This document discusses various lesions of the cervix including cervical erosion, cervical polyps, cervical intraepithelial neoplasia (CIN), and cancer of the cervix. It provides details on the causes, symptoms, diagnosis, and treatment of each condition. Screening is important for early detection of premalignant lesions and cancers of the reproductive organs. Cervical cancer remains a major public health problem worldwide and its prevention through screening and HPV vaccination is crucial.

2. What we learn today
Different lesion of cervix .
Different pathological aspect.
Cervical Erosion.
Cervical polyp.
Ca cervix.
Endometrial carcinoma.
Cervical intraepithelial neoplasia (CIN)
Screening.

3. Congenital hypertrophy.
Haematocervix associated with atresia.
Hypertrophy or elongation of the supra vaginal cervix
associated with prolapse.
Congestion & oedema of the vaginal portion of the
cervix associated with Prolapse ,Pregnancy ,
Cervicities.
Partial extrusion of a uterine tumour.
Cervical pregnancy.

4. Cervical erosion / Cervical ectopy with Cause
Cervical erosion is a condition where the squamous
epithelial of the ectocervix is replaced by the columnar
epithelium ,which is continuous with the endometrium.
Cause :
1.Congenital.
2.Acquired : Hormonal & Infection.

7. Vaginal Discharge.
Post coital bleeding.
Infertility.
Backache.
Pelvic discomfort.

8. On speculum Examination: A Bight red areas surrounding and
extending beyond the external os on the ectocervix .
The outer edge is clearly demarcated.
The lesion may be smooth or having small papillary folds.
It is neither tender nor bleed to touch.
On rubbing with gauze piece there may be multiple bleeding spots
and bleeding is minimal.
The feeling is granular and gives rise to grating sensation.

9. Cervical smear for cytology.
Cervical biopsy.
Treatment :
A symptomatic case need no treatment.
In pregnancy & early puerperium treatment is not required.
In pill user pill should be stopped and barrier method should be
advised.
If erosion still persist treatment should be given :
Thermal cauterization.
Cryosurgery (use of extreme cold to destroy abnormal tissues, such as tumors.)
Laser vaporization.

10. A Cervical polyp is a common benign polyp or tumour on the surface of
the cervical canal.
Types of cervical polyp
Benign polyp:
Adenoma (Mucous)
Fibroid (Leiomyoma)
Placental ( or foetal)
Malignant:
Carcinoma
Sarcoma .
Choriocarcinoma .

12. Intermenstrual bleeding.
Excessive per-vaginal bleeding discharge which may be
offensive.
Sensation of something coming down per – vaginal.
Colicky lower abdominal pain.
History of recent childbirth or abortion ( increase placental
polyp).
History of contact bleeding.

13. On general examination: Varying degree of Anaemia.
On per vaginal examination:
Per vaginal offensive discharge may be present.
The cervix may be patulous and tip of the polyp can be felt distinctly
outside the external os.
On Speculum examination:
Variable size of polyp.
Reddish ( mucous polyp) or usually pale ( fibroid polyp) in colour and
bleeds easily when touched.
Attached usually by a slender pedicle to the cervix.

14. Hysterosalpingography.
Hysteroscopy .
Culture of the cervical discharge ( If necessary).
Treatment :
General treatment:
Correction of the anaemia .
Control of infection by antibiotics.
Nutritional supplements .
Surgical treatment :
Mucous polyp : Cauterization of the base of the pedicle , D&C.
Fibroid polyp: Polypectomy , Hysterectomy .

15. Endometrial cancer is a cancer that arises from the endometrium (the
lining of the uterus or womb).
It is the result of the abnormal growth of cells that have the ability to
invade or spread to other parts of the body.

17. Late menopause.
Nulliparity.
Unopposed estrogen therapy.
History of irregular & excessive premenstrual bleeding .
Obesity , DM.
Personal family history of breast , ovary ,colon or endometrial
carcinoma.

18. Patient profile of Endometrial carcinoma
The patient is usually nulliparous , post menopausal.
There may be history of menopause.
The patient may be obese.
Patient may have hypertension & Diabetes.

19. Postmenopausal bleeding (75%) which may be slight ,irregular or
continuous.
In premenstrual women ,there may be irregular & excessive bleeding.
At time watery & offensive discharge due to Pyometra.
Pain is not uncommon.
Few patient (5%) remain asymptomatic.

20. On general examination:
Obese.
Hypertension.
Pallor.
On speculum examination:
Cervix looking healthy & blood or purulent offensive discharge
escape out of the external os.
On bimanual examination:
The uterus is either atropic ,normal or may be enlarged due to
spread of the tumour , associated fibroid or pyometra.
The uterus is usually mobile unless in late stage , when it becomes
fixed.

21. Endometrial biopsy.
TVS.
Hysteroscopy.
Fractional curettage.
CT- scan.
MRI.

22. This is premalignant lesion of the cervix.
CIN is histological observation where part or whole of the
thickness of the cervical squamous epithelium is replaced by
varying degree of atypical cells.

