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Flashcards in Disorders of the Cervix Deck (60)
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1

ABNORMAL CONDITIONS OF THE CERVIX
3

1. Cervicitis
2. Polyps
3. Nabothian Cysts

2

Disorders of the Cervix
1. Infections often present how?

2. Early detection of abnormal cell changes and the presence of HPV leads to treatment that prevents the progression to what?

1. asymptomatic

2. cervical cancer

3

Cervisitis
1. Primarily affects what cells?
2. Can cause visual changes of the what?

3. Etiologies? 4

Cervicitis
1. Primarily affects the columnar epithelial cells
2. Can cause visible changes of the ectocervix

3. Etiologies
-Often caused by STIs—often asymptomatic
-Local trauma
-Malignancy, radiation therapy, chemical irritation, systemic inflammatory disease (Behcet's syndrome)
-Idiopathic

4

Hx questions for Cervisitis?
6

Sexual hx
1. # of partners
2. use of condoms
3. Hx of STIs (women under 25…1 out of 3 have chlamydia)‏

4. Use of pessiary, diaphragm, douches etc.
5. Specific symptoms
6. Constitutional symptoms

5

Symptoms of cervisitis?
6

1. Purulent or mucopurulent discharge from the vagina

2. Intermenstrual or postcoital bleeding

3. Dysuria or urinary frequency

4. Dyspareunia

5. Vulvovaginal irritation

6. Pain & fever are atypical in the absence of upper tract infection

6

Physical exam
Cervitis may appear how?
5

1. Purulent discharge on the surface and/or exuding from the canal

2. Minor trauma from insertion from a cotton swab—bleeding (friability)‏

3. Diffuse vesicular lesions suggest HSV

4. Punctate hemorrhages consistent w/ trichomonas infection

5. Cervical motion tenderness is a sign of coexisting PID

7

Gonnorrhea tx?

Chlamydia tx?

250 mg Rocephin bid

1000mg Azithro

8

What is pathogonomic for Trchomonas infection?

Strawberry spots

9

1. Dx how?

2. Treat empirically to cover gonorrhea, chlamydia and trichomonas: Which abx? 3

3. All patients evaluated for STIs should be offered counseling and testing for what?

4. If exam shows what then other etiologies might be in play; then there may be an offending agent that needs to be stopped? 3

1. From exam and determination of risk— test for gonorrhea and chlamydia, HSV if indicated

2.
-Ceftriaxone
-Doxycycline
-Metronidazole

3. HIV!!!

4.
-minor erythema and
-low risk person, or
-cultures are negative

10

Treatment for persistant cervisitis?
3

1. If persists after initial round of antibiotics then repeat testing w/ most sensitive diagnostic tests

2. Re-examine possible exposure to chemical irritants

3. Have sex partner(s) be examined and tested for STIs

11

What is the most common benign neoplastic growth of the cervix?
-occurs in 4% of all gynecologic patients

Cervical Polyps

12

1. Cervical Polyps
are what?
2. In what numbers can they present?
3. Believed to be a result of what?
4. May be associated with what?
5. Found commonly in what dz process?
6. Most common amoung what population?

1. Benign, pedunculated growths of varying size that extend from the ectocervix or endocervical canal

2. May occur singularly or may be multiple

3. Etiology is unknown
-Believed to result from chronic inflammation

4. May be associated with hyperestrogen states

5. Found commonly with endometrial hyperplasia

6. Most common among multiparous women in their 30s and 40s

13

Cervical Polyps
1. Commonly occur in what years?
2. Usually arise from where?
3. How common is malignant change?

4. Removed Easily. Always do what with this?

1. Commonly occur during reproductive years

2. Usually arise from the endocervical canal

3. Malignant change is rare-about 1% will show neoplastic changes

4. Removed fairly easily
Always send to pathology

14

Cervical Polyps: Symptoms

7

1. Usually asymptomatic
2. Thick leukorrhea
3. Postcoital bleeding
4. Intermenstrual bleeding
5. Menorrhagia
6. Post-menopausal bleeding
7. Mucopurulent or blood-tinged vaginal discharge

15

Cervical Polyps: Physical Exam
findings?
4

1. Single or multiple pear-shaped growths may protrude from the cervix into the vaginal canal

2. Usually smooth, soft, reddish purple to cherry red

3. May readily bleed when touched

4. May be small or very large

16

Cervical Polyps: Differential Diagnoses
3

1. Endometrial polyps
2. Small prolapsed myomas
3. Cervical malignancy

17

Cervical Polyps-
Treatment
4

1. Tie off base
2. Twist off at base with forceps
3. May need to cauterize site
4. Recurrence low

18

1. Nabothian Cysts are what?
2. Most often caused when what?
3. Tissue growth can cause what complications?

1. Mucous filled cyst on the surface of the cervix

2. Most often caused when stratified squamous epithelium of the ectocervix grows over the simple columnar epithelium of the endocervix

