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Flashcards in Disorder of Cervix Deck (17):
1

Cervicitis:
-causes
-sx
-PE findings

Cause;
-STI (which may be asymptmatic)
-local trauma
-malignancy, radiation therapy, chemical irritation, systemic inflamm dz (behcets)
-idiopathic
-use of pessiary, diaphragm, douches
(gonorrhea, chlamydia, trichomonas, HSV)

sx:
-purulent vaginal discharge, postcoital bleeding, vaginal spotting, deep pain
-dysuria or urinary frequency
-vulvovaginal irritation
-constitutional sx: fever, chills, malaise

PE:
-purulent discharge on surface and/or exuding from canal
-minor trauma from insertion from a cotton swab= bleeding
-vesicular lesions suggesting HSV
-punctate hemorrhages consistent with trichomonas
-cervical motion tenderness = coexisting PID.

2

Cervicitis; treatment of STIs:
-Gonorrhea?
-Chlamydia?

Gonorrhea: 250mg IM Rocephin

Chlamydia: 1g Azithro PO

*make sure you always treat for both infections because they are almost always concurrent.

3

Cervicitis:
-dx
-tx

Dx:
-may require gonorrhea, chlamydia, and HSV testing
-HIV testing and counseling


Tx:
-if persists after intial round of abx then repeat testing w/ most sensitive dx test
-re-examine possible exposure to chemical irritants
-have sex partners tested for STI

4

Cervical polyps:
-what are these?
-cause
-found MC in who?
-sx

What: benign, pedunculated growths of varying size that extend from the ectocervix or endocervical canal. May be single or multiple

Cause: unknown, believed to result from chronic inflammation, may be associated with hyperestrogen states

Found MC in multiparous women in their 30-40s.

Sx:
-usually asymptomatic
-thick leukorrhea
-postcoital bleeding
-intermenstrual bleeding
-menorrhagia
-post-menopausal bleeding
-mucopurulent or blood-tinged vaginal discharge.

5

Cervical Polyps:
-PE findings
-tx

PE:
-single or multiple pear-shaped growths may protrude from cervix into vaginal canal
-smooth, soft, reddish purple to cherry red in color
-may bleed when touched
-may be small or large.

Tx:
-tie at base and twist off at base with forceps
-may need to cauterize

6

Nabothian Cysts:
-what is this?
-cause
-tx

What: harmless mucous filled cyst on the surface of the cervix

Cause:
-stratified squamous epithelium of the ectocervix grows over the simple columnar epithelium of the endocervix

Tx:
-resolve on own
-may be removed via electrocautery or cryotherapy

7

Cervical Cancer:
-pathologic types
-sx
-risk factors

Pathologic types:
-squamous cell (69%)
-adenocarcinoma
-adenosquamous

Sx:
-frequently asymptomatic
-abnormal vaginal bleeding
-postcoital spotting
-vaginal discharge--can be watery, mucoid, or purulent and malodorous

Risk factors:
-early onset of intercouse (less then 18YO)
-three or more sexual partners
-male partner who has had other partners or is uncircumcised
-Hx of STI
-1st child before 20YO & multiparity
-cigarette smoking
-oral contraceptive use
-low SES
-daughter of mother who took DES

8

Cervical CA:
-protective factors
-which infection has a huge role in cervical cancer?

protective:
-virginity
-long term celibacy
-life-long mutual monogamy
-long term use of condoms
-obtaining regular pap smears

Role:
-HPV!!! most HPV infections are transient and are cleared on their own.
-HPV can be detected in 99.7% of all cervical CA!
-takes about 15yrs from time of infection to presentation of Cervical CA.

9

HPV & its role in Cervical Cancer:
-how is this neoplastic?
-which HPV subtypes?

neoplastic:
-HPV integrates into the human genome and can result in abnormal high grade lesions and cancer.

HPV 16 & 18 cause cervical cancer.

10

Dx of Genital HPV

Prevention of HPV

Pap smear

Prevention: vaccination!!!! Gardasil; for men and women ages 9-26YO.
--3 separate IM injections at 0, 2, 6 MO

11

What part of the cervix is the most likely site of dysplasia?

Definition of a satisfactory pap?

Results of PAP

Squamo-columnar junction

Satisfactory pap:
-proper amount of squamous cells
-proper labeling
-endocervical cells present***

PAP results:
-normal: no abnormal cells seen.

-abnormal: atypical cells of undetermined significance, low grade squamous intraepithelial lesions or cervical intraepithelial neoplasia (CIN) 1. [these are mild, subtle cell changes, and most go away without tx]

-high grade squamous intraepithelial lesions (HSIL) or CIN 2 or 3. [moderate and severe cell changes which require further testing or tx]

-carcinoma


**cervical CA may present at ANY POINT in the spectrum, depending upon the associated HPV type and other host factors.

12

Tx of Cervical CA

tx is according to staging system

Early stage: surgery or chemo-radiation

Locally advanced dz: chemo-radiation

disease w/ distant mets: chemo, palliative care with radiation and chemo possibly

13

Cervical CA Screening
-when do you start?
-screening intervals
-when do you stop?

begin at age 21; earlier screening may result in over-dz of cervical lesions, these usually regress spontaneously but may lead to inappropriate intervention.

Screening intervals:
-q3years from 21-30 pap smear
-Over 30YO; q3years pap or q5yrs pap and HPV test

Stop: age 65 as long as woman had 2 consecutive tests negative prior to stopping

14

Management of abnormal pap

for low grade lesions: give periodic pap tests until abnormality resolves or colposcopy referral for persistent lesions

for higher grade lesions: refer for colposcopy


-HPV is very common
-the longer HPV is present and the older the pt the greater the risk of CIN
-vast majority clear the virus or suppress it

15

What type of f/u is required if:
-pap normal, HPV positive?

repeat pap and HPV testing in 12mo, then colposcopy if either is positive.

16

What is colposcopy?

allows examination and bx of the cervix.
-acetic acid solution applied to cervix

17

What is cold knife conization and LEEP?

Cold knife: done in OR, cut out a cone of cervix and send it to pathology.

LEEP: loop electrosurgical procedure, use thin loop that carries an electric current to cut out tissue.