What is the anatomy of the cervix?
Cylindrical shaped neck of tissue
uterus, ~2-3cm long
* Facilitates the entry of sperm
from the vagina into the uterus
for fertilization
What are the risk factors of cervical cancer?
- Early age of first intercourse
- Having multiple sexual partners
- Having a high-risk sexual partner
- History of sexually transmitted infections
- HIV that causes suppression of immune system
- Cigarette smoking
- Oral contraceptives
- Multiple pregnancies
What causes cervical cancer?
Persistent infection with high-risk strains of Human Papilloma Virus (HPV)
Where does HPV infection occur?
At the basal cell layer of stratified squamous epithelial cells during sexual activity.
What effect does HPV have on infected cells?
It stimulates cellular proliferation, leading to abnormal growth.
What happens when HPV infection persists?
Viral persistence allows ongoing cellular changes and increases the risk of neoplastic transformation.
What range of cellular changes can HPV cause?
From benign hyperplasia → dysplasia → invasive carcinoma (though many regress spontaneously).
How is HPV transmitted?
- ~50% risk of transmission with
unprotected sex - Spread by vaginal, anal and
oral sex - People can be infected with
more than one type of HPV
What are the signs of cervical cancer in the early stages?
often have no symptoms and can go undetected
What are the signs of cervical cancer in late stages?
*Abnormal (irregular or heavy) vaginal bleeding
*Bleeding after sexual intercourse
*Dysuria (painful or difficult urination)
If cervical cancer is left untreated what can it invade?
- Surrounding tissue: uterus, bladder, ureters, rectum and peritoneum
- Lymphatic spread to pelvic nodes
- Distant metastases: lung, liver, brain
What are the stages of cervical cancer?
- Stage 0: Carcinoma in-situ: confined to
intra epithelial - Stage I: is confined to the cervix
- Stage IIa: Upper 2/3 of vagina
- Stage IIb: Parametrial involvement
- Stage IIIa: Lower 1/3 of vagina
- Stage IIIb: Pelvic sidewall or
hydronephrosis - Stage IVa: Rectal or bladder mucosa
- Stage IVb: Distant disease
What is the management of cervical cancer?
- Cyrosurgery
- Loop electrosignal excision
- Hysterectomy
- Radiation therapy
How to prevent cervical cabcer?
- Early detection of papsmear
- Vaccination GARDASIL
What does a papsmear do?
- Detect potentially precancerous
(=cervical intraepithelial
neoplasia/CIN) and cancerous
processes
What can pap smear detect?
- 90% of cervical cancers
- 50% of uterine cancers
- 10% of ovarian cancers
What does the prostate gland surround?
the male urethra at base of
bladder, adjacent to rectum
How does the prostate gland grow?
Growth stimulated at puberty due to rising levels of testosterone
How does the prostate gland liquify sperm?
Secretes some enzymes and Prostate Specific Antigen (PSA) to liquify sperm
What are the lobes of the prostate gland?
Anterior, posterior, medial, lateral
What are the layers of the prostate gland?
*Inner - glandular structure of epithelial cells
*Middle – known as transitional zone, commonly enlarges with age = BPH
*Outer – stromal cells, connective and muscle tissue
What are the zones of the prostate gland?
*Peripheral: glands of endodermal origin, prone to
carcinoma
*Transitional: glands of mesodermal origin, prone
to BPH
*Central: mucosal gland surrounding the ejaculatory duct
What is benign prostatic hyperplasia?
BPH is a benign enlargement of the prostate gland due to nodular or diffuse proliferation of musculofibrous and glandular component of the gland
What is the pathogenesis of benign prostatic hyperplasia?
- Hyperplasia thought to be stimulated by dihydrotestosterone
(DHT) - Type II 5 alpha-reductase metabolises testosterone into
DHT - DHT binds to androgen receptors in cell nuclei and stimulates prostate cell growth
