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Year 4 OBGYN > Cervical Pathology > Flashcards

Cervical Pathology Flashcards

(40 cards)

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1
Q

Define Cervical Polyps

A

Benign growths protruding from inner cervix that have the ability to undergo malignant change
Due to focal hyperplasia of columnar epithelium of endocervix

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2
Q

Give three potential causes of Cervical Polyps

A

Chronic Inflammation
Abnormal response to Oestrogen
Localised congestion of vasculature

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3
Q

Give four potential clinical features of Cervical Polyps

A
  • May be Asymptomatic
  • Abnormal Vaginal Bleeding (PMB, Post Coital, Intermenstrual)
  • Increased Vaginal Discharge
  • Subfertility if blocking cervical canal
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4
Q

Describe four investigations that should be carried out for Cervical Polyps

A
  • Triple Swabs
  • Cervical Smear
  • USS for Endometrial Polyps
  • Histological Analysis after removal
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5
Q

What are Triple Swabs?

A
  • High Vaginal Charcoal (TV,BV,Candida, GBS)
  • Endocervical Charcoal (Gonorrohea)
  • Endocervical NAAT (Chlamydia)
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6
Q

How are Cervical Polyps removed?

A

Small: Polypectomy with forceps in primary care setting
Large: Colposcopy

Removed due to 0.5% malignancy risk

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7
Q

Define Ectropian

A

Eversion of the endocervix, exposing columnar epithelium to vaginal environment

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8
Q

Explain two symptoms of Cervical Ectropians and why this occurs

A

Post coital/ IMB (due to exposure of fine blood vessels)

Heavy Discharge (Endocervix is columnar epithelium mucous secreting)

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9
Q

Give three risk factors for Cervical Ectropians

A

Menstruating Age
COCP
Pregnancy

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10
Q

What are the three main investigations for a Cervical Ectropian?

A

Triple Swabs
Cervical Smear
Pregnancy Test

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11
Q

Cervical Ectropian are normal variants that don’t require treatment unless symptomatic, what are the treatment options?

A

1) COCP

2) Ablation (warn patients of heavy discharge until healed)

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12
Q

Define Cervicitis

A

Inflammation of Uterine Cervix, primarily affecting Columnar Epithelium

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13
Q

Give an Acute and Chronic cause of Cervicitis

A

Acute - Infection

Chronic - Local Irritant (Tampons, Latex)

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14
Q

What is CIN?

A

Varying degrees of Dyskaryosis in the transformation zone of the cervix

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15
Q

Describe the three stages of CIN

A

1 - involved 1/3 of basal epithelium (mild)

2 - involves 2/3 of basal epithelium (moderate)

3 - involves full thickness, AKA Carcinoma In Situ

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16
Q

How is CIN managed?

A

1 - Expectant

2 and 3 - large loop excision and retest for HPV in 6m

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17
Q

Give three risk factors for Cervical Cancer

Study These Flashcards
A
  • Smoking
  • HPV (high risk oncogenic strains 16 and 18, low risk 6 and 11)
  • Other STIs
18
Q

Name four features of the pathology of Cervical Cancer

Study These Flashcards
A

Majority caused by HPV infection

70% SCC, 15% Adenocarcinoma

Occurs as progression from CIN over 10-20 years

Commonly metastasises to lung/liver/bone/bowel

19
Q

What is the peak age of Cervical Cancer diagnosis?

20
Q

Describe 5 features of Cervical Cancer

Study These Flashcards
A 
Abnormal Vaginal Bleeding (IMB,PMB,PCB)
Vaginal Discharge (Foul, Blood Stained)
Dyspareunia
Pelvic Pain
Weight Loss
21
Q

State two signs of advanced Cervical Cancer

Study These Flashcards
A
  • Oedema

- Loin Pain

22
Q

How would you investigate a Pre-Menopausal woman for Cervical Cancer?

Study These Flashcards
A

1) Test for Chlamydia

2) If symptoms persist/test is negative then Colposcopy and Biopsy

23
Q

How would you investigate a Post Menopausal woman for Cervical Cancer?

Study These Flashcards
A

Urgent Colposcopy and Biopsy

Acetic Acid stains the dysplastic areas (binds to proteins - white) and biopsies are taken

24
Q

Describe the FIGO staging 0 and 1 for Cervical Cancer

Study These Flashcards
A

0- Carcinoma in Situ
1A - Confined to Cervix , identified only microscopically
1B - Confined to Cervix, gross lesions clinically identifiable

25
Describe the FIGO staging 2 for Cervical Cancer
Beyond Cervix but not beyond pelvis (and not involving lower 1/3 of Vagina) A) No Parametrial Involvement (involves upper 2/3 Vagina though) B) Gross Parametrial Involvement
26
Describe the FIGO staging 3 for Cervical Cancer
Extends to pelvic side wall/involves lower vaginal third/hydronephrosis 'B' - Hydronephrosis
27
Describe the FIGO staging 4 for Cervical Cancer
A) Involves bladder/rectum | B) Involves distant organs
28
When are Women invited for Cervical screening?
Every three years from 25-49 Every five years from 50-64 If HIV +ve then screened every year
29
Why are Women not invited for screening before the age of 25?
CIN1 is common in<25 and often self resolves Would lead to over treatment
30
What happens if the HPV screening sample is positive?
No abnormal cells - recalled in 12 months to see if virus has cleared Inadequate Sample - recalled in 3 months Dyskaryosis - Colposcopy
31
If there were no abnormal cells still but the patient was still HPV positive 12 months later, how would you manage?
Recheck in another 12m If still positive then - Colposcopy
32
Should you have HPV screening if you have had a previous Hysterectomy?
Only if Subtotal
33
Should you have HPV screening if you have had previous radiotherapy to the area?
No
34
Name two reasons a Cervical Screening appointment should be delayed
- Menstruation | - <12w post partum/miscarriage/TOP
35
Other than the procedure, name four things you should discuss with the patient pre Cervical Smear
- The purpose of screening and its limitations - The likelihood of a normal result (93%) - That a normal result means LOW risk but not NO risk of cancer - What happens if the result is inadequate or positive
36
How is a Cervical Smear taken?
- Insert the correct size lubricated speculum so that you can visualise the cervix - Insert the brush swab up to the cervical os, and rotate 360 degrees 5 times - Insert back into tube, replace lid, and shake gently
37
How is Cervical Cancer stage 1a managed?
Radical Trachelectomy (Cervix and Upper Vagina - fertility preserved) Or come biopsy to retain fertility
38
How is Cervical Cancer stage 1b and above managed?
Radical Hysterectomy | Radiochemotheapy for 5-8 weeks
39
How is Cervical Cancer stage 4a and above managed?
Removal of all of pelvis +/- bladder and rectum
40
How should Cervical Cancer patients be followed up?
Every 4m for first 2y Then Every 6m for next 3y

Year 4 OBGYN (15 decks)

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