Cervical Pathology

Question 1

What is an ectropion?

Answer 1

This is cervical metaplasia (the change from columnar to squamous in response to erosion) and occurs at the TZ

Question 2

What is the TZ?

Answer 2

this is the transitional zone and is the area of transition between endocervical columnar epithelium and ectocervical squamous epithelium

Question 3

Is the TZ a fixed point?

Answer 3

no - it changes with menarche, pregnancy and menopause

Question 4

What is a natholion follicle?

Answer 4

a mucous filled cyst caused by the growth of squamous epithelium over the columnar

Question 5

What is a cervical polyp?

Answer 5

This is an inflammatory outgrowth - NOT premalignant

Question 6

What is an ectropion associated with?

Answer 6

High levels of oestrogen

Question 7

What is the presentation of an ectropion?

Answer 7

red area around the os, increased secretion of mucous, post-coital bleeding

Question 8

How is ectropion treated?

Answer 8

Removal of OCP/oestrogens

ablation therapy

Question 9

Can a cervical polyp bleed?

Answer 9

Yes if ulcerated

Question 10

What is cervicitis?

Answer 10

This is an inflammatory process where the lymphoid follicles of the cervix become reactive in response to infection e.g. chlamydia/HSV

Question 11

What can cervicitis present as?

Answer 11

Usually asymptomatic so will often go unnoticed - this can thus cause silent damage to the fallopian tubes and eventual infertility

Question 12

Which cells at the cervix are cilliated?

Answer 12

columnar (endocervical)

Question 13

what is CIN?

Answer 13

cervical intra-epithelial neoplasia - dysplasia of the squamous cells

Question 14

What can cause CIN?

Answer 14

most commonly HPV 16 and 18 is there is persistent infection

Question 15

What are the RF for CIN development?

Answer 15

Anything that increases HPV infection risk e.g. multiple partners, long term oral contraceptive use, barrier methods not used
Disruption to the TZ at earlier age e.g. early sexual age
Smoking (x3)
immunosuppression

Question 16

What is koilocytosis?

Answer 16

This is the presence of vacuolation in the cell film and is indicative of HPV infection

Question 17

What is the timeline of progression from HPV infection to CIN to invasive carcinoma?

Answer 17

HPV to CIN = 6 months to 3 years

CIN to invasive carcinoma = 5 to 20 years

Question 18

What is dyskaryosis?

Answer 18

The presence of abnormal cells on a cervical blood film

Question 19

Explain dyskaryotic cell features?

Answer 19

increased NC ration, hyperchromatic, open chromatin structure, increased mitotic figures, pleomorphism

Question 20

Explain CIN 1

Answer 20

the presence of dyskaryosis affecting the 1/3 of the epithelium closest to the BM

Question 21

Explain CIN 2

Answer 21

The presence of dyskaryosis affecting 2/3 of the epithelium (closest to the BM)

Question 22

Explain CIN 3

Answer 22

full thickness dyskaryosis without invasion through the BM

Question 23

What is invasive squamous carcinoma?

Answer 23

Malignant tumour of the cervix (75-95% of all) which develops from CIN and is assoicated with HPV infection

Question 24

Explain stages 1-4 of invasive squamous carcinoma?

Answer 24

1 = confined to cervix
2= spread to local structures (uterus, vagina)
3 = spread to the pelvic wall
4 = distance mets or spread to the bladder/rectum

Question 25

How will invasive squamous carcinoma present?

Answer 25

Usually picked up at smear (almost entirely preventable) but if not then will present with abnormal bleeding e.g. post-coital, post-menopause, contact bleeding or blood stained discharge pelvic pain, haematuria, urine infection and ureteric obstruction/renal failure are all other presenatations

Question 26

What is CGIN?

Answer 26

this is the precursor for adenocarcinoma - screening is less effective

Question 27

What is invasive adenocarcinoma?

Answer 27

this represents 5-25% of malignant cervical cancers and is to do with the glandular tissue overgrowth - will appear to have lots of abnormal glands under microscope.

Question 28

What are the RF for adenocarcinoma?

Answer 28

higher SE class, later sexual activity, HPV 18, smoking

Question 29

What is the most commonly used treatment for CIN2 and 3?

Answer 29

LLETZ - large loop excision of the TZ with diathermy

Question 30

What other surgeries can be carried out for invasive squamous/adeno carcinoma?

Answer 30

Fertility sparing or a Werthiem-Mieg's procedure

Question 31

What is werthiem-Mieg's procedure?

Answer 31

This is an abdominal procedure for the total hysterectomy, lymphectomy and removal of vaginal tissue (between the obturator foramen and the pelvic floor)

Question 32

What is brachytherapy?

Answer 32

This is radiotherapy that is administered directly on to the cervix

Question 33

What chemotherapy can be used?

Answer 33

cisplatin + carboplatin/paclotaxel