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REPRODUCTION & GYNAECOLOGY > Cervical Screening and Vulval Pathology > Flashcards

Cervical Screening and Vulval Pathology Flashcards

1
Q

Ho do the linings of the ectocervix and the endocervical canal differ?

A

Ectocervix - lined by squamous epithelium (same as vagina)

Endocervical Canal - lined by glandular epithelium

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2
Q

What cells in the squamous lining of the ectocervix proliferate?

A

Basal cells

- the cells mature and move upwards to surface (like in the skin)

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3
Q

What cells does a cervical smear test remove?

A

Mature surface cells of ectocervical lining

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4
Q

Why is there a Transformation Zone in the cervix rather than a squamo-columnar junction?

A 
Location of squamocolumnar junction changes over time
Due to:
- menarche
- Pregnancy
- menopause

=> area between the original SC Junction and the New SC junction is the Transformation Zone

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5
Q

What causes erosion of the endocervical tissue causing it to undergo squamous metaplasia?

A

acidic environment of vagina

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6
Q

What are Nabothian follicles and are these benign or malignant lesions of the cervix?

A
  • dilated endocervical glands
  • form almost polypoid-like structure
  • Benign
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7
Q

What percentage of Cervical Intraepithelial Neoplasia (a precursor to cancer) occurs in the Transformation Zone?

A

90%

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8
Q

What inflammatory pathologies can present in the cervix?

A

Cervicitis

  • often asymptomatic
  • can lead to infertility due to silent fallopian tube damage
  • non-specific acute/chronic inflammation.

Cervical polyp

  • localised inflammatory outgrowth,
  • Cause of bleeding, if ulcerated
  • Not premalignant
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9
Q

What can cause cervicitis?

A

Chemical Irritants

Infection e.g. Chlamydia, Herpes Simplex

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10
Q

What neoplastic pathologies can present in the cervix?

A
  • Cervical Intraepithelial Neoplasia (CIN)
  • Cancer
    => Squamous carcinoma
    => Adenocarcinoma
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11
Q

What is the most important risk factor for development of neoplastic pathology in the cervix?

A

High Risk Human Papilloma Virus (HPV) types
- 16,18 = highest
(31,33,35,45,48…)

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12
Q

What other risk factors exist for CIN and cervical cancer?

A
  • many sexual partners = increased risk of acquiring high risk HPV subtypes
  • younger age of first intercourse/pregnancy
  • long term use of oral contraceptives
  • non-use of barrier contraception
  • Smoking: 3 x risk
  • Immunosuppression
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13
Q

How do genital warts appear on histology?

A
  • thickened “papillomatous” squamous epithelium
  • Cytoplasmic vacuolation
  • Koilocytosis => Nuclear enlargement (2-3x normal size) and Irregularity of the nuclear membrane contour
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14
Q

How does the appearance of CIN differ from that of genital warts?

A
  • Affected epithelium remains flat (unlike wart)

- shows koilocytosis, which can be detected in cervical smears

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15
Q

CIN is graded from 1-3 with Grade 3 being the most severe. What is Grade 3 CIN homologous to?

A

Carcinoma in situ

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16
Q

When does CIN 3 thought to become a cancer on microscopic analysis?

A

When the cells break through the basement membrane to invade the stroma

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17
Q

How long does it usually take for HPV infection to progress to CIN 3, and how long for CIN 3 to progress to cancer?

A

HPV infection to High grade CIN:
=> 6 months - 3 years

High Grade CIN to Invasive Cancer
=> 5 -20 years

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18
Q

What is dyskaryosis and how is this analysed from a smear sample?

A
  • nuclear abnormalities (enlarged and pleomorphic)
  • Nuclear:cytoplasm ratio increase
  • analysed using cytology
19
Q

CIN is asymptomatic and not visible to the naked eye. TRUE/FALSE?

A

TRUE

20
Q

Mitotic figures present in mature cells above the basal layer is abnormal and indicates CIN. TRUE/FALSE?

A

TRUE

  • mitotic figures should only be seen in basal layer as this is only dividing layer
  • if mitotic figures are present in mature cells then these are replicating when they should not be
21
Q

CIN grading depends on the severity of what 3 factors?

A
  • Delay in maturation/differentiation
  • Nuclear abnormalities
  • Excess mitotic activity
22
Q

Describe the differences between cytology of CIN 1-3?

