CERVIX

Question 1

This inflammatory condition is characterised by loads of lymphocytes in the sub-epithelial tissue (sub-epithelial reactive lymphoid follicles)

Answer 1

Follicular cervicitis

Question 2

When might a cervical polyp cause bleeding?

Answer 2

If it becomes ulcerated

Question 3

The squamo-columnar junction is very vulnerable in early life, what could influence this

Answer 3

• age at first intercourse
• long term use of OCP
• non-use of barrier contraception

Question 4

Effect of smoking on cervical cancer risk

Answer 4

Increases risk times THREE

Question 5

Cervical intraepithelial neoplasia is caused by which types of HPV?

Answer 5

HPV 16 and 18

Question 6

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

Answer 6

6 months - 3 years

Question 7

How long does it take for high grade CIN to transform into invasive cancer?

Answer 7

5-20 years

Question 8

What is the pre-invasive stage of cervical cancer?

Answer 8

Cervical intraepithelial neoplasia

Question 9

Where does cervical intraepithelial neoplasia occur? What type of cells?

Answer 9

• Occurs in the transformation zone
• dysplasia of squamous cells
• detectable by cervical screening

Question 10

Percentage of CIN1 that progress to invasion?

Answer 10

1%

Question 11

Percentage of CIN2 that progress to invasion

Answer 11

5%

Question 12

Percentage of CIN3 that progress to

Answer 12

> 12%

Question 13

Stage 1 cervical cancer

Answer 13

Confined to cervix

Question 14

Stage 2 cervical cancer

Answer 14

Spread to adjacent organs (vagina, uterus etc)

Question 15

Stage 3 cervical cancer

Answer 15

Involvement of pelvic wall

Question 16

Stage 4 cervical cancer

Answer 16

Distant metastases or involvement of rectum or bladder

Question 17

Symptoms of invasive cervical carcinoma

Answer 17

Abnormal bleeding:

• post coital
• post menopause
• brownish or blood stained vaginal discharge
• contact bleeding - friable epithelium

Pelvic pain
Haematuria/urinary infections
Ureteric obstruction / renal failure

Question 18

Spread of squamous carcinoma

Answer 18

Local - uterine body, vagina, bladder, ureters, rectum

Lymphatic - EARLY, pelvic, para-aortic nodes

Haematogenous - LATE, liver, lungs, bone

Question 19

Lymphatic spread of cervical carcinoma

Answer 19

This spread is EARLY

-pelivc, para-aortic nodes

Question 20

Haematogenous spread of cervical carcinoma

Answer 20

This spread is LATE

-liver, lungs, bone

Question 21

What is CGIN?

Answer 21

Cervical glandular intraepithelial neoplasia (CGIN)

Question 22

CGIN is the preinvasive phase of which type of cancer

Answer 22

Endocervical adenocarcinoma

Question 23

What is the preinvasive phase of ednocervical adenocarcinoma?

Answer 23

CGIN

Question 24

Which HPV is associated with cervical adenocarcinoma

Answer 24

HPV 18

Question 25

Which age groups get vulval intraepithelial neoplasia?

Answer 25

Bimodal incidence: Young women and older women Can present as an ulcer of an exophytic mass Often but not always HPV related

Question 26

Crusting rash

Answer 26

Vulvar pagets disease

Question 27

Where does vulvar pagets disease arise from?

Answer 27

Tumour cells in epidermis (CONTAIN MUCIN !!) - cancer arises from the sweat glands in the skin

Question 28

What do the tumour cells contain in vulvar paget's disease?

Answer 28

Tumour cells contain mucin !!

Question 29

How does vulvar invasive squamous carcinoma present?

Answer 29

In elderly women, as an ulcer or as an exophytic mass

Question 30

Melanoma of the vagina?

Answer 30

This is vary rare, but may present as a polyp

Question 31

What type of cells will you see in cervicitis?

Answer 31

Subeptihelial reactive lymphoid follicles

Question 32

How might vulval carcinoma present?

Answer 32

Very itchy May present as a nodule (this could then ulcerate) or may present as a cauliflower growth -burning, tingling -sex may be sore

Question 33

Smoking effect on cervical cancer

Answer 33

3x risk

Question 34

Condyloma Acuminatum: thickened "papillomatous" squamous epithelium with cytoplasmic vacuolation (“koilocytosis”)

Answer 34

HPV

Question 35

Which cells are affected in CIN?

Answer 35

Dysplasia of squamous cells

Question 36

Stage 1A1

Answer 36

Depth up to 3mm | Width up to 7mm

Question 37

Stage 1A2

Answer 37

Depth up to 5mm | Width up to 7mm

Question 38

Stage 1B

Answer 38

Confined to cervix

Question 39

Stage 2A

Answer 39

Spread to adjacent organs (vagina, uterus etc)

Question 40

Stage 3

Answer 40

Involvement of pelvic wall

Question 41

Stage 4

Answer 41

Distant metastases or involvement of rectum or bladder

Question 42

Lymphatic spread of squamous carcinoma?

Answer 42

Lymphatic spread it early to pelvic and para-aortic nodes | Haematogenous spread is late to liver, lungs and bone

Question 43

Which nodes does vulvar invasive squamous carcinoma spread to and why is this important?

Answer 43

Spreads to inguinal nodes | -important prognostic factor

Question 44

Crusting rash. | Tumour cells in epidermis, contain mucin

Answer 44

Pagets disease | Arises from sweat glands

Question 45

What is it about HPV that increases risk of cervical cancer?

Answer 45

PERSISTENCE increases risk of disease

Question 46

Mild karyotosis management

Answer 46

Check HPV status if negative, patient goes back to routine recall If HPV positive --> patient is referred for colposcopy

Question 47

Moderate karyotosis management

Answer 47

This is consistent with CIN II - refer for coloposcopy

Question 48

Severe dyskaryosis management

Answer 48

This is consistent with CIN III - refer for colposcopy

Question 49

Suspected invasive cancer management

Answer 49

Refer for urgent colposcopy (within 2 weeks)

Question 50

Results from smear are inadequate, what should you do?

Answer 50

Repeat smear - if persistent (3 inadequate samples - assess by colposcopy)

Question 51

Histology findings of CIN

Answer 51

- the cells take longer to mature (so you'll see lots more immature cells, like me lol) - Nuclear abnormalities (hyperchromasia, increased nucleocytoplasmic ratio, pleomorphism) - Excess mitotic activity

Question 52

What does koilocytosis indicate?

Answer 52

Indicates HPV infection

Question 53

This cancer is associated with a higher SE class

Answer 53

Adenocarcinoma

Question 54

This cancer is associated with a later onset of sexual activity

Answer 54

Adenocarcinoma