What are Nabothian cysts?
- Very common, benign cervical cysts
- Develop when crypts and clefts of columnar epithelium are bridged over and become occluded
- Yellow or translucent
- No tx required
Describe cervical polyps
- Small penduculated neoplasms of cervix
- Common (but rare before menarche)
- Most are benign but should be removed and biopsied
Types of cervical polyps
- Endocervical: red, flame shaped, fragile
- Ectocervical: pale, smooth, rounded, less likely to bleed
S/S cervical polyps
Intermenstrual or postcoital bleeding is MC
Treatment of cervical polyps
- R/o infection w/cultures
- Polypectomy
MC type of cervical polyp
Ectocervical
Describe DES exposure in utero
- DES is synthetic non-steroidal estrogen
- Was used 1940-1971 to prevent premature birth, miscarriages
- DES passed placenta and caused complications in offspring (increased risk of infertility, complicated pregnancies, vaginal clear cell carcinoma)
What is cervical intraepithelial neoplasia (CIN)?
Disordered growth and development of the epithelial lining of the cervix
Classification systems of CIN
- Histologic (based on biopsy results alone)
- Bethesda system (cytologic, based on pap smear results)
Histologic classification of CIN
- CIN 1: mild (disordered growth of lower 1/3 epithelial lining)
- CIN 2: moderate (lower 2/3)
- CIN 3: severe (more than 2/3)
- Carcinoma in situ (full thickness dysplasia)
Bethesda system of CIN
- ASC-US (atypical squamous cells of undetermined significance)
- ASC-H (high grade lesion can’t be excluded)
- LSIL (low grade squamous intraepithelial lesion, CIN 1)
- HSIL (high grade lesion, CIN 2/3)
When is annual pap smear recommended?
- HIV (twice in first year)
- Hx of CIN 2 or 3 or cancer
- DES in utero exposure
- Immunosuppressed
How does CIN relate to cervical cancer?
- CIN can become cancer
- All cancers start as CIN, grows slowly
Primary risk factor for CIN/cervical cancer?
HPV (esp 16 and 18)
MC s/s of cervical cancer?
Abnormal vaginal bleeding
Signs of late stage cervical cancer?
Weakness, wt loss, anemia
Where does cervical cancer MC occur?
90% occur within 1 cm of squamocolumnar junction
What is a colposcopy?
- Directed biopsy of cervix
- Visualizes the extent and location of CIN
- Acetic acid brings out areas of dysplasia
Treatment of CIN
- Destroy abnormal cells to prevent progression
- Electrocautery, cryocautery, laser therapy
- LEEP (loop electrodiathermy excision procedures)
When does recurrence of cervical cancer MC occur?
Early after initial treatment (so frequent follow up necessary)
MC causes of cervicitis
- N. gonorrhoeae
- C. trachomatis
- HSV
- HPV
- Bacterial vaginosis
Primary s/s of cervicitis
Purulent vaginal discharge (appearance depends on pathogen)
What is cervicitis?
Inflammation of the cervix secondary to bacterial infection (MC STD)
What is chancroid?
STI caused by gram negative rod H. ducreyi
