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Lecture 14: Cervical Disorders Flashcards

1
Q

The primary complications of cervicitis include: (2)

A
  • PID
  • Passing infection to newborn during delivery
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2
Q

The main presenting symptom of acute cervicitis is

Typically asymptomatic

A

Discharge

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3
Q

The S/S of acute cervicitis are: (3)

A
  1. Discharge
  2. Vaginal bleeding
  3. Cervical tenderness
  4. Urethritis
  5. Salpingitis
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4
Q

The discharge caused by a gonorrhea/chlamydia infection is usually described as…

A
  • Creamy
  • Thick
  • Purulent
  • Maybe malodorous

Acutely inflamed cervix

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5
Q

The discharged caused by a candidiasis infection is typically described as…

A
  • “Curd-like”
  • Itchy
  • non-malodorous

Adherent

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6
Q

The discharge caused by a trichomonas infection is described as…

A
  • Green
  • Foamy
  • Strawberry petechiae cervix
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7
Q

The discharge caused by a bacterial infection of the cervix is described as

A
  • Thin
  • Gray
  • Fishy odor
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8
Q

The discharge from an HSV infection of the cervix is described as…

A
  • Clear to serous

Vesicular lesions on the base

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9
Q

The main presenting symptom of chronic cervicitis is…

A

Discharge

Less than acute

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10
Q

What colposcopy finding of cervicitis is characteristic of trichomonas?

A

Double hairpin capillaries

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11
Q

What histopathology is characteristic of cervicitis due to HPV?

A
  • Large cells
  • Multinucleated
  • Perinuclear halos
  • Hyperchromasia
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12
Q

HSV and HPV both enlarged cells and have multinucleated cells. However, HSV causing cervicitis has 2 additional features:

A
  • Ground-glass appearance
  • Inclusion bodies
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13
Q

Both bacterial and Trichomonas cervicitis are treated with

A

Nitroimidazoles (metro, tinidazole, secnidazole)

Orally

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14
Q

Who are the high-risk groups for cervicitis?

A
  • Young adults 19-25
  • Previous hx of STIs
  • Inconsistent condom use
  • Substance abuse
  • Multiple partners/high-risk
  • Tx of partners with STIs
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15
Q

Define cervical insufficiency

A

Painless cervical shortening/dilation in the 2nd or 3rd trimester, resulting in preterm birth.

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16
Q

The 4 primary RFs for cervical insufficiency are

A
  • Hx of having it
  • Hx of cervical injury, surgery, or conization
  • DES exposure
  • Anatomic abnormalities
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17
Q

Classic presentation of cervical insufficiency

A

2nd trimester dilation of 2+ cm with minimal contractions

4+ cm might have active contractions or ROM

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18
Q

When can you first check for cervical insufficiency and how?

A

At 14-16 wks via US

No way to check prior!

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19
Q

The 4 types of cervical insufficiency seen on US are

A

T, Y, V, U

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20
Q

The TOC for cervical insufficiency is

A

Cervical cerclage

Purse-like ring of stitch around cervix

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21
Q

Prior to cervical cerclage, you must check for… (2)

A
  • Viable intrauterine pregnancy
  • Cultures of gonorrhea/chlamydia/GBS
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22
Q

The pharmacological adjunct to cervical cerclage for cervical insufficiency is

A

Progesterone

Vaginal/IM/SC, starting at 16wks to 36+.

Can start before cerclage is placed

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23
Q

How do females often realize they have nabothian cysts?

A

Feel a bump when trying to put on cervical cap or diaphragm

Often just found incidentally since asymptomatic.

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24
Q

The tx for nabothian cysts is

A

Nothing

Only drain if theyre huge.

