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L.15 Cervical pathology Flashcards

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1
Q

What is the function of the ovaries in the female reproductive tract?

A

Produces ova & hormones (estrogen, progesterone)

Ovaries are essential for female reproductive health and fertility.

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2
Q

What is the role of the uterus?

A

Muscular organ for implantation and fetal development

The uterus supports pregnancy and childbirth.

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3
Q

Describe the cervix.

A

Neck of uterus, gateway to vagina

The cervix plays a critical role in childbirth and menstrual flow.

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4
Q

What is the function of the vagina?

A

Muscular canal leading to external genitalia

The vagina serves as the birth canal and the passage for menstrual fluid.

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5
Q

What does the term ‘vulva’ refer to?

A

External female genital organs

The vulva includes structures such as the labia and clitoris.

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6
Q

What are the two main epithelial components of the cervix?

A
  • Ectocervix: Covered with stratified squamous epithelium
  • Endocervix: Lined by glandular columnar epithelium

These components serve different protective and functional roles.

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7
Q

What are the types of cervical samples used for screening?

A
  • HPV testing (high-risk HPV detection)
  • Cytology (Pap smear/Liquid-Based Cytology - LBC)

These tests help in early detection of cervical abnormalities.

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8
Q

What is included in histology samples for diagnosis/treatment?

A
  • LLETZ/LEEP (Large Loop Excision of Transformation Zone)
  • Cone Biopsy
  • Resection specimens for advanced cases

These procedures are used to diagnose and treat cervical cancer.

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9
Q

At what age is primary HPV screening recommended for women?

A

Aged 25–65

This age range is based on guidelines for cervical cancer screening.

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10
Q

What sample collection method is used for primary HPV screening?

A

Collected via a plastic broom device into liquid-based cytology medium

This method enhances the accuracy of HPV detection.

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11
Q

What does a negative HPV test result indicate?

A

Routine recall (3-5 years)

Regular follow-up is essential for ongoing monitoring.

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12
Q

What is required after a positive HPV test?

A

Cytology triage required

This step helps determine the need for further investigation.

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13
Q

What is the purpose of cytology triage after an HPV+ result?

A

Not all HPV+ women have cervical disease

This process minimizes unnecessary procedures for women with transient infections.

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14
Q

What happens if the cytology result is negative for intraepithelial lesions?

A

Repeat HPV test in 12 months

This follow-up helps ensure that any potential issues are caught early.

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15
Q

What does ASCUS stand for in cytology results?

A

Atypical squamous cells of undetermined significance

ASCUS results may require further evaluation through colposcopy.

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16
Q

What is the recommended action for cytology results that show ASCUS or worse?

A

Refer for colposcopy

Colposcopy allows for a closer examination of the cervix.

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17
Q

What is colposcopy?

A

Visual examination of cervix using a colposcope

Colposcopy is a procedure to closely examine the cervix for signs of disease.

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18
Q

What substances are applied during colposcopy to highlight abnormal areas?

A

Acetic acid & iodine

These substances cause acetowhite changes and iodine negativity in abnormal tissues.

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19
Q

What is the purpose of correlating cytology findings with colposcopic appearance?

A

To plan management

This is crucial for determining the appropriate treatment for cervical abnormalities.

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20
Q

What procedures can be performed during colposcopy?

A
  • Laser/Cryocautery: Ablation of abnormal tissue
  • Punch biopsy: Small tissue samples
  • LEEP/LLETZ: Excision of transformation zone
  • Cone biopsy: Larger/deeper excision, especially for glandular lesions

These procedures help in diagnosing and treating cervical pathologies.

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21
Q

What are common cervical pathologies?

A
  • Infections: HPV, HSV, Chlamydia, HIV
  • Endometriosis: Ectopic endometrial tissue involving cervix
  • Premalignant lesions: CIN, CGIN
  • Malignancies: SCC, endocervical adenocarcinoma, adenosquamous carcinoma, TEM/SMILE lesions
  • Metastatic cervical involvement (rare)

These conditions can affect the cervix and may lead to serious health issues.

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22
Q

What are symptomatic clinical presentations of cervical pathology?

A
  • Postcoital bleeding (PCB)
  • Postmenopausal bleeding (PMB)
  • Abnormal vaginal discharge
  • Cervical irritation/pain
  • Irregular cervical contour on examination

Symptoms can vary widely based on the underlying pathology.

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23
Q

What is a common method for detecting asymptomatic cervical pathologies?

A

Cervical cancer screening programmes

These programs are essential for early detection of cervical cancer and other abnormalities.

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24
Q

What is the global ranking of cervical cancer in women?

A

4th most common cancer in women

This statistic highlights the significant public health impact of cervical cancer worldwide.

