Cervical Flashcards Preview

Toni's Obs and Gynae > Cervical > Flashcards

Flashcards in Cervical Deck (25):
1

Low risk HPV

6
11

2

Cervical screening


25-49: 3 yrly
50-64: 5 yrly

3

HPV vaccination

Bivalent
Quadrivalent

4

High risk HPV

16
18

5

Treatment for symptomatic cervical ectropion

Smear
Ideally colposcopy too
Cryotherapy

6

Complications of cervical ectropion

Columnar epithelium at greater risk of infection
Acute cervicitis: STI
Chronic cervicitis: discharge + inflammatory smear
Cryotherapy +- abx

7

Cervical polyps

Benign tumours of endocervical epithelium
Seen mostly in women >40 yrs
Usually

8

Nabothian follicles

Where squamous epithelium has formed by metaplasia over endocervical epithelium
Columnar cells continue to secrete = retention cysts
White swellings on ectocervix
Treatment not usually required

9

CIN

Cervical intraepithelial neoplasia
A histological diagnosis
Dyskaryosis in the squamous epithelium
Larger nuclei with frequent mitoses
3 stages

10

CIN1

Mild dyskaryosis
Dysplasic cells only found in the lower 1/3 epithelium

11

CIN2

Moderate dyskaryosis
Dysplasic cells found in lower 2/3 of epithelium

12

CIN3

Severe dyskaryosis
Displasic cells occupy full thickness of epithelium
Aka carcinoma in situ

13

% women with CIN2/3 developing cervical carcinoma in 10 years if left untreated

33%

14

In what age group is there peak incidence of CIN?

25-29

15

Risk factors for CIN

Smoking
Oral contraceptive use
HIV/other immunocompromise

16

Why does HPV infection predispose to carcinoma?

When the virus invades the cell it incorporates its viral DNA into host cell DNA
Viral proteins inactivate key tumour suppressor gene products-> cell into cell cycle
other mutations build up-> uncontrolled proliferation = carcinoma
Virus changes hide the cell from the immune system

17

Why does screening only start from 25?

Whilst women younger than 25 may have cervical changes they are unlikely to cause cancer
Starting screening from 25 reduces the number of unnecessary recalls and colposcopy

18

What method is used to examine smear tests?

Liquid based cytology
Inadequate sample: 2.5%
Same sample can be tested for HPV 'HPV triage'

19

CIN1 treatment

HPV triage
+High risk= colposcopy
+Low risk= return to 3/5yrly recall

20

Smear following treatment

No abnormal cells + no high risk HPV = return to routine recall

21

What is CGIN

Cervical glandular intraepithelial neoplasia
Uncommon
Adenocarcinoma or cervix and endometrium should be excluded

22

Colposcopy procedure

Cervix inspected with surgical magnification (10-20x)
Squamocolumnar junction visualised
Acetic acid applied
Aceto White (incr protein, less glycogen)
Biopsy abnormal areas/ LLETZ

23

Features of dyskaryosis

Anaplasia
Incr nuc:cytoplasmic ratio
Hyperchromatism

Follow up
2 smears in first year
Annual smears next 5 yrs
Return to routine schedule

24

LLETZ

High frequency current passed through wire loop
Tissue goes for histology
Out patient procedure
Small risk cervical incompetence + stenosis

25

Cone biopsy

Surgical excision of cervical tissue under anaesthesia
Large specimen for pathology
Associated with cervical incompetence and stenosis