Cervical Cancer Screening and

Treatment Clinical Training

Session 2

Anatomy of the Uterine Cervix

 Session Objectives

At the end of this session participants will be able to:

•Describe the anatomy of the uterine cervix

•Define squamo columnar junction (SCJ),

Transformation Zone and its importance
•Describe variation of the normal cervix
Anatomy of external genitalia

DC Dutta’s textbook of Gynecology 2013

Anatomy of Uterine Cervix
The Cervix
 The Cervix
Ectocervix

Endocervix
Normal Cervix
Normal Cervix
 The Cervix

• Composed of dense fibromuscular tissue

• Covered by two types of epithelium
• squamous epithelium (ectocervical)
• columnar epithelium (endocervical)
• These two kinds of epithelium meet at the squamo-
columnar junction (SCJ)
 The Cervix
Ectocervix

Squamo-columnar
junction (SCJ)

Endocervix Endocervical canal

 Squamous Epithelium
• Found on the ectocervix (outer portion)
• Smooth and pink in colour

Squamous
Epithelium
 Columnar Epithelium
• Lines the endocervical canal (inner portion)
• Visible on the ectocervix (outer portion) from
adolescence to menopause
• Appears red in color
Columnar
Epithelium
 Squamo-Columnar Junction (SCJ)
The area where red columnar epithelium meets pink
squamous epithelium

Squamo-columnar
junction (SCJ)
 Squamo-Columnar Junction (SCJ)
The location of the squamo-columnar junction in
relation to the external os varies, depending upon
•Hormonal status
• Age
• Physiological conditions, e.g pregnancy
• Estrogen Containing hormonal therapy
•Birth trauma
 Squamo-columnar junction (2)
• During childhood, it is located at, or very close to, the
external os.
• During reproductive period, cervix enlarges and
endocervical canal elongates.
• This leads to the eversion of the columnar epithelium
onto the ectocervix, the ectropion.
 Squamo-columnar junction (3)
• Thus, the SCJ is located in the ectocervix, far away
from the external os during the reproductive years
and pregnancy.
• On visual inspection, ectropion is seen as a strikingly
reddish ectocervix.
 Squamo-columnar junction (4)
• From reproductive life to peri-menopausal age, the
SCJ progressively starts moving on the ectocervix
towards the external os.

• In post-menopausal women, the SCJ is located in the

endocervical canal and, hence, often cannot be seen
on visual examination
 Transformation zone (TZ)
• Is the area where columnar epithelium has been
replaced and/or is being replaced by metaplastic
squamous epithelium

• With the naked eye, one can identify the inner border of
the transformation zone by tracing the SCJ.

• Almost all cervical neoplasia occurs in this zone, close

to the SCJ.

• The cells of the transformation zone are vulnerable to

HPV infection and it is here that most squamous cell
carcinoma develops.
 Transformation zone (2)
• In pre-menopausal women, the transformation zone
is primarily located on the ectocervix.

• After menopause/in old age, the cervix shrinks due

to decrease in the levels of oestrogens.

• Consequently, the SCJ and the transformation zone

may move into the endocervical canal.
Locate the Squamo-Columnar Junction (SCJ)
Locate the Squamo-Columnar Junction (SCJ)
Locate the Squamo-Columnar Junction
(SCJ)
Locate the Squamo-columnar junction (SCJ)
 Normal Variations of the Cervix

• Cervical ectropion

• Nabothian cyst

• Cervical polyp
 Cervical ectropion
Physiological state were columnar epithelium is visible on
the ectocervix.
 Normal cervix with ectropion
NOTE :The squamo-columnar junction is far away from the
external os; the columnar epithelium is red and the squamous
epithelium is pink in color.
 Nabothian Cysts
• Mucus glands in the columnar epithelium that are covered
over by squamous cells.
• They collect mucusal secretions
 Cervical Polyp
Cervical Polyp is a growth that starts in the cervical canal
and extends to the ectocervix.
 Small Group Activity

Flash Cards – in small groups

1. Identify endocervix, ectocervix, SCJ

2. Draw the SCJ on the grid
3. Identify ectropion, nabothian cysts, and
cervical polyps
 Review the Words
• Endocervix • Squamo-columnar
junction (SCJ)
• Ectocervix
• Ectropion/Ectopy
• Endocervical Canal

• Squamous Epithelium • Nabothian Cyst

• Columnar Epithelium • Cervical Polyp

 Key Messages
• Cervix is covered with two epithelium

• SCJ is line were columnar epithelium of the endocervix

meet with squamous epithelium of the ectocerix
• Transformation zone is the area where columnar
epithelium has been replaced and/or is being replaced
by metaplastic squamous epithelium
• All precancerous lesions starts at or near SCJ
/transformation zone