25, F, first smear test

Question 1

25, F
first smear
ICE: pain, embarrassed about procedure, anxious/nervous due to intimate test

EXPLAIN PROCEDURE

Answer 1

1) CONSENT, CHAPERONE, CLEAN HANDS
2) EXPOSURE
3) POSITION - ankles together, knees relaxed to the side
4) SPECULUM
5) VISUALISE CERVIX
6) COLLECT SAMPLE - Rotate brush around 5 to 10 times around cervix
7) PRESERVE SAMPLE - transfer to preservative fluid for liquid cytology
8) LABEL sample

Question 2

What is the cervical screening programme for?

Answer 2

To pick up CIN (not visible
and no symptoms). High risk of developing carcinoma of cervix

Question 3

What ages do women have cervical smears?

Answer 3

25-49 - every 3 years
50-64 - every 5 years

Question 4

What does a smear test pick up?

Answer 4

CIN I = mild dysplasia
CIN II = moderate dysplasia
CIN III = severe dysplasia

Question 5

Cervical cancer risk factors?

Answer 5

• Multiple sexual partners
• smoking
• COCP
• immunosuppression
• HPV infection

Question 6

What is colposcopy?

Answer 6

Colposcopy involves inserting a speculum and using a colposcope (a microscope with a light) to visualise the cervix in detail

Question 7

Management of CIN I,II,III?

Answer 7

CIN I but HPV -ve:
- repeat in 6 mths - often resolves, if still present do colposcopy
- if HPV +ve, do colposcopy
CIN II:
- colposcopy
CIN III:
- urgent colposcopy

Mgx of CIN II/III: LLETZ procedure - examine sample histologically / small biopsy first

Question 8

25, F
first smear
ICE: pain, embarrassed about procedure, anxious/nervous due to intimate test

COUNSEL PATIENT ON CIN I RESULT

Answer 8

Inform patient of result
Reassure patient it isn’t cancer, just early warning cells - CIN III 30% cancer chance in 8-15 years

Do NOT mention reasons why eg. multiple partners (can lead to guilt) - say common in girls this age

Next steps: repeat smear in 6mths, may have resolved on its own, if not, treat with colposcopy

Cervical cancer rates down 75% in last 20yrs