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25
How many new cases of cervical cancer were reported globally in 2020?
604,000 new cases ## Footnote This figure underscores the ongoing challenge of cervical cancer prevention and treatment.
26
What percentage of cervical cancer deaths occur in low- and middle-income countries?
90% ## Footnote This statistic indicates a disparity in healthcare access and cancer treatment across different regions.
27
What was the incidence of cervical cancer in Ireland from 2017 to 2020?
~290 cases/year ## Footnote This figure reflects the prevalence of cervical cancer within the Irish population.
28
What was the annual death rate from cervical cancer in Ireland during the same period?
~90 deaths/year ## Footnote This data emphasizes the mortality associated with cervical cancer in Ireland.
29
What is the primary cause of cervical cancer?
Human Papillomavirus (HPV) infection ## Footnote HPV is the most significant risk factor for developing cervical cancer.
30
Which HPV types are considered high-risk for cervical cancer?
* 16 * 18 * 31 * 33 * 45 ## Footnote High-risk types are associated with cervical neoplasia.
31
Which HPV types cause genital warts but not cervical cancer?
* 6 * 8 ## Footnote These low-risk types do not lead to cancer but cause benign lesions.
32
List three co-factors that increase the risk of cervical cancer.
* Smoking * Multiple sexual partners * Early age of sexual debut ## Footnote Other factors include high parity, long-term oral contraceptive use, co-infections, low socioeconomic status, DES exposure, and family history.
33
What is the significance of persistent infection with high-risk HPV?
It is the critical event leading to neoplasia ## Footnote Persistent infections are more likely to progress to cervical cancer.
34
How does HPV infect basal epithelial cells?
Via micro-abrasions ## Footnote This entry point allows the virus to establish infection in the epithelial layer.
35
What are the viral oncoproteins associated with HPV and their functions?
* E6: p53 inhibition * E7: pRb inhibition ## Footnote These proteins disrupt cell cycle regulation, promoting dysplasia and carcinogenesis.
36
Define metaplasia in the context of cervical epithelium.
Replacement of glandular columnar epithelium with squamous epithelium ## Footnote It is a protective adaptation and is not malignant itself.
37
What is the transformation zone in cervical anatomy?
Area where metaplasia occurs (squamocolumnar junction) ## Footnote It is the site of origin for CIN and cervical cancer.
38
What is cervical intraepithelial neoplasia (CIN)?
Precancerous squamous epithelial lesion ## Footnote CIN is classified histologically into three grades.
39
Classify the grades of Cervical Intraepithelial Neoplasia (CIN).
* CIN I: Mild dysplasia (low-grade SIL) * CIN II: Moderate dysplasia (high-grade SIL) * CIN III: Severe dysplasia to carcinoma in situ (high-grade SIL) ## Footnote These classifications help in determining the management and treatment approach.
40
What does dyskaryosis refer to in cytology?
Nuclear abnormalities detected in cervical smears ## Footnote It is reported using the Bethesda system.
41
What are the two categories reported in the Bethesda system for cervical lesions?
* Low-grade Squamous Intraepithelial Lesion (LSIL) * High-grade Squamous Intraepithelial Lesion (HSIL) ## Footnote These categories indicate the severity of the lesions and guide clinical management.
42
What is the precursor of adenocarcinoma?
Cervical Glandular Intraepithelial Neoplasia (CGIN) ## Footnote CGIN is a significant precursor lesion that can lead to the development of adenocarcinoma.
43
From which epithelium do adenocarcinomas arise?
Endocervical glandular epithelium ## Footnote Adenocarcinomas are specifically associated with the glandular cells of the cervix.
44
What is the primary screening method for cervical cancer?
HPV Primary Screening (Age 25-65) ## Footnote HPV screening is crucial for early detection of cervical cancer risk.
45
What happens if HPV screening is negative?
Routine recall ## Footnote A negative HPV test typically means that the individual will be recalled for regular screening.
46
What is the triage process if HPV screening is positive?
Cytology triage: * Normal cytology → repeat in 12 months * ASCUS+ → colposcopy referral ## Footnote This triage helps determine the need for further investigation.
47
What is colposcopy used for?
To visualise and assess lesion severity ## Footnote Colposcopy allows for a closer examination of any abnormalities found during screening.
48
List some treatments performed during colposcopy.
* Punch biopsy * LEEP/LLETZ excision * Cone biopsy ## Footnote These treatments are used to remove or sample abnormal tissue.
49
What pathologies can be detected on cervical smears?
* Inflammation and Infections (Candida, Trichomonas, HSV, Chlamydia) * Cervical Intraepithelial Neoplasia (CIN) * Invasive Squamous Cell Carcinoma (SCC) * Cervical Glandular Intraepithelial Neoplasia (CGIN) * Endocervical Adenocarcinoma * Endometrial/Ovarian/Extra-uterine malignancies * Metastatic malignancy to cervix ## Footnote These pathologies represent a range of conditions affecting cervical health.
50
What is Cervical Intraepithelial Neoplasia (CIN)?
Precursor to Invasive SCC ## Footnote CIN indicates abnormal changes in cervical cells that may lead to cancer if untreated.