24. CIN 1: Basal third or less of the epithelium is occupied
by atypical cells or abnormal cells.
CIN 2: Basal 1/3rd to 2/3rd of the epithelium is
replaced by atypical or abnormal cells.
CIN 3: Whole thickness or more than 2/3rd of the
epithelium is occupied by atypical cells.

25. Risk factor of CIN
Early sexual intercourse (Below 16 year)
Multiple sexual partner.
STD.
Husband whose previous wife died of cervical
malignancy.
Oral pill user.

26. CIN are symptoms less and show no naked eye signs of their
presence . It is diagnosed incidentally or routine screening by
cervical cytology or colposcopy.
Investigation:
Cervical smear for cytology.
Colposcopic examination.
Endocervical curettage.

27. Cervical cancer is a type of cancer
that occurs in the cells of the cervix the
lower part of the uterus
that connects to the vagina.

28. Etiology of Ca cervix
HPV.
Multiple sex partner.
Early marriage .
Multiple pregnancies.
Poor genital hygiene.
Smoking.
OCP.

29. The patient are usually multiparous in premenopausal age group.
Previous history of post coital or intermenstrual bleeding which they
ignored.

30. Irregular or continued uterine bleeding.
Offensive vaginal discharge.
Pelvic pain of varying degree.
Leg oedema.
Bladder symptoms : Frequency of micturition ,dysuria ,haematuria
,true urinary incontinence.
Rectal involvement : Diarrhoea , Rectal pain ,bleding , rectovaginal
fistula.
Urethrar obstruction.

31. On general examination:
Anaemia .
Cachexia.
On Speculum examination:
Cervix may be enlarged ,ulcerated ,excavated or completely
destroyed or replaced by hypertrophic mass.
Cardinal sign : Cervix is fixed, Hard is consistency , Irregular bleed on
touch.
On rectal examination: May found nodular induration

32. Stage 0 : Pre –invasive carcinoma ( carcinoma of situ)
Stage 1: Carcinoma strictly confined to the cervix .
1A: Preclinical carcinoma.
1A1:< 3 mm invasion.
1A2: Invasion > 3 mm from the base of the epithelium.
1B:Invasion >5 mm.
1B1:Lesion < 4 cm in diameter.
1B2:Lesion > 4 cm in diameter.
Continue ………….

33. Stage 2 : Carcinoma extends beyond the cervix but not into the pelvic wall.
Carcinoma involves the vagina but not the lower one third.
2A:Carcinoma involves the upper 2/3rd of the vagina.
2B:Obvious parametrial involvement.
Stage 3:
3A: Carcinoma involves the lower 1/3rd of the vagina.
3B:Extension on to the pelvic wall and /or hydronephrosis or non functioning
kidney.
Stage 4: Carcinoma has spread beyond the true pelvis or involved the
bladder or rectal mucosa.
4A: Spread to the adjacent organ.
4B:spread to the distant organs.

34. Pap test.
Colposcopy.
Biopsy.
Cystoscopy.
X-ray chest.
CT scan.
MRI.

35. General treatment :
Nutritional support.
Correction anaemia by blood transfusion.
Control of infection by antibiotics.
Relieve pain by analgesics.
Primary Surgery : Pelvic exenteration .
Chemotherapy : Bleomycine, Doxorubicin, Cisplatin.

36. Palliative treatment
Relief pain : NSAIDs.
Hemorrhage: Hot vaginal douches .
Follow up:
3 month interval for 1 year.
6 month interval for next 1 year.
Then yearly afterwards.

37. Hemorrhage.
Pyometra .
Vesicovaginal fistula.
Rectovaginal fistula.
Uraemia .
Cachexia.
Sepsis.

38. Screening are procedures which are designed to sought out
apparently healthy persons who are probably harbouring the
disease but do not show clinical examination.
Type of screening
Mass screening : Include whole population.
Multiphasic: when a person can screened for several condition at the
same time sitting for cervical , breast & genital tract cancer.
Opportunistic : Attends at the hospital for any complications.
Selective : High risk case are screen.

39. VIA.
Pap smear.
Colposcopy.
Schiller’s test.
HPV DNA antibody test.

41. Synthesis Repertory Rubrics
1. FEMALE GENITALIA/SEX - EROSION of cervix.
2. FEMALE GENITALIA/SEX - POLYPUS - Uterus – Cervix.
3. FEMALE GENITALIA/SEX - CANCER of – Uterus.
4. FEMALE GENITALIA/SEX - CANCER of - Uterus – Cervix.

42. 1. Female - POLYPS, genitalia .
2. Female - BLEEDING, uterus, metrorrhagia - polyps, from.
3. Female - CANCER, genitalia.
4. Diseases - CANCER, general - ulcers, cancerous.
5. Diseases - CANCER, general - uterus, cancer.
6. Diseases - CANCER, general - vagina, cancer.
7. Diseases - CANCER, general - vagina, cancer - labia, vulva, cancerous..
8. Diseases - CANCER, general - cervix, cancer of uterine cervix
9. Diseases - CANCER, general - genitalia, cancer, female.
10. Diseases - CANCER, general - vagina, cancer.
11. Diseases - CANCER, general - cervix, cancer of uterine cervix - os of
cervix.

43. Thank you
Noman Ahmad
28/10/2020