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25
You always treat CIN II and III, except in...
* Pregnant women * Do not treat CIN II in adolescents
26
CIN grading is used to describe...
Amt of disordered growth of cervical epithelial lining.
27
The highest peak incidence age range for CIS is...
25-35 years
28
Overall, cervical cancer peak incidence occurs around
40+ years
29
The Dx of cervical dysplasia is made primarily via
Abnormal pap smear | Physical exam is usually normal.
30
Besides high-risk sex and related, the other RFs for cervical dysplasia are
* HPV * Immunosuppression * Multiparity * Long-term OCP use
31
The MC HPV strain overall found in a majority of cervical cancers is
HPV 16 | Followed by 18
32
T/F: Most women with HPV+ pap smears will go on to develop cervical cancer
False | But wary if they smoke!
33
Cervical cancer screening guidelines from 21-65+
* 21-29: Pap Q3y * 30-65: Pap Q3y or Pap+HPV Q5y * 65+: Stop only if no hx of dysplasia + 3 neg paps or 2 neg pap+HPVs in past 10 yrs. | Guidelines dont apply if hx of cervical ca, HIV, immunodeficient, or DES
34
* ASC-US * ASC-H * LGSIL/LSIL * HGSIL/LSIL All describe what system? | Squamous intraepithelial lesions
Bethesda system
35
In the Bethesda system, LGSIL corresponds to what CIN? HGSIL/HSIL?
* LSIL corresponds to CIN 1 * HSIL corresponds to CIN 2 and 3
36
T/F: Atypical Grandular cells are cancerous
False
37
What are squamous epithelial cells of the cervix most associated with?
* Adenocarcinoma of the endocervix * Endometrium
38
For a patient with ASC-US, the 3 management options are
1. Repeat serial cytology Q6m unil you get 2 normals. (2 abnormals = colposcopy) 2. Test for high-risk HPV (Colposcopy if positive) 3. Immediate referral to colposcopy
39
For ASC-H, AGC, LSIL, and HSIL, the preferred next step in management is
Colposcopy
40
Endocervical sampling during colposcopy is contraindicated if
Pregnant
41
After colposcopy for CIN 1, the management is...
2 paps Q6m OR pap+HPV at 6m | Repeat colposcopy if any abnormal. ## Footnote Switch back to routine screening if 2 smears normal or HPV normal.
42
After colposcopy, the management for CIN II/III, invasive cancer, or abnormal colposcopy is...
Surgical therapy | Cryo, laser, LEEP, cone biopsy
43
For an ectocervix-only lesion with satisfactory colposcopy, the surgery options are (3)
* Cryotherapy * Laser ablation * Superficial LEEP
44
The 3 indications to do deeper LEEPs or conization for the cervix are...
* Endocervical lesion/Ecto with + ECS * Unsatisfactory colposcopy * Discrepancy between cytology and colposcopy
45
Pros of cryotherapy
* Cheap, easy, no anesthesia * Mild SEs
46
The main caveat to cryotherapy for cervical lesions is...
It can only do superficial
47
Pros of CO2 laser ablation for cervical lesions
* Precise and versatile * Can ablate or assist with cone biopsies | Can cut down to 7mm
48
LEEP is primarily used in CIN...
2 and 3
49
Why might we want a LEEP procedure for CIN?
Provides a tissue sample for histology
50
What is the main advantage of cold knife conization over LEEP for tissue sampling?
No thermal artifact | However, it is an OR only procedure
51
Because LEEP and cold knife conization affect the cervical anatomy drastically, they both increase the risk of...
Cervical insufficiency
52
What features of a cervical lesion suggest there is a high chance for recurrence? (4)
* Larger lesion * Endocervical gland involvement * Positive margins * Positive endocervical curettage | Similar rates across all tx modalities
53
How much does treatment of a cervical lesion reduce the risk of cervical cancer by?
95%! | But still higher risk than gen pop for 20-25yrs :(
54
Overall, the average age of diagnosis for cervical cancer is...
51
55
The majority of cervical cancers are (cell type)
Squamous cell carcinomas | 70-75%, then 20-25% adenocarcinomas, then mixed
56
The MC symptom of cervical cancer | Early is asymptomatic usually
Abnormal vaginal bleeding
57
What are the usual late symptoms of cervical cancer?
* Weakness * Wt Loss * Anemia * **unilateral** pelvic pain that radiates to hip/thigh
58
Early on in cervical cancer, the cervix appears ?? on physical exam
Grossly normal | Ulceration could occur, but usually normal.
59
The terms endophytic and exophytic are used to describe cervical cancer on physical exam and mean....
* Endophytic = barrel-shaped enlargement of cervix * Exophytic = friable, bleeding, cauliflower-like lesions
60
What ligaments eventually thicken with parametrial involvement of cervical cancer?
Uterosacral ligaments, which fixate the cervix
61
T/F: Cervical cancer can be ruled out via cytology
False, biopsy any sus lesion
62
Biopsy of the cervix reveals a CIS, negative colposcopy, but abnormal pap. The next step in evaluation should be
Conization
63
A patient's cervix appears to have invasive cancer just on physical exam. The next step in workup is...
Simply biopsy | No need to do conization
64
Overall, the tx for cervical cancer is
Radical hysterectomy + lymphadenectomy | Can add chemo and radiation, but not the mainstay.

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