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Reproduction & Sexual Health > Cervical Cancer > Flashcards

Cervical Cancer Flashcards

1
Q

What is the transformation zone?

A
  • squamo-columnar junction between the ectocervic (squamous) and endocervix (columnar).
  • It is where lesions (neoplasia) usually form
  • Smears should be taken at this site
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2
Q

What is cervical erosion

A

-exposure of endocervical epithelium to acidic environment which causes squamous metaplasia

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3
Q

What are Nabothian follicles?

A
  • benign expanded endocervical glands
  • caused by growth of stratified squamous epithelium onto simple columnar epithelium which block the cervical crypt and traps cervical mucus within the crypts
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4
Q

What is cervicitis?

A
  • non-specific acute/chronic inflammation

- can lead to infertility due to silent fallopian tube damage

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5
Q

What infections can cause cervicitis?

A
  • chlamydia trachomatis

- HSV

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6
Q

What is a cervical polyp

A

It is a benign localised inflammatory outgrowth.

May be able to look for CIN

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7
Q

Which HPV types are typically known to cause cervical cancer?

A

HPV 16 and 18 causing 70% of all cervical cancers

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8
Q

What factors increase the vulnerability of transformation zone in early reproductive life?

A
  • age at first intercourse
  • long term use of oral contraception
  • use of non barrier contraception
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9
Q

What are the risk factors for devleoping cervical cancer?

A
  • vulnerable transformation zone
  • smoking
  • immunosuppression
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10
Q

What can HPV cause?

A
  • genital warts
  • cervical intraepithelial neoplasia
  • cervical cancer
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11
Q

What are the histological features of genital warts (condyloma acuminatum)?

A

thickened papillomatous squamous epithelium with cytoplasmic vacuolation (koilocytosis)

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12
Q

What are the histological features of cervical intraepithelial neoplasia (CIN)?

A

infected epithelium may remain flat but koilocytosis may be detected in cervical smears

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13
Q

What does koilocytosis in cervical epithelium usually indicate and what does it look like?

A
  • cells infected with HPV
  • high nuclei to cytoplasm ratio
  • darkened nuclei
  • perinuclear halo
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14
Q

What is cervical cancer?

A

when virus is intergrated in the host cell DNA. CIN has broken through basement membrane

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15
Q

How long does it take for HPV infection to progress to high grade CIN?

A

6months-3years

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16
Q

How long does it take for high grade CIN to progress to cervical cancer?

A

5-20 years

17
Q

What is CIN?

A
  • preinvasive stage of cancer
  • occurs at the transformation zone
  • dysplasia/dyskaryosis of squamous cell
  • detectable on smears
  • asymptomatic
18
Q

What are the histological features of CIN?

A
  • nuclear abnomalities (hyperchromasia)
  • excess mitotic activity (mitosis usually occurs just above basement membrane, abnormal if mitosis occuring in higher cell layers)
  • delay in maturation and differentiation (immature basal cells occupying most of the epithelium)
19
Q

What are the features of CIN I,II and III?

A
  • I (basal 1/3 of epithelium occupied by abnormal cells)
  • II (abnormal cells extend to middle 1/3)
  • III (abnormal cells extend to upper 1/3)
20
Q

What is the most common malignant cervical tumour?

A

invasive cervical squamous carcinoma

21
Q

How does invasive cervical squamous carcinoma develop?

A

from pre-existing cervical intraepithelial neoplasia which can be easily screen and detected

22
Q

What are the symptoms of invasive cervical squamous ca?

A
  • asymptomatic (if detected early)
  • abnormal bleeding (post-coital, post menopausal, contact bleeding, bloody vaginal discharge)
  • pelvic pain
  • hydronephrosis/ renal failure (blockage of ureters)
  • hematuria/UTI (if bladder invaded)
23
Q

Where would squamous carcinoma spread to?

A
  • local spread(uterine body, vagina,bladder, ureters, rectum)
  • lympathic (pelvic, para-aortic nodes)
  • haematogenous (liver, lungs, bone)
24
Q

What is the treatment for affected lymph nodes?

A

radiotherapy not surgery

25
Q

What could CT of lymph nodes show?

A

rough, enlarged lymph nodes

26
Q

What is the grading for squamous carcinoma?

A
  1. well differentiated
  2. moderately differentiated
  3. poorly differentiated
  4. undifferentiated/anaplastic
27
Q

What is cervical glandular intraepithelial neoplasia (CGIN)?

A
  • originates endocervical epithelium
  • preinvasive phase of glandular adenocarcinoma
  • more difficult to diagnosis in smear so screening less effective
  • less common than CIN but very aggressive (poorer prognosis)
28
Q

What are the risk factors for adenocarcinoma?

A
  • later onset of sexual activity
  • smoking
  • HPV 18
29
Q

What are other HPV driven diseases?

A
  • vulvar intraepithelial neoplasia
  • vaginal intraepithelial neoplasia
  • anal intraepithelial neoplasia
30
Q

What are the features of vulvar intraepithelial

neoplasia?

A
  • highly variable compared to CIN
  • may be HPV related
  • may progress to vulvar invasive squamous ca especially in older women
31
Q

what are the features of vulvar invasive squamous ca

A
  • ulcerative/exophytic mass
  • mostly well differentiated (verrucous is a very well differentiated type)
  • may spread to inguinal lymph nodes (important prognostic factor-poorer in node invasion)
32
Q

what is the management for vulvar invasive squamous ca?

A
  • radical vulvectomy

- inguinal lymphadenectomy

33
Q

What is vulvar paget’s disease?

A
  • crusting rash on vulva
  • tumour cells in epidermis contain mucin
  • mostly, no underlying cancer but tumour arises from sweat gland
34
Q

What are other vulval diseases?

A
  1. infections (candida, genital warts, bartolin’s glands abscess)
  2. non neoplastic epithelial diseases (lichen sclerosis, lichen planus, psoriasis)
  3. atrophy (postmenopausal)
35
Q

What vaginal pathologies may occur?

A
  • vaginal intraepithelial neoplasia. May be accompanied by vulvar/cervical lesions
  • squamous carcinoma (rare)
  • melanoma (Rare)-may appear as polyp

Reproduction & Sexual Health (10 decks)

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