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3rd Year - Reproductive Diseases > 17. Cervical Screening - HPV / CIN / Cervical Cancer > Flashcards

17. Cervical Screening - HPV / CIN / Cervical Cancer Flashcards

1
Q

What Virus is associated with Cervical Cancer?

A

Human Papilloma Virus Types 16 and 18

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2
Q

What is the Prevalence of Human Papilloma Virus (HPV)?

A
  1. Peak Prevalence at 15-25 Years
  2. Prevalence declines with Age
  3. 10% overall but 30% in young women
  4. Lifetime risk of Exposure is about 75%
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3
Q

What Cancers is Human Papilloma Virus (HPV) associated with?

A
  1. Cervix - >99%
  2. Penis - 40%
  3. Vulva / Vagina - 40%
  4. Anus - 90%
  5. Mouth - 3%
  6. Oropharynx - 12%
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4
Q

What is the Pathology of HPV infection to Cervical Disease?

A
  1. Human Papilloma Virus (HPV) infection
  2. a) Viral Lesions / Cervical Intraepithelial Neoplasia
  3. b) Persistent HPV Infection
    Note - 2b. can go to 2a., and this follows from 2a
  4. Cervical Intraepithelial 2/3 (Pre-Cancer Potential)
  5. Cervical Cancer
    Note - 1. / 2a. / 3 can go to Cleared HPV Infection
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5
Q

What is the UK HPV Immunisation Programme?

A

2 Dose Regime of Quadrivalent Vaccine against Human Papilloma Virus (HPV):
Type 16 / 18 - Cancer
Type 6 / 11 - Genital Warts

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6
Q

What are the components of the Scottish Cervical Call Recall System (SCCRS)?

A
  1. Smear taker enters request onto SCCRS database
  2. Vials send to Lab Receipt logged on SCCRS
  3. Patient details recieved from SCCRS, Vials Processed, Slides Stained and Screened
  4. Cytology Lab results put on database
  5. SCCRS creates Colposcopy Referral
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7
Q

Who is Screened for Cervical Cancer?

A
  1. Women aged 25-64 years old
  2. 3 Yearly smears up to the age of 50
  3. 5 Yearly smears from 50
  4. Liquid Based Cytology
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8
Q

What is the Transformation Zone?

A
  1. Columnar Epithelium line the Cervix
  2. Squamous Epithelium line the Vagina
  3. 1 cell thick Columnar Epithelium goes through Metaplasia - Changing from Columnar to Squamous
  4. Difference between Old and New Squamo-Columnar Junction is called the Transformation Zone
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9
Q

What is the Significance of the Transformation Zone?

A

This is where changes will arise

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10
Q

What is Cervical Cytology?

A

Microscopic detection of Abnormal Squamous Cells that suggest Underlying Cervical Intraepithelial Neoplasia

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11
Q

What is the purpose of Cervical Cytology?

A

Identify women that have no abnormality vs those requiring further investigation

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12
Q

What are the Cytological Features of the normal Cervix?

A
  1. Squamous Epithelial Cells
  2. Glandular Cells
  3. Inflammatory Cells
  4. Benign Nuclear Features - Small, Uniform Size / Shape, Regular Chromatin evenly distributed
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13
Q

What are the Cytological Features of the abnormal Cervix?

A

Dyskaryosis - Abnormal Cells may be few with Nuclear Features:
1. Increased Size and Nuclear:Cytoplasmic Ratio
2. Variation in Size, Shape and Outline
3. Coarse Irregular Chromatin
4. Nucleoli
Note - This is graded Low / High Grade Dyskaryosis - Reflects the degree of underlying CIN

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14
Q

What is the management after Cytology?

A
  1. Normal - Routine Call (3 years)
  2. BNA & Low Grade Dyskaryosis - Repeat in 6 months
  3. High Grade Dyskaryosis - Refer to Colposcopy
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15
Q

What happens in Colposcopy?

