Weibliche Geschlechtsorgane - Cervix Flashcards
Cervicitis
- How common are inflammatory conditions of the cervix?
- They are extremely common
Cervicitis
- What can you see immediately when you see a cervicitis?
A purulent (eitrig) vaginal discharge
Cervicitis
Name the more important organism!
What do they all have incommon?
Important are Chlamyida trachomatis, Ureaplasma urealyticum,
T. vaginalis, Candida spp., Neisseria gonorrhoeae, HSV-2 and certain HSV types
-> C. Trachomatis is the most important organism
All types are often sexually transmitted
Cervicitis
Why are herpetic infections important? Are they common?
Herpetic infection are rare, but important because the maternal-infant transmission during childbirth may result in serious, sometimes fatal systemic herpetic infection in the newborn
Cervicitis
- which is more common: acute or chronic cervicitis?
- What are the organism causing acute cervicitis and when is a
women able to get acute cervicitis?
- The chronic form is more common than the acute
- Staphylococci or streptococci usually causes the acute form
which is limited (begrenzt) to women in the postpartum period
Cervicitis
- chronic cervicitis consists of inflammatory and epithelial
regeneration. When does it occur? - What pathology does the cervix-epithelium of a chronical
cervicitis show?
- to all women of reproduvtive age (very common)
- The cervical epithelium may show hyperplasia and reactive
changes in both squamous and columnar(zylinder) mucosa.
Eventually, the columnar epithelium undergoes squamous
metaplasia
Neoplasia of the cervix
What is the most important reason formost of the tumors of the cervix?
Oncogenic strains of human papillomavirus (HPV)
Neoplasia of the cervix
- what typ of cells do we have physiologically in the cervix?
- What organism is important for cervix cancer and where does
it attac?
1.
Endocervix: columnar (mucus-secreting) epithelial
Exocervix: squamous epithelial
-> they are joined via the squamocolumnar junction
With the onset of puberty, the squamocolumar junction undergoes eversion (Umstülpung) causing columnar cells become visible. These exposed cells finally turn into squamous cells because of squamous metaplasia -> this region is called transformation zone
- Cave: HPV is attacing immature squamous cells
Neoplasia of the cervix
- What organism are behind Low-Risk and high-risk HPV?
- Which diseases does low-risk and high-risk HPV cause?
- Low-Risk: HPV 6, 11
High-Risk: HPV 16, 18 - Low-Risk: Condyloma (hundreds of thousands/yr)
High-Risk: CIN (cervical intraepithelial neoplasia)
-> Higher grade CIN
-> Invasive cancer
-> Metastasis
Neoplasia of the cervix
What is an early test for Neoplasia of the cervix?
The Pap-Test (Papanicolaou), in which cells are scraped from the transformation zone an examined microscopially
Neoplasia of the cervix
What are the clinical symptoms of CIN (cervical intraepithelial neoplasia)?
CIN is asymptomatic and comes to clinical attention through an abnormal Pap smear(Abstrich) result
Neoplasia of the cervix
Via a colposcopy the biopsy follows. How do you treat women with LSIL and HSIL?
LSIL: Low-grade squamous intraepithelial lesion
HSIL: High-grade squamous intraepithelial lesion
LSIL are managed conservatively with careful observation
HSIL are treated with surgical excision (cone biopsy) with
lifetime smears
Neoplasia of the cervix
What are the most common cell types of cervical carcinomas?
What do have all these carcinomas incommen?
75% squamous cell carcinomas
20% adenocarcinomas and mixed adenosquamous carcinomas
Less 5% small cell neuroendocrine carcinomas
All of these types of carcinomas are caused by HPV
Neoplasia of the cervix
What is the peak incidence of squamous cell carcinoma of the cervix?
Squamous cell carcinoma has a peal incident at the age of about 45 years
Some 10-15 years after detection of precursor CIN
Neoplasia of the cervix
Where does invasive carcinoma of the cervix develop?
They develop in the transformation zone
Neoplasia of the cervix
What does Tumors encircling the cervix and penetraiting into the underlying stroma produce?
They produce a barrel cervix! This can be identified by direct palpation.
Extension into the parametrial soft tissue can affix(befestigen)
the uterus to the surrounding pelvic structures
Neoplasia of the cervix
What is the risk that a invasive carcinoma of the cervix spreads?
Which lymph nodes are affacted?
The risk relates with the depth of tumor invasion and the presence
(Anwesenheit) of tumor cells in vascular spaces
Unter 3mm - less than 1%
Over 3mm - over 10%
The tumor spreads to the surrounding pelvic structures
Neoplasia of the cervix
What are the symptoms?
Unexpected vaginal bleeding
Leukorrhea
Painful coitus
Dysuria
Neoplasia of the cervix
What is the treatment of cervical cancer?
What is the treatment of Small microinvasive?
Surgical treatment: hysterectomy and lymph node dissection
Small microinvasive carcinomas:
Treated via cone(Zapfen) biopsy
Neoplasia of the cervix
- Tumor of Cervix - What are the causes of death?
1.
- Most patients with advanced disease die as a result of lokal
invasion rather distant metastasis
In particular: renal failure, stemming from obstruction of the
urinary bladder and ureters is a common cause of death
Neoplasia of the cervix
Name 5 risk factors fpr cervical neoplasia?
- HPV exposure
- intercourse at an early age
- multiple sex partners
- other factors including cigarette smoking
- immunodeficiency
Neoplasia of the cervix
What is helping to prevent Neoplasia of the cervix?
HPV Vaccine: prevents effective infection due
HPC types 16 and 18
Neoplasia of the cervix
Name all HPV infections, which cause cervical carcinomas?
High-risk HPV: 16, 18, 31, and 33
Neoplasia of the cervix
Explain why HPV causes cancer!
- HPV expresses E6 and E7 proteins
- > E6 and E7 inactivate the p53 and Rb tumor suppressors
–> increased cell proliferation and suppression of DNA
damage-induced apoptosis
–> Loss of LKBI gene is also involved
