The cervix and its disorders

Question 1

Cervix to sacrum

Answer 1

uterosacral ligaments

Question 2

Cervix to pelvic wall

Answer 2

Cardinal ligaments

Question 3

squamocolumnar junction

Answer 3

endocervix- columnar
ectocervix- squamous
Boundary

Question 4

Transformation zone

Answer 4

Low vaginal pH causing metaplasia of columnar to squamous- vulnerable to metaplasia

Question 5

Upper cervix supplied by and drains into

Answer 5

uterine artery, external iliac-paraaortic

Question 6

Lower cervix supplied by and drains into

Answer 6

upper vaginal arteries, internal iliac- common iliac

Question 7

Cervical ectropion is…

Answer 7

benign eversion of cervix relvealing columnar epithelium of endocervix as red area

Question 8

Cervical ectropion age and RF

Answer 8

young on OCP or pregnant

Question 9

Treating cervical ectropion

Answer 9

Cryotherapy only after ruling out cancer by colposcopy

Question 10

Acute cervicitis is rare and occurs mainly due to

Answer 10

STDs

Question 11

Chronic cervicitis is and presents as

Answer 11

Chronic inflammation/infection of the ectropion

Question 12

Treatment for chronic cervicitis

Answer 12

Cryotherapy +/- Antibiotics

Question 13

Cervical polyps are derived from what tissue

Answer 13

benign polyps of the endocervical epithelium

Question 14

How do Cervical polyps present?

Answer 14

Aysmptomatic or IMB/PCB in women over 40 and smaller than 1cm.

Question 15

Treatment for cervical polyps?

Answer 15

Avulsion without anaesthetic

Question 16

What are nabothian follicles?

Answer 16

Endocervical cells have changed by metaplasia into squamous epithelium and columnar cell secretions are trapped and form retention cysts- white opaque swellings on the ectocervix. Rare, benign.

Question 17

Define CIN

Answer 17

Presence of atypical cells within the squamous epithelium

Question 18

CIN cell histology

Answer 18

Dyskaryotic with large nulei and frequent mitoses

Question 19

CIN grading

Answer 19

CIN I- lower 1/3, CIN II- lower 2/3, CIN III- carcinoma in situ full thickness of epithelium

Question 20

CIN–>malignancy

Answer 20

Invades the basement membrane. 1/3 of women over the next 10 years

Question 21

CIN I prognosis

Answer 21

Has no malignant potential, progresses to CINII/II or can regress spontaneously

Question 22

CIN epidemiology- what % under 45? Peak incidence at?

Answer 22

90%. 25-29

Question 23

HPV causes dysplastic changes to metaplastic cells. What is the most important factor in getting HPV ?

Answer 23

Number of sexual partners at a young age, unknown in virgins

Question 24

Which HPV strains are most commonly associated with cervial cancer?

Answer 24

16, 18, 31, 33

Question 25

HPV Vaccine targets what demographic and which viruses?

Answer 25

16 and 18, women before first sexual contact

Question 26

Who are at risk of CIN?

Answer 26

OCP, Smoking, Immunocompromise (HIV/Steroids)

Question 27

CIN screening is done by what and for who?

Answer 27

Smear test, ages 25-49 every 3 years, ages 50-64 every 5 years.

Question 28

What method of microscopy is used for smear results?

Answer 28

Liquid based cytology- more adequate sampling and high risk HPV strains detected

Question 29

What happens to Smear results- Normal, Borderline or mild dyskaryosis +/- HPV, moderate, severe, cervical glandular intraepithelial neoplasia

Answer 29

repeat every 3 years(5), back to routine recall if HPV -, colposcopy if HPV +, colposcopy, urgent colposcopy, colposcopy if normal hysteroscopy

Question 30

Treatment of CIN

Answer 30

LLETZ or DLE- CIN I, II

Question 31

What do you tell a woman with CIN III smear?

Answer 31

Without treatment you have a 30% chance of developoing cancer over 8-15 years.

Question 32

Two peak ages for cervical carcinoma

Answer 32

30's and 80s

Question 33

What is the histopathology of cervical cancer?

Answer 33

90% squamous cell carcinomas, 10% Adenocarcinomas, worse prognosis.

Question 34

How does cervical cancer present?

Answer 34

PCB, IMB, Pain is a late feature, obstructive and invasion into ureters, bladder, rectum, nerves can cause- uraemia, haematuria, rectal bleeds and pain.

Question 35

Staging of cervical carcinoma

Answer 35

Stage 1- Confined to cervix Stage 2- into vagina but not pelvic side wall Stage 3- Invasion of lower vagina or pelvic wall or causing ureteric obstruction Stage 4- Invasion of bladder or rectal mucosa, or beyond true pelvis

Question 36

How would you investigate cervical malignancy

Answer 36

Biopsy tumour to confirm diagnosis, VE and PR to assess size of lesion/parametrial/rectal invasion. EUA-Examination under anaesthetic Cystoscopy- bladder involvement MRI-size spread lymph nodes

Question 37

How would you treat microinvasive stage 1ai cervical cancer

Answer 37

Cone biopsy or simple hysterectomy

Question 38

How would you treat stage 1 and 2a cervical cancer

Answer 38

Surgery or chemo therapy. Chemo is preferred with lymph node enlargement. MRI/node sampling to confirm. Lymph nodes dissected lap- Radical abdominal hysterectomy/Wertheim's clearance/ radical trachelectomy

Question 39

What is Wertheims hysterectomy?

Answer 39

Pelvic node clearance, hysterectomy, removal of parametrium, and upper 1/4 vagina.

Question 40

What is Radical Trachelectomy?

Answer 40

Procedure to conserve fertility- lap pelvic lymphacdenectomy. +ve nodes=chemo-radio instead of surgery if Negative- 80% cervix removed and upper vagina. Cervical suture to prevent preterm delivery.

Question 41

Stage 2b cervical Ca or worse with positive lymph nodes.

Answer 41

Radio + platinum chemo.

Question 42

Specific complications to Wertheims hysterectomy? (5)

Answer 42

haemorrhage, uteteric and bladder damage and fistulae, voiding problems, lymphocysts

Question 43

What is pelvic exenteration and when is it used?

Answer 43

Used for recurrent tumours. Involves removal of vagina, bladder, rectum. 50% cure rate. Tried in young fit women.

Question 44

Poor prognostic indicators for cervical ca?

Answer 44

``` Lymph node involvement Advanced clinical disease large primary tumour poorly differentiated early recurrence ```

Question 45

How do people die with Cervical Ca?

Answer 45

Uraemia due to ureteric obstruction