Cervix

Cervix-

-Cervical Carcinoma-

-Cervical carcinoma is unique that there is a precursor lesion called  CIN (cervical intraepithelial neoplasia)

-CIN typically has a slow progression to frank cervical cancer

-Pap Smear is the non invasive screening test where samples are taken from the endocervix and exocervix

-Colposcopy is the follow up procedure for diagnosis on pap smears that are positive

-Treatments for precursor lesions CIN include cryotherapy, laser ablation, LEEP procedure (loop electrosurgical excision procedure), and cold knife cone biopsy with high cure rates

-Cervical cancer is now the second most common malignancy of women due to early detection

-Risk factors for development of cervical cancer:  early intercourse, multiple sex partners, early childbearing, male factors that are high risk, venereal infection, immune status, oral contraception, cigarette smoking, intrauterine DES exposure, and human papilloma virus exposure

-The area of metaplasia occurs for CIN between the old and new squamous columnar junction (SCJ)

-Ninety five percent of squamous intraepithelial neoplasia occurs in an area called the transformation zone

-Types of HPV associated with cervical carcinoma include types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, or 58

-Pap smears are recommended at age of first sexual intercourse or age of 18.

-The average age of invasive cervical carcinoma is 50

-The mainstays of treatment for invasive cervical carcinoma are radical surgical therapy and/or pelvic radiation


-Cervicitis-

-Cervicitis is inflammation of the uterine cervix

-Cervicitis can be infectious or non infectious.  Can be acute or chronic

-Acute cervicitis is usually due an infection (gonorrhea and chlamydia), sometime a specific infection cannot be identified

-Chronic cervicitis is usually due to a non infectious source

-Non infectious cervicitis is usually due to mechanical or chemical irritation

-Chemical irritation can come from latex, contraception cream, vaginal douches

-Mechanical irritation can be from tampons, pessary, diaphragms, tampons, cervical caps, and string from IUD

-Non infectious cause also can include systemic disease (Bechet's) and radiation therapy

-Symptoms of cervicitis include purulent vaginal discharge, post coital bleeding, dysuria, urinary frequency, dyspareunia, and vulvovaginal irritation

-Empiric treatment for gonorrhea includes Rocephin 250 mg IM

-Empiric treatment  for chlamydia includes Zithromax 1 gram PO times one dose or Doxycycline 100 mg BID for 10 days


-Dysplasia (Cervical)-

-Cervical dysplasia is abnormal growth of precancerous cells on the surface of the cervix

-Cervical dysplasia is classified as high grade or low grade determined by the extent of the cell growth

-Cervical dysplasia is associated with HPV

-Surgical removal of abnormal tissue is the treatment of choice for cervical dysplasia

-Cervical Incompetence-

-Cervical incompetence is painless dilation that occurs in the second trimester that can cause pregnancy loss of otherwise normal pregnancies

-Structural weakness of the cervical tissue was though to cause or contribute to these adverse outcomes

-It has also been defined as the inability for the cervix to retain a pregnancy in the absence of signs and symptoms of clonal contraction in the second trimester

-Risk factors for cervical incompetence include:  collagen abnormalities (Ehlers Danlos syndrome), uterine abnormalities, Uterine DES exposure, and biologic trauma.  Also obstetrical trauma, mechanical trauma from procedures, and treatment of CIN.

-Diagnosis can be confirmed by exam and transvaginal ultrasound

-Treatment may include cerclage or ultrasound surveillance