A

CIN I

  • Basal 1/3 of epithelium = abnormal cells.
  • Mitotic figures in lower 1/3
  • Surface cells mature, but nuclei abnormal.

CIN II

  • Abnormal cells extend to middle 1/3.
  • Mitoses in middle 1/3
  • Abnormal mitotic figures

CIN III

  • Abnormal cells occupy full thickness of epithelium.
  • Mitoses in upper 1/3.
23
Q

What is the largest risk factor for developing cervical cancer?

A

Not participating in the cervical screening programme

24
Q

How will the cervical screening programme be changing as of March 2020?

A
  • instead of analysing cytology, patients will be directly tested for high risk HPV subtypes
  • If these are present, patients will then go on to have cells analysed by cytology
25
Q

Describe the progression of Stage 1-4 cervical cancer?

A

Stage 1 - confined to cervix
Stage 2 - local spread => vagina/uterus
Stage 3 - Spread to pelvic wall
Stage 4 - Distant Metastases or bladder/rectal involvement

26
Q

If patients do not attend screening and cervical cancer is not picked up early, what symptoms may they have?

A 
- Abnormal bleeding
=> Post coital
=> Post menopausal
=> Brownish or blood stained vaginal discharge
=> Contact bleeding – friable epithelium
  • Pelvic pain
  • Haematuria (not really - just blood staining urine)
  • Ureteric obstruction / renal failure
27
Q

Describe how squamous cervical cancer normally spreads?

A

Local - uterine body, vagina, bladder, ureters, rectum
Lymphatic - EARLY => pelvic, para-aortic nodes
Haematogenous - LATE => liver, lungs, bone

28
Q

What is meant by a well-differentiated tumour?

A

Completely changed to appear exactly like new cell type (e.g. like squamous epithelium)

29
Q

Some squamous cancers found in the cervix can keratinise. TRUE/FALSE?

A

TRUE

30
Q

What glandular lesions can occur in the endocervical region?

A
  • cervical glandular intraepithelial neoplasia
  • from endocervical epithelium
  • preinvasive phase of endocervical adenocarcinoma
  • also caused by HPV
31
Q

Screening is less effective for CGIN (glandular lesions of endocervix). TRUE/FALSE?

A

TRUE
- More difficult to diagnose on cervical smear than squamous
=> Screening less effective

32
Q

Endocervical Adenocarcinoma has a worse prognosis than squamous carcinoma of the cervix. TRUE/FALSE?

A

TRUE

33
Q

Who is more likely to get endocervical adenocarcinoma?

A
  • Higher Socioeconomic Class
  • Later onset of sexual activity
  • Smoking
  • HPV infection => particularly HPV18.
34
Q

What other abnormalities of the reproductive tract are caused by HPV?

A

Vulvar Intraepithelial Neoplasia, VIN
Vaginal Intraepithelial Neoplasia, VaIN
Anal Intraepithelial Neoplasia, AIN

ALSO
PeIN (Penile Intraepithelial Neoplasia)
PaIN (para-anal)

35
Q

What is the difference between vulval intraepithelial neoplasia in younger vs older women?

A

Young women: often multifocal/ recurrent/ persistent causing treatment problems

Older women: greater risk of progression to invasive squamous carcinoma.

36
Q

Vulval intraepithelial neoplasia is associated with what other disease?

A

Paget’s

  • crusting rash (keratin on surface)
  • Tumour cells in epidermis, contain mucin.
  • No underlying cancer, tumour arises from sweat gland in skin
37
Q

What age group usually develop invasive cancers from VIN?

A
  • elderly women
  • well differentiated
  • Spread to inguinal lymph nodes (important for prognosis)
38
Q

How is Vulvar Invasive Squamous Carcinoma (derived from VIN) treated?

A

Surgical treatment – radical vulvectomy and inguinal lymphadenectomy

39
Q

What non-neoplastic diseases can occur in the vulval epithelium?

A

Lichen Sclerosis

Other dermatoses

  • Lichen planus
  • Psoriasis
40
Q

Patients with VaIN also have CIN or VIN. TRUE/FALSE?

A

TRUE

41
Q

Patients with VaIN have much less chance of progressing to vaginal cancer than CIN/VIN do for their respective cancers. TRUE/FALSE?

A

TRUE

42
Q

Squamous carcinoma is common in what age group?

A

disease of the elderly

43
Q

Melanoma can rarely appear in the vagina. Describe how this may appear?

A

Polyp

REPRODUCTION & GYNAECOLOGY (58 decks)

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