Cervical pathology

Question 1

What is the transformation zone?

Answer 1

squamo-columnar junction

Question 2

What type of epithelia line the ectocervix?

Answer 2

squamous

Question 3

What type of epithelia line the endocervix?

Answer 3

columnar

Question 4

Why does the position of the TZ alter throughout life?

Answer 4

in reponse to menarche, pregnancy and menopause

Question 5

What are Nabothian follicles?

Answer 5

dilated endocervical glands that are benign

Question 6

What is Cervicitis?

Answer 6

inflammation that can lead to simultaneous silent fallopian tube damage
often asymptomatic

Question 7

What can cause cervicitis?

Answer 7

chlamidya trachoma’s
follicular cervicitis
herpes simplex infections

Question 8

What are the properties of a cervical polyp?

Answer 8

localised inflammatory outgrowth that can cause bleeding if ulcerated

Question 9

Are cervical polyps pre malignant?

Answer 9

NO

Question 10

What are risk factors for CIN/Cervical cancer?

Answer 10

perisistance of high risk HPV virus' - 16+18
many sexual partners
vulnerability of TZ in early life
smoking - x3
Peutz-jeghurs syndrome

Question 11

What is the action of HPV?

Answer 11

invades basal cells at the TZ which then divide and increase in number and produce E6 and E7 proteins that inhibit p53

Question 12

Is Peutz-jeghurs syndrome picked up on cervical smears?

Answer 12

NO

Question 13

What makes the action of HPV worse?

Answer 13

STIs

Question 14

What is cervical intraepithelial neoplasia (CIN)?

Answer 14

pre invasive stage of cervical cancer that occurs at the TZ

dysplasia of squamous cells

Question 15

What is seen histologically in CIN?

Answer 15

hyperchromasia, increased N:C ratio, pleomorphism

excess mitotic activity

Question 16

What is seen on cervical smears in CIN?

Answer 16

koilocytosis

Question 17

What is dyskaryosis?

Answer 17

abnormality in the squamous part

Question 18

What are glandular abnormalities?

Answer 18

abnormalities in the columnar/glandular part

Question 19

What is CIN 1?

Answer 19

basal 1/3rd of epithelium occupied by abnormal cells

Question 20

Is there a chance that CIN 1 can turn back to normal?

Answer 20

YES

Question 21

What is CIN 2?

Answer 21

abnormal cells extend to middle 1/3rd

Question 22

What is CIN 3?

Answer 22

abnormal cells occupy full thickness in the epithelium

Question 23

How long does it take a HPV infection to turn into a high grade CIN?

Answer 23

6months -> 3 years

Question 24

How long does it take a high grade CIN to turn into an invasive cancer?

Answer 24

5-20years

Question 25

How does an invasive squamous carcinoma of the cervix arise?

Answer 25

from pre existing CIN

Question 26

What is the 2nd commonest female cancer world wide?

Answer 26

invasive squamous carcinoma of the cervix

Question 27

What are the symptoms of invasive squamous carcinoma of the cervix?

Answer 27

abnormal bleeding - post coital, post menopausal, brown/blood stained discharge pelvic pain haematuria/urinary infections uteric obstruction/renal failure

Question 28

What is the local spread of invasive squamous carcinoma of the cervix?

Answer 28

vagina bladder uterus rectum

Question 29

What is the lymphatic spread of invasive squamous carcinoma of the cervix?

Answer 29

pelvic and para aortic nodes

Question 30

What is the haematogenous spread of invasive squamous carcinoma of the cervix?

Answer 30

liver lungs bone

Question 31

What happens first - lymphatic or haematogenous spread?

Answer 31

lymphatic

Question 32

What is Cervical Glandular Intraepithelial Neoplasia (CGIN)?

Answer 32

pre malignant lesion - pre invasive phase of endocervical adenocarcinoma

Question 33

Why are CGINs difficult to diagnose with a smear?

Answer 33

often hidden down inside the gland

Question 34

How do you treat mild cervical cancer?

Answer 34

increase screening

Question 35

How do you treat moderate cervical cancer?

Answer 35

surgery - LLETZ, trachelectomy (fertility sparing), radical hysterectomy radiotherapy followed up by brachytherapy chemo therapy - give before treatement (cisplatin, carboplatin, paclitaxol)

Question 36

What is the 5 yr survical for cervical cancer with vaginal involvement?

Answer 36

75-78%

Question 37

What is the 5 yr survical for cervical cancer with lower vaginal or pelvic side wall involvement?

Answer 37

47-50%

Question 38

What is the 5 yr survical for cervical cancer with bladder/rectum involvement?

Answer 38

20-30%

Question 39

What % of cervical cancers does endocervical adenocarcinoma make up?

Answer 39

5-25%

Question 40

What are the risk factors for endocervical adenocarcinoma?

Answer 40

higher socioeconomic class later onset of sexual activity smoking HPV - esp 18

Question 41

What two populations does vulvar intraepithelial neoplasia affect?

Answer 41

young women - recurrent or persistant | older women - greater risk to progress to invasive squamous carcinoma

Question 42

What can vulvar invasive squamous carcinoma arise from?

Answer 42

normal epithelium or VIN

Question 43

Who does vulvar invasive squamous carcinoma affect?

Answer 43

elderly women

Question 44

How does vulvar invasive squamous carcinoma present?

Answer 44

ulcer or exophytic mass | spreads to inguinal lymph nodes

Question 45

What is the treatment for vulvar invasive squamous carcinoma?

Answer 45

radical vulvectomy and inguinal lympahdenoctomy

Question 46

What is the 5yr survival for vulvar invasive squamous carcinoma if node -ve and +ve?

Answer 46

``` -ve = 90% +ve = <60% ```

Question 47

What is Vulvar pagets disease?

Answer 47

crusting rash tumour arises from the sweat glands lots of keratin on the surface