Q

The human papillomavirus (HPV) has the ability to infect different cellular types ultimately to produce a successful infection. This ability is called viral tropism, where the HPV has viral tropism for immature squamous epithelial cells. Not all HPV infections lead to cancer, but those that do cause what to occur?

A
  • cause squamous cervical intraepithelial lesions/neoplasia (CIN), alsso known as squamous intraepithelial lesions (SILs)
  • precursor for cervical carcinomas
41
Q

How does the human papillomavirus (HPV) replicate in immature basal squamous cells of the cervix?

A
  • uses host cells DNA polymerase to replicate its genome
42
Q

The human papillomavirus (HPV) replicate in immature basal squamous cells of the cervix by using host cells DNA polymerase to replicate its genome. 2 specific proteins are able to ensure that the basal cells continually replicate, called E6 and E7 proteins. E6 is able to inhibit p53 and E7 inhibits etinoblastoma (Rb). What are p53 and RB and why is this important?

A
  • p53 and RB are tumour suppressor genes

- E6 and E7 inhibit these genes and allows tumours to develop

43
Q

The human papillomavirus (HPV) replicate in immature basal squamous cells of the cervix by using host cells DNA polymerase to replicate its genome. There are over 100 forms of HPV, but which 2 are high risk and account for aprox 70% of squamous intraepithelial lesions and cervical carcinomas?

1 - HPV 16 and 18
2 - HPV 16 and 11
3 - HPV 18 and 11
4 - HPV 21 and 18

A

1 - HPV 16 and 18

  • account for 70% of cervical cancers
  • 99% of cervical cancers are because of HPV virus
44
Q

Squamous intraepithelial lesions (SIL), also known as cervical intraepithelial lesions (CIN) are abnormal growth of epithelial cells on the surface of the cervix, commonly called squamous cells. This condition can lead to cancer. There are 2 types of SIL, what are they?

1 - high grade and abnormal
2 - high grade and negative
3 - high and low grade
4 - low grade and negative

A

1 - low grade-SIL-I or low grade CIN-I

2 - high-grade SIL-II and III or low grade CIN-Ii and III

45
Q

quamous intraepithelial lesions (SIL), also known as cervical intraepithelial lesions (CIN) are abnormal growth of epithelial cells on the surface of the cervix, commonly called squamous cells. This condition can lead to cancer. There are 2 types of SIL:

1 - low grade-SIL-I or low grade CIN-I
2 - high-grade SIL-II and III or low grade CIN-Ii and III

Do they both lead to cancer?

A
  • LSIL = generally no, they regress, small % may progress to cancer
  • HSIL = treated as high risk to become cancerous
46
Q

On histology what can we expect to see in low-grade squamous intraepithelial lesion (SIL-I)?

1 - dysplastic changes in the lower third of the squamous epithelium
2 - dysplasia extends to the middle 3rd of epithelium in various cell number and nuclear size
3 - complete loss of differentiation, large variation in cell and nuclear size, most cells affected
4 - unrecognisable borders

A

1 - dysplastic changes in the lower third of the squamous epithelium
- koilocytotic changein the superficial layers of the epithelium (halo type cell)

47
Q

What are koilocytes?

A
  • a squamous epithelial cell that has undergone a number of structural changes
  • changes are caused by human papillomavirus (HPV)
  • on histology we can tell if a patient has had HPV
48
Q

On histology what can we expect to see in high-grade squamous intraepithelial lesion (SIL-II or CIN-II)?

1 - dysplastic changes in the lower third of the squamous epithelium
2 - dysplasia extends to the middle 3rd of epithelium in various cell number and nuclear size
3 - complete loss of differentiation, large variation in cell and nuclear size, most cells affected
4 - unrecognisable borders

A

2 - dysplasia extends to the middle 3rd of epithelium in various cell number and nuclear size
- superficial layer of cells in CIN II still shows differentiation and occasional koilocytotic changes

49
Q

On histology what can we expect to see in high-grade squamous intraepithelial lesion (SIL-III) CIN-III?

1 - dysplastic changes in the lower third of the squamous epithelium
2 - dysplasia extends to the middle 3rd of epithelium in various cell number and nuclear size
3 - complete loss of differentiation, large variation in cell and nuclear size, most cells affected
4 - unrecognisable borders

A

3 - complete loss of differentiation, large variation in cell and nuclear size, most cells affected

  • complete loss of differentiation
  • large variation in cell and nuclear size
  • almost all layers of the epithelium are affected
  • Koilocytotic change usually is absent
50
Q

The image below shows cytology of some tissues samples. Which image is:

normal tissue
low-grade squamous intraepithelial lesion (LSIL)
high-grade squamous intraepithelial lesion (HSIL) CNII and CNIII

A

A = normal
B = low-grade squamous intraepithelial lesion (LSIL)
C and D = high-grade squamous intraepithelial lesion (HSIL) CNII and CNIII

51
Q

Squamous intraepithelial lesions (SIL) can be detected on smear tests and followed up by colposcopy. How would the following be treated:

low-grade squamous intraepithelial lesion (SIL-I or CIN-I)
high-grade squamous intraepithelial lesion (SIL-II and III or CIN-II and CIN-III)

A
  • low grade SIL-I = monitored with observation
  • high grade SIL-II and III and persistent low grade SIL-I = surgical excision (cone biopsy)
  • if high grade SIL-II or III patients will have follow up smears and remain at risk of HPV and associated cervical, vulvar, and vaginal cancers
52
Q

How common is cervix cancer?

A
  • worldwide 2nd most common cancer amongst women
53
Q

How many cases of cervix cancer and deaths from cervix cancer each year?

A
  • incidence = 430,000

- deaths = >200,000

54
Q

What are the most common types of cervix cancer?

A 
1st = squamous cell carcinoma
2nd = adenocarcinoma
55
Q

What are the most common risk factors for cervix cancer?

A
  • mutations in suppressor genes and human papillomavirus (HPV) together
  • smoking
  • HIV
56
Q

What is the only reliable way to monitor the disease course of cervix cancer?

A
  • frequent physical examination with pep smears
57
Q

In the cervix, what is the most common location for invasive carcinoma to develop?

A
  • transformation zone
58
Q

What are some common clinical presentations of cervix cancer?

A
  • vaginal bleeding and discomfort
  • foul smelling vaginal discharge
  • pain in groin (hydronepherosis)
  • constipation
  • pelvic pain (lymph nodes)
59
Q

How can cervix cancer be treated?

A
  • surgically remove the tumour
  • uterus and lymph nodes may need to be removed
  • radiation
  • chemotherapy
60
Q

If a patient has a cervical tumour and it has spread to the uterus and lymph nodes, what would the treatment be?

1 - radical hysterectomy, chemotherapy and radiotherapy
2 - chemotherapy and radiotherapy
3 - radical hysterectomy, and chemotherapy
4 - radical hysterectomy and radiotherapy

A

1 - radical hysterectomy, chemotherapy and radiotherapy

61
Q

If a patient has a cervical tumour and it has spread to the uterus and lymph nodes, what is the imaging modality of choice to stage the disease?

1 - ultrasound with doppler
2 - MRI
3 - X-ray
4 - CT scan

A

2 - MRI

Year 2 RE (53 decks)

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