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Reproduction Week 6 2018/19 > 2: Cervical screening and vulval pathology > Flashcards

2: Cervical screening and vulval pathology Flashcards

1
Q

Which type of epithelium lines the vaginal end of the cervix?

A

Squamous epithelium

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2
Q

What is the vaginal end of the cervix called?

A

Ectocervix

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3
Q

What is the uterine end of the cervix called?

A

Endocervix

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4
Q

Which type of epithelium is found in the endocervix?

A

Columnar, glandular epithelium

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5
Q

What is the transformation zone of the cervix?

A

Transition between squamous (vaginal end; ectocervical) and columnar (uterine end; endocervical) epithelium

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6
Q

Where does cervical cancer arise?

A

Squamo-columnar junction / Transformation zone

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7
Q

What causes the squamo-columnar junction to rise?

A

Menarche

Pregnancy

Menopause

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8
Q

The vagina is an (acidic / alkaline) environment.

A

acidic

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9
Q

What process occurs when the endocervix is opposed to the acid of the vagina?

A

Squamous metaplasia

Inflammation causes columnar epithelium to change into squamous epithelium

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10
Q

What is cervicitis?

A

Inflammation of the cervix

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11
Q

Which sexually transmitted infection, causing cervicitis, can lead to infertility?

A

Chlamydia

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12
Q

What is a cervical polyp?

A

Abnormal inflammatory growth in the cervix

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13
Q

Are cervical polyps malignant?

A

No

And most don’t become malignant

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14
Q

What is CIN?

A

Cervical intraepithelial neoplasia

Precursor to cervical cancer

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15
Q

What are the two most common forms of cervical cancer?

A

Squamous carcinoma

Adenocarcinoma

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16
Q

Which specific viruses are associated with a percentage of cervical cancers?

A

HPV 16

HPV 18

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17
Q

Which percentage of cervical cancers are caused by HPV 16 & 18?

A

70 - 75%

This means that 25 - 30% aren’t and you have to stay vigilant

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18
Q

What are risk factors for cervical cancer?

A

HPV infection (particularly 16 and 18)

Long-term oral contraceptive use

Smoking (big one)

Immunosuppression

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19
Q

What is a sign of HPV infection on histology?

A

Koilocytosis

Dyskaryosis (nuclear abnormalities) in an epithelial cell, giving them a HALO appearance

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20
Q

What causes CIN to be reclassified as cancer?

A

Breaks through basement membrane

21
Q

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

A

Cervical intraepithelial neoplasia (CIN)

22
Q

Is CIN symptomatic?

A

No

Not visible to the human eye

23
Q

By which process do the nuclei of cervical cells become enlarged, signalling CIN?

A

Koilocytosis

24
Q

What are some nuclear signs of CIN?

A

Hyperchromasia - stain dark black

Increased nucleus:cytoplasm ratio

Pleomorphism - variable appearance between cells

25
Q

How is CIN classified?

A

CN I - III

more invasive as you go up

26
Q

What is CIN III also known as?

A

“Carcinoma-in-situ”

Impending malignancy

27
Q

At which layer of squamous epithelium should mitosis be occurring?

A

Basal layer

If it’s happening above this then suspect CIN

28
Q

What is the most common type of cervical cancer?

A

Squamous carcinoma

29
Q

Why isn’t squamous carcinoma as common in the UK as it used to be?

A

Cervical screening program

30
Q

Why can’t every cervical cancer be prevented by HPV vaccination?

A

Vaccinated HPV subtypes (6, 11, 16 and 18) only responsible for around 70% of cancers

31
Q

What are the symptoms of high stage cervical cancer?

A

Abnormal bleeding

Pelvic pain

Renal symptoms (suggests obstruction of ureters)

Red flag cancer symptoms - fever, night sweats, unexpected WL

32
Q

What investigations are done for suspected cervical cancer?

A

Cervical screening (to catch dysplasia early)

If abnormal, refer for Colposcopy

If high stage, MRI pelvis / other scans to look for metastasis

33
Q

Which precursors of cervical cancer develop from the

a) ectocervix
b) endocervix?

A

a) CIN (cervical intraepithelial neoplasia)

b) CGIN (cervical GLANDULAR intraepithelial neoplasia)

34
Q

Which invasive forms of cervical cancer develop from the

a) ectocervix
b) endocervix?

A

a) Squamous carcinoma

b) Adenocarcinoma

35
Q

Which risk factor causes most cases of cervical cancer?

A

HPV infection

36
Q

Which skin disease is implicated in vulval intraepithelial neoplasia (VIN) seen in older women?

A

Lichen sclerosus

37
Q

Why is VIN a sinister diagnosis?

A

Vulva is closely associated with superficial inguinal nodes

So spread occurs easily

38
Q

Which rare skin disease presents as a red, crusting rash and signals the presence of glandular tumours in the epidermis of the vulva?

A

Paget’s disease

different from the bone one

39
Q

What is dyskaryosis?

A

Nuclear abnormalities in a cell, e.g

pleomorphism, high nucleus:cytoplasm ratio, hyperchromatosis (dark staining)

caused by acid damage, HPV infection, i.e damage to the cell

40
Q

What is koilocytosis?

A

Dyskaryosis of an epithelial cell due to HPV infection

41
Q

What does a koilocyte look like?

A

Darkly stained halo cell

42
Q

What is a Nabothian cyst?

A

A cyst formed when ectocervix (squamous) grows over the top of endocervix (columnar)

43
Q

Which lifestyle factor is highly associated with cervical cancer?

A

Smoking

44
Q

How long does it take for initial HPV infection to develop into high-grade CIN?

A

Up to 3 years

45
Q

How long does it take for high grade CIN to develop into invasive cervical cancer?

A

Up to 20 years

46
Q

CIN classification depends on the ___ of epithelium occupied by abnormal cells.

A

thickness

CIN I - one third, CIN II - two thirds, CIN III - full thickness, impending malignancy

47
Q

Which type of pre-malignant tumour arises from the endocervix?

A

Endocervix is made up of columnar glandular epithelium

So it develops CGIN (cervical glandular intraepithelial neoplasia)

Which can develop into adenocarcinoma

48
Q

Which forms of cervical cancer are most common?

A

Squamous carcinoma (75%)

Adenocarcinoma (5-25%)

Reproduction Week 6 2018/19 (9 decks)

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