3. Tissue growth can block the cervical crypts and trap mucous inside the crypts

19

Nabothian cysts
1. Appear how?
2. Prognosis?
3. Appearance may be related to what?
4. Not considered problematic unless what?
5. May be removed how? 2

1. Appear as firm bumps on the surface

2. Considered harmless and usually resolve on their own

3. Appearance may be related to menses

4. Not considered problematic unless they grow very large and present secondary symptoms

5. May be removed by electrocautery or cryotherapy

20

Cervical Cancer
1. Pathology in order of prevalence? 3

2. Symptoms? 4

1. Pathology:
-Squamous cell—69%
-Adenocarcinoma—25%
-Adenosquamous, rare types (sarcomas)—6%

2. Symptoms:
-Frequently asymptomatic
-Abnormal vaginal bleeding
-Postcoital spotting
-Vaginal discharge—can be watery, mucoid or purulent and malodorous

21

What does an adenocarcinoma of the cervix look like?

An elevated white and dense lesion overlying columnar epithelium with coarse punctation

22

Risk Factors for Cervical Cancer
10

1. Early onset of intercourse (3 term pregnancies)

6. Cigarette smoking (for squamous cell CA)

7. Immunosuppression

8. Oral contraceptive use—especially long term (?)

9. Low socioeconomic status (?)

10. Daughter of a mother who took diethylstibestrol (DES) (1970s)

23

Protective Factors for cervical cancer?
5

1. Virginity
2. Long-term celibacy
3. Life-long mutual monogamy
4. Long-term use of condoms
5. Obtaining regular Pap smears

24

Most HPV infections are transient—but:
1. Over 50% are cleared in ____ months

2. 80-90% will have resolved within ___ years

3. ____ can be detected in 99.7% of cervical CAs!

4. Generally HPV alone cannot cause cervical CA—it usually takes about ____ from time of infection to presentation of cervical CA

1. 6-18
2. 2-5

3. HPV

4. 15 yrs

25

How does HPV cause cancer?

HPV integrates into the human genome & can result in abnormal high grade lesions and cancer

26

Major factors associated w/ development of HGL and cervical Cancer are?
3

1. HPV subtype: 18 & 16 (involved in the bulk of cervical CAs)

2. Persistence: age, duration, oncogenic subtypes

3. Environmental factors: cigarette smoking, infection w/ HIV, gonorrhea & chlamydia, herpes simplex virus, OCP

27

1. The earliest squamous cell carcinoma is confined to the epithelial layers: What are these?

2. The disease remains confined to the mucous membrane for several years before invading the what?

3. Carcinoma in situ (CIS) occurs most frequently in the _____ decade

4. Invasive carcinoma is encountered most often in women between age what?

1.
-intraepithelial neoplasia
-preinvasive carcinoma (carcinoma in situ)

2. subjacent stroma

3. fourth

4. 40 and age 50

28

1. Oncogenic HPV infection at the what?

2. This leads to what?

3. Progression of a what from persistent viral infection to precancerous cells?

4. Development of carcinoma & invasion through the what?

1. transformation zone

2. Persistence of the infection

3. clone of epithelial cells

4. basement membrane

29

Diagnosis of Genital HPV
3

1. Papanicolaou (Pap) smears prepared from cervical or anal scrapings often show cytologic evidence of HPV infection

2. Persistent or atypical lesions should be biopsied and examined by routine histologic methods

3. The most sensitive and specific methods of virology diagnosis, use techniques such as the
-polymerase chain reaction or
-the hybrid capture assay to detect HPV nucleic acids and to identify specific virus types

30

Prevention of HPV: Vaccination

1. Which vaccine?

2. Who should receive it and what ages?
-boys
-girls

Recently developed HPV vaccines dramatically reduce rates of infection and disease produced by the HPV types in the vaccines

1. Currently, one quadrivalent product (Gardasil, Merck):
Recommended by the Centers for Disease Control

2.
-Vaccination in boys and men 9 through 26 years of age for the prevention of genital warts caused by HPV types 6 and 11

-Vaccination in people ages 9 through 26 years for the prevention of anal cancer and associated precancerous lesions due to human papillomavirus (HPV) types 6, 11, 16, and 18


As of December 2014 Gardisil 9 was approved by the FDA