Vaginal Pathology & Cervical Cancer

Question 1

Describe the transition zone in the cervix in terms of the type of epithelium

Answer 1

Ectocervix: squamous
Endocervix: columnar

Question 2

How is the transition zone in the cervix formed?

Answer 2

Acidic environment of vagina causes squamous metaplasia of the endocervical epithelium

Question 3

What is a Nabothian cyst?

Answer 3

Distended endocervical gland

Question 4

What causes cervicitis?

Answer 4

Chlamydia (40%)
Herpes simplex virus
IU devices
Allergic reactions

Question 5

Cervicitis is often asymptomatic. True/False?

Answer 5

True

Question 6

Where do cervical polyps typically grow?

Answer 6

Surface of cervical canal

Inner lining of uterus

Question 7

What are the 2 main groups of neoplasia that affect the cervix?

Answer 7

Cervical intraepithelial neoplasia
Cervical cancer (adenocarcinoma, squamous carcinoma)

Question 8

Which strains of HPV are associated with cervical cancer?

Answer 8

16 and 18

Question 9

Smoking increases the risk of cervical cancer by 3x. True/False?

Answer 9

True

Question 10

How long does it take HPV infection to cause high grade cervical intraepithelial neoplasia?

Answer 10

6 months - 3 years

Question 11

How long does it take HPV infection to cause invasive cervical cancer?

Answer 11

5-20 years

Question 12

Cervical intraepithelial neoplasia is the pre-invasive stage of cervical cancer. True/False?

Answer 12

True

Question 13

Where does cervical intraepithelial neoplasia occur?

Answer 13

Transition zone of cervix

Question 14

Cervical intraepithelial neoplasia is usually asymptomatic. True/False?

Answer 14

True

Important to screen before becomes invasive

Question 15

What 3 histological factors are assessed when determining the grade of CIN?

Answer 15

Delay in differentiation
Nuclear abnormalities
Excess mitotic activity

Question 16

Describe CIN grade I

Answer 16

Basal 1/3 of epithelium occupied
Raised mitotic figures
Surface cells mature
Nuclei slightly abnormal

Question 17

Describe CIN grade II

Answer 17

Extension to middle 1/3 of epithelium

Abnormal mitotic figures

Question 18

Describe CIN grade III

Answer 18

Occupy full thickness of epithelium

Abnormal mitotic figures

Question 19

Invasive cervical cancer always develops from pre-existing CIN. True/False?

Answer 19

True

Question 20

Describe stage 1 invasive squamous carcinoma of cervix

Answer 20

1A1: depth 3mm, width 7mm
1A2: depth 5mm, width 7mm
1B: confined to cervix

Question 21

Describe stage 2 invasive squamous carcinoma of cervix

Answer 21

Spread to adjacent organs (uterus, vagina)

Question 22

Describe stage 3 invasive squamous carcinoma of cervix

Answer 22

Involvement of pelvic wall

Question 23

Describe stage 4 invasive squamous carcinoma of cervix

Answer 23

Distant metastases or involvement of rectum/bladder

Question 24

Describe the clinical features of invasive cervical cancer

Answer 24

Abnormal bleeding
Brown/bloody vaginal discharge
Contact bleeding
Pelvic pain
Haematuria
Infections

Question 25

Which cervical epithelium does adenocarcinoma derive from - ecto or endo -cervix?

Answer 25

Endocervical (glandular) epithelium

Question 26

Adenocarcinoma of cervix is easier to diagnose than squamous carcinoma of cervix. True/False?

Answer 26

False

Often harder to diagnose as endocervix is more difficult to reach

Question 27

Which carries the worse prognosis - adenocarcinoma or squamous carcinoma of cervix?

Answer 27

Adenocarcinoma

Question 28

Which HPV is particularly associated with adenocarcinoma of cervix - 16 or 18?

Answer 28

18

Although both are associated