Cervix Flashcards by Adele Harris

What is the cervix?

Part of the uterus below the internal os

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What is the endocervical canal lined with?

Mucous columnar epithelium

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The transition zone is also known as the —– - ——- junction

Squamo-columnar junction

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The position of the transitional zone changes during life as a response to which 3 events?

Menarche
Pregnancy
Menopause
(also using COCP)

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What is the most common cancer in females <35

Cervical

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What are the 6 Wilson and Jugner Criteria

Important Health problem
Treatment available
Recognisable latent or early symptomatic phase
Suitable screening test available
Natural history of condition understood
Cost effective

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Why do cervical screening?

Screening can identify cell changes which may develop to be pre-cancerous

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How many lives are saved per year in the UK due to cervical screening?

5,000

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What is the best protection against cervical cancer?

Screening (even if you have been immunised with HPV)

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TRUE/FALSE If you develop symptoms this should be picked up on screening test as usual

Meh

If symptoms then diagnostic testing NOT screening

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Screening is for which two strains of HPV?

Strain 16 and 18

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What percentage of cancers does screening pick up?

75%

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What age range do you have to fall within in order to be eligible for cervical cancer screening?

25-64

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What is the algorithm for determining coverage?

Screened population/ eligible population x 100

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What is the algorithm for determining uptake?

Screened population/ Invited population x 100

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TRUE/FALSE You can do a smear even if they are bleeding?

Kinda
Difficult to do a smear when bleeding
If persistent then examination of cervix and/or considered for endometrial biopsy

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What do smears collect?

Cervical cells for microscopy

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With smears what correlates to the severity?

Degree of dyskaryosis

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What is the pre-invasive phase of cervical cancer called?

Cervical intra-epithelial neoplasia (CIN)

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What strains of HPV is CIN associated with?

16, 18, 31, 33

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TRUE/FALSE

Once CIN has spread down the endocervical crypts it is cancer

FLASE

It does not mean cancer- it is just the path of least resistance

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What are the RF for CIN?

Persistent high risk HPV infection
Multiple partners
Smoking
Immunocompromise
OCP
Lack of barrier contraception
Young age for first intercourse

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What does koilocytosis indicate is present?

HPV infection

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How much of the epithelium does CIN I affect?

Lower basal 1/3 epithelium

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With CIN III what percentage regress and what percentage progress to infection?

30% regress | 10% progress to invasion

What type of carcinoma are 75-95% of malignant cervical tumours?

Squamous carcinoma

Why should squamous carcinoma of the cervix be preventable?

As it develops from pre-existing CIN therefore it should be preventable by screening

What are some symptoms of cervical cancer?

- Usually none at early invasive stage - Abnormal bleeding - Brownish/blood stained discharge - Pelvic pain - Haematuria/urinary infections - Ureteric obstruction/renal failure

What are the 3 types of spread fo cervical cancer?

Local Haematogenous Lymphatic

In stage 3 cervical cancer there is involvement of the

Pelvic wall

What type of glands does adenocarcinoma form in?

Mucous secreting glands

TRUE/FALSE Squamous carcinoma of the cervix has a better prognosis than adenocarcinoma

FALSE | Adenocarcinoma has a worse prognosis

In which age group is adenocarcinoma of the cervix increasing?

Young

What is the epidemiology of adenocarcinoma of the cervix?

Higher S.E class Later onset of sexual activity Smoking HPV (esp HPV 18)

What is the preinvasive phase of endocervical adenocarcinoma?

Cervical Glandular Intraepithelial neoplasia (CGIN)

If you think someone may have cervical cancer the first line is colposcopy TRUE/FALSE

FALSE Colposcopy is part of the screening for asymptomatic pre-cancer If you think cancer then need to do internal examination

What are the 4 types of surgery for cervical cancer

LLTEZ- up to stage 1a1 Cone biopsy- up to stage 1a2 Trachelectomy- up to stage 1b Radical hysterectomy if confined to cervix

If you use cisplatin why does there need to be good hydration?

It is excreted by the kidneys

Which chemotherapy agent causes lots of neurological SE e.g. tinnitus, pins and needles?

Cisplatin

What is the risk that you warn all patients about who are undergoing chemotherapy?

Neutropenia

If they are going to what is the period that they will be neutropenic after chemo?

5-12 days period

Of the 80 types of HPV identified how many are known to cause infection int eh genital tract?

What is the shape of the DNA in HPV?

Circular, double stranded DNA, protected by capsid proteins

What does HPV 6 and 11 cause?

Genital warts

What is the period of time from HPV infection to High grade CIN?

6 months- 3 years

What is the period of time from high grade CIN to invasive cancer?

5 years - 20 years

Which age groups is vulval intraepithelial neoplasia common in?

Bimodal - Young women - Older women

What is the most important prognostic indicator in vulvar invasive squamous carcinoma?

Spread to inguinal lymph nodes

What is the treatment for vulvar intraepithelial neoplasia?

Radical vulvectomy | Inguinal Lymphadenopathy

What are the three things that ectropians are prone to?

Bleeding Excess mucous production Infection

Why do ectropians extend during puberty, with the COCP and during pregnancy?

Hormonal influence

Treatment of cervical ectropian

None if asymptomatic/pregnant/pubertal If taking hormonal contraceptive- consider change to non-hormonal Cautery with diathermy if the patient wishes

What is an ectropion?

A red ring around the os as endocervical epithelium extended its territory over the paler epithelium of the ectocervix

What is another name for mucous retention cysts?

Nabothian cysts

What are cervical polyps?

Pedunculated benign tumours of endocervical epithelium, localised inflammatory outgrowth

Cervical polyps are premalignant TRUE/FALSE

FALSE

Treatment of cervical polyps

Young women--> avulsion | Old women--> avulsion + TVS +- hysteroscopy

What are the two risks with cervicitis?

1. Can lead to infertility | 2. May mask neoplasia on a smear

What is the cause of 50% of cervicitis?

Chlamydia

Squamous carcinoma of the vagina is a disease of what age group?

The elderly