Lecture 7: Cervical Disorders Flashcards

1
Q

makeup of cervix?

When does the transformation zone appear?
- what causes it? where?
Overall result?

A

fibrous/collagen tissue + small amt of smooth muscle

transformation zone appears during menarche
- acidification –> ectcoervix undergoes squamous metaplasia –> form columnar epithelium on inner cervix

Result (after menarche)

  • endocervix = columnar epithelium
  • ectocervix = sqaumous epithelium
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2
Q

4 types of benign cervical conditions?

A
  1. Ectropion
  2. Nabothian Cysts
  3. Cervical Polyps
  4. Cervical Stenosis

Other: cervical insuffic (not on obj)

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3
Q

Ectropion

  1. When is commonly seen? (2)
  2. What cells are on the surface of the cervix –> causing what presentation?
  3. What 3 things is cervix vulnerable to?
A

Ectropion

  1. occurs during pds of high estrogen
    - Menarche
    - Hyperestrogen states (OCPs, Preg)
  2. COLUMNAR cells on surface of the cervix –> cervix looks rough, red + beefy
  3. Vul to: inf, trauma, friction
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4
Q

Nabothian Cysts

  1. When do they form?
  2. How to they form? result?
  3. Tx?
A
  1. Form during squamous metaplasia
  2. Squam epithelium entraps columnar cells–> mucus trapping –> blebs –> blisters (popping –> mucus leakage)
  3. No Tx, benign
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5
Q

Cervical Polyps

  1. definition
  2. Presentation (2)
  3. Normally removed (benign) but when are they not removed (2)
A
  1. hyperplastic endocervical folds of columnar epithelium
  2. presentation
    - Post-coital bleeding but NO PAIN
    - pink, fleshy, mobile mass protruding thru external cervical os
  3. Not removed when pregnant or risk of bleeding
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6
Q

Cervical Stenosis

  1. What is it?
  2. What is it in response to? Ex?
  3. When is it MC?
A
  1. ACQUIRED scarring of cervical canal –> smaller/closed
  2. Response to trauma or HYPOestrogenism
    - Ex: hematometra, infertility, recurrent/deep cervical Bx
  3. MC in labor
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7
Q

What is the MC STI?

A

HPV

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8
Q

What is the biggest RF for HPV?

Which is more common: cytologic abn or genital warts?

Which type of HPV causes cervical CA? (MC type of CA)

A

Strongest RF = # of lifetime partners

More common = cytologic abn

High risk HPV types–> Cervical CA (MC = SCC)

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9
Q

Is an HPV more commonly:

  1. latent or expressed?
  2. transient or persistent?
A

HPV inf more commonly

  1. LATENT - most ppl clear
  2. TRANSIENT - most regress in 2 yrs
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10
Q

Why are pap smears not generally done annually anymore?

A

Take 5 yrs to progress to high grade dysplasia and longer tor Cervical CA

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11
Q

Current Pap Recommendations:

  1. What age does Pap testing start?
  2. What if person is HIV +? how often?
  3. How often to do if 21-29?
  4. How often Pap done alone and how often Pap + HPV testing done if 30-65?
  5. When is it okay to stop testing at age 65
  6. When is a pap of a vaginal cuff done annually? with what?
A

Current Pap Recommendations:

  1. Pap testing starts at age 21
  2. HIV + —> start at time of dx/sexually active (annually)
  3. Pap testing Q3 yrs for 21-29
  4. Pap + HPV done Q5 yrs and Pap alone Q3 yrs if 30-65
  5. stop testing at age 65 if: no hx of dysplasia/cervical CA
  6. pap of vaginal cuff (no uterus) done when Hx of dysplasia/cervical CA
    - use spatula
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12
Q

When is colposcopy done (2)?

What is applied to perform it?

A

Colposcopy:
- Eval abn pap or persistent HPV infection

  • apply acetic acid + Lugol’s iodine soln –> highlights abn
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13
Q

What are the 3 concerning results seen w/colscopy?

A
  1. acetowhite changes (brighter white)
  2. Abn staining w/Lugol’s (cells DONT take up iodine stain)
  3. Squamous changes that are most dense/intense at transformation zone
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14
Q

What are the 3 concerning results seen w/colscopy?

A
  1. acetowhite changes (brighter white)
  2. Abn staining w/Lugol’s (cells DONT take up iodine stain)
  3. Squamous changes that are most dense/intense at transformation zone
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15
Q

What is intraepithelial cervical dyplasia d/t, what is concern w/it?

Low risk type?
2 High risk types?

A

intraepithelial cervical dyplasia is HPV mediated abn growth that is potentially pre-malignant

Low risk = CIN-I
high risk = CIN-II, III

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16
Q

Low risk = CIN-I
high risk = CIN-II, III

what is the involvement for each?

A

CIN-1 = lower 1/3 (only 1/3 total involved)

CIN-2 = middle 1/3 (2/3 total involved)

CIN-3 = upper 1/4 (> 2/3 - full thickness involvement)

17
Q

Tx for intraepithelial cervical dyplasia:

When is it usually reserved for?
- exceptions

What are the 2 methods of Tx?
- specifics?

A

Usually reserved for high risk dysplasia
- exceptions = preg, young ppl

2 Tx methods

  • excisional (LEEP or scapel: cold knife cone)
  • ablative (cryotherapy or cautery)
18
Q

What is the MC GYN CA in women?

A

Cervical CA

19
Q

What types of HPV are most a/w Cervical CA?

Which types most a/w warts?

A

Cervical CA= types 16, 18, 31, 33, 45

Warts = Types 6 + 11

20
Q

What is the only modifiable RF for Cervical CA

Other RFs:

  1. Low SES
  2. Earlier age sexual activity, STIs
  3. incr # sexual partners
  4. CIN
  5. DES exposure
  6. Immunosuppresion
A

smoking

21
Q

What is the MC type of Cervical CA? 2nd MC?

How do they each look?

A

MC = SCC
- dense in middle, spreads glowly

2nd MC = Adenocarcinoma
- skip lesions, sprinkler effect

22
Q

Pt presents w/ abn bleeding, watery d/c and post-coital bleeding, and friable transformation zone is seen on PE…most likely Dx?

A

Cervical CA

23
Q

What stages of cervical CA is surgery possible for?

A

Stage I and IIA

24
Q

How can you help prevent cervical CA?

A

Gardasil Vaccine

25
Q

When is the gardasil vaccine given?

Gardasil 9 = newest version (covers 5 more strains than quadrivalent version)

A

age 9-26

- needs to be given 6 mo apart