51
How is CIN graded based on epithelial involvement?
* CIN 1: Lower third * CIN 2: Lower two-thirds * CIN 3: Full thickness ## Footnote This grading system helps assess the severity of dysplastic changes.
52
What does dyskaryosis on cytology indicate?
Abnormal nuclear features suggesting CIN/invasive carcinoma ## Footnote Dyskaryosis is a key indicator of potential malignancy.
53
What is the relationship between Low-Grade SIL/Dyskaryosis and CIN?
Low-Grade SIL/Dyskaryosis ≈ CIN 1 ## Footnote This equivalence helps in understanding the severity of cytological abnormalities.
54
What is the relationship between High-Grade SIL/Dyskaryosis and CIN?
High-Grade SIL/Dyskaryosis ≈ CIN 2/3 ## Footnote High-grade lesions indicate a higher risk for progression to cancer.
55
What features characterize dyskaryosis?
* Irregular chromatin pattern * Irregular nuclear membranes & contours * Nuclear enlargement * Hyperchromasia or hypochromasia * Nucleolar abnormalities ## Footnote These features are critical for identifying abnormal cells in cervical smears.
56
What is invasion in the context of invasive squamous cell carcinoma?
Breach of basement membrane (not visible in smears) ## Footnote Invasion indicates the tumor's aggressive nature and ability to spread beyond its original site.
57
List suggestive cytological features of invasive squamous cell carcinoma.
* Windowing (holes in chromatin) * Fibre/tadpole/bizarre cells * Keratinisation * Tumour diathesis (necrotic debris, inflammation) * Presence of blood ## Footnote These features help in identifying the presence of invasive squamous cell carcinoma in cytological samples.
58
What is the rising incidence of endocervical adenocarcinoma associated with?
Younger women (~30s) ## Footnote This trend indicates a shift in the demographic most affected by this type of cancer.
59
What type of HPV is associated with endocervical adenocarcinoma?
High-risk types ## Footnote HPV is a significant risk factor for various cervical cancers.
60
What does CGIN (AIS) stand for?
Cervical glandular intraepithelial neoplasia (adenocarcinoma in situ) ## Footnote CGIN is considered a precursor to invasive adenocarcinoma.
61
List cytological features of endocervical adenocarcinoma.
* Supercrowding (loss of architecture) * Feathering * Pseudostratification * Rosette formation ## Footnote These features are critical in diagnosing endocervical adenocarcinoma through cytological examination.
62
What are some other pathologies that can be identified on cervical smears?
* Endometrial adenocarcinoma * Ovarian carcinoma * Colorectal metastases * Bladder metastases * Melanoma metastasis ## Footnote Recognizing these pathologies may indicate the first signs of malignancy.
63
What are the diagnostic techniques used in cervical pathology?
* Histochemistry * Papanicolaou stain (cytology) * H&E stain (histology) * Special stains (for connective tissue, infections) * Immunohistochemistry (IHC) ## Footnote These techniques are essential for accurate diagnosis and characterization of cervical lesions.
64
What is the purpose of cytokeratins in immunohistochemistry?
Distinguish squamous vs adenocarcinoma ## Footnote Cytokeratins are proteins that help differentiate between different types of carcinoma.
65
What does the p16 marker indicate in cervical pathology?
HPV surrogate marker ## Footnote The presence of p16 is often used to indicate HPV infection in cervical lesions.
66
What is Ki67 used to measure?
Proliferation index ## Footnote Ki67 is a marker that indicates the growth fraction of a given cell population.
67
What is CINTec PLUS?
Dual stain (p16 & Ki67) ## Footnote This dual staining technique is used to enhance the diagnostic accuracy for cervical lesions.
68
List some molecular diagnostic techniques for HPV.
* Chromogenic in-situ hybridization (CISH) for HPV (histology) * Primary HPV tests (DNA/RNA) (cytology) * HPV genotyping * Emerging methylation markers ## Footnote These techniques help in the detection and characterization of HPV-related lesions.
69
What are colposcopy-directed procedures for cervical treatment?
* Punch biopsy * LEEP / LLETZ * Cone biopsy ## Footnote These procedures aim to obtain tissue samples for further analysis or to remove abnormal tissue.
70
What treatments are available for invasive cervical disease?
* Trachelectomy (fertility-sparing) * Hysterectomy * Chemotherapy * Radiotherapy * Brachytherapy ## Footnote Treatment options depend on the stage and extent of the disease.
71
What are the vaccines included in HPV vaccination programs?
* Cervarix * Gardasil * Gardasil 9 ## Footnote These vaccines target high-risk HPV types to prevent cervical cancer.
72
What is the aim of HPV vaccination programs?
Reduce HPV prevalence → decrease cervical cancer incidence ## Footnote Vaccination programs have been implemented to lower the rates of cervical cancer by targeting HPV.
73
When were HPV vaccination programs implemented for boys?
Since 2019 ## Footnote This expansion aims to achieve herd immunity and further decrease HPV transmission.
74
What is the long-term impact of HPV vaccination on screening programs?
Shift to HPV primary testing ## Footnote As vaccination rates increase, the nature of cervical cancer screening may evolve.

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