A
  1. Counselling
  2. Colposcopy
  3. a) Magnification & Light to see Cervix
  4. b) Exclude Obvious Malignancy
  5. c) Use of Acetic Acid =/- Iodine - Identify limits of Lesion / Select Biopsy Site / Define area to Treat
  6. Punch Biopsy - Return for treatment if CIN 2/3
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16
Q

What are the layers of the Normal Cervical Epithelium?

A
  1. Superficial Cells
  2. Large Intermediate Cells with Glycogen Vacuoles
  3. Small Intermediate Cells
  4. Parabasal Cells
  5. Basal Cells
17
Q

What Histological Changed occur at the Transformation Zone?

A

Glandular Lining Cells of Exposed Endocervical Epithelium Transformed into Squamous Cell - Squamous Metaplasia
Note - This is the Site of HPV infection

18
Q

What is the Pathology of Human Papilloma Virus (HPV)?

A
  1. Infects Basal Layer of Cervix
  2. Utilizes host for Replication
  3. As Host-Cell Matures, Different Viral Genes are Expressed
  4. Multinucleation and Kiolocytosis occurs - Cells with Wrinkled Nucleus and Perinuclear Halo
19
Q

What is Cervical Intraepithelial Neoplasia?

A

Abnormal Proliferation of Cells in the Squamous Epithelium - CIN

20
Q

What are the Risk Factors of Cervical Intraepithelial Neoplasia?

A
  1. Human Papilloma Virus (HPV) Types 16 and 18
  2. Early age at first intercourse
  3. Multiple Sexual Partners
  4. Prolonged Oral Contracptive use
  5. Smoking
  6. Sexually Transmitted Diseases
  7. Immunodeficiency
21
Q

What is Cervical Intraepithelial Neoplasia a precursor of?

A

Invasive Cancer (Squamous Carcinoma) - Disarray in the arrangement of the cells within the Epithelium

22
Q

What are the Grades of Cervical Intraepithelial Neoplasia?

A

CIN 1
CIN 2
CIN 3

23
Q

What is the Treatment of Cervical Intraepithelial Neoplasia?

A
  1. Large Loop Excision of the Transformation Zone (LLETZ)
  2. Cold Coagulation
  3. Laser Ablation
24
Q

What is the purpose of the Follow-Up Treatment of Cervical Intraepithelial Neoplasia?

A
  1. To Confirm that Treatment was effective
  2. To prevent Invasive Cancer
  3. To reassure the woman
25
Q

What is the Aetiology of Cervical Cancer?

A
  1. Peak Age 45-55
  2. HPV (16 & 18) Related
  3. Multiple Partners
  4. Early age at First Intercourse
  5. Older age of Partner
  6. Smoking
26
Q

What are the Symptoms of Cervical Cancer?

A
  1. Abdominal Vaginal Bleeding
  2. Post-Coital Bleeding
  3. Intermenstrual Bleeing / PMB
  4. Discharge
  5. Pain
27
Q

How is Cervical Cancer Diagnosed?

A
  1. Clinical
  2. Screen Detected
  3. Biopsy (full thickness)
28
Q

How is Cervical Cancer Staged?

A
  1. Examination under Anaesthesia (EUA)
  2. PET-CT
  3. MRI
29
Q

What are the Different Stages of Cervical Cancer?

A

1a - Microinvasive Cancer - 99% Cure Rate
1b - confined to the Cervix - 85% Cure Rate
2a - 75% Cure Rate
2b - Beyond the Cervix - 60% Cure Rate
3b - Involves Vaginal Sidewalls - 33% Cure Rate
4 - Beyond the Pelvis - 15% Cure Rate

30
Q

What is the treatment of Cervical Cancer?

A
  1. Radical Hysterectomy - Removal of:
  2. a) Uterus / Cervix / Upper Vagina
  3. b) Parametria
  4. c) Pelvic Nodes
  5. d) Ovaries Conserved
  6. Radiotherapy
  7. Chemotherapy
  8. Caesium Insertion

3rd Year - Reproductive Diseases (41 decks)

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