Cervical erosion
Mandera I
Definition
• This is a down-growth of cervical columnar
epithelium which extends out from the
internal os to the surface of the cervix.
• The columnar epithelium replaces the
squamous stratified epithelium which
normally covers the surface of the Cx.
• The exact cause is not known but it
usually follows pregnancy
causes
• Hormonal – as cervical erosion is not
found in post- menopause women.
• The exposed columnar epithelium is less
resistant to infection than squamousstratified epithelium. Therefore a chronic
infection of the cervix ( chronic cervicitis) is
common in cervical erosion.
s/s
• She reports abnormal vaginal D/C
• If erosion is not infected, D/C is mucous
• If infected, muco-purulent D/C
• May experience slight post coital bleeding
as the penis rubs against delicate
columnar epithelium
• In pregnancy, when the erosion is more
vascular, intermittent but slight P/V
bleeding occur
Speculum examination
Two conditions will be clearly diagnosed
• In erosion, the Cx looks raw, red and there
might be profuse D/C coming from Cx
• In chronic cervicitis, several distinct small
swellings are seen on the Cx ( known as
Nabothian cysts and they contain small
collections of pus when the infection is
active or clear mucus when it is resolved.
Cont’
• Nabothians are formed when the clefts
and tunnels of the endocervical mucous
glands are blocked by chronic
inflammation.
Management
• Refer patient to hospital
• It is important to distinguish the condition
from early Cx cancer
• A Papanicolaou (PAP) Smear or biopsy
may have to be done to exclude
malignancy
• Treat with antibiotic
• Give pain relief
• Counsel your patient and give hope
Cont’
• After clearing infections, Dr cauterizes (
burns) the Cx by diathermy or using
chemicals such as silver nitrate.
Carcinoma of the cervix
• This is a common genital malignancy
Incidence
• Common in women who have delivered
many children
• Accounts for 47% of malignant cases in
women and is ranked number one in
developing countries.
Predisposing factors
• Grandmultiparity
• Genetic predisposing
• Having multiple sexual partners
• Early sexual encounters
Pathology
• Cancer starts at the cervix at the margin of
the external os where it stays for some
time before it begins to penetrate the
neighboring tissues.
• It extends outwards the pelvic wall, down
wards into the vagina , back ward to the
rectum and forwards to the bladder.
s/s
• Age 30-45 yrs
• Post-coital bleeding
• Little vaginal bleeding progressively
becoming heavier
• Post-menopausal bleeding
• An offensive purulent vaginal D/C which
indicates infection of necrotic surface of
the tumor
• Pain in the lower abdomen or back ( last)
Diagnosis
• History may be suggestive of CaCx
• Physical examination will confirm irregular
Cx mass, hard, ulcerated and bleeds
easily to touch
• Biopsy confirms Ca Cx
• NB early in the Dx, Cx looks normal but if
Ca is present, it will be shedding malignant
cells from its surface
Treatment
• Refer Dr”s case
• Once diagnosed early, surgery is the Rx
• Or Surgery combined with radiotherapy
• Early Rx yields good results
• Encourage women in reproductive age
(delivering) to do PAP smear yearly as
their counter parts in developed world.
• Counsel and provide palliative care to
terminally ill
References
• Kagimba at el (2005),gynecology and
obstetrics
• Jonathans at el (2002),Norvak”s
gynecology