Abnormal Smear Flashcards
What is the purpose of screening?
- To detect disease among healthy population without symptoms of disease
- Ultimately to decrease mortality due to the disease screened
Criteria for Disease appropriate for screening
- High prevalence of disease
- Known natural history, precursor lesion and course of progression
- Detection of early stage disease amenable to cure
- Method used is simple, acceptable, risk-free and cost- effective
Screening of malignancies on the NHS (UK)
- Cervical (25–64years)
- Breast (50–70years)
- Bowel (60–70years)
Commonest cancer affecting women under the age 35
Carcinoma of the cervix
Cervical cancer screening guidelines
- Computerised call and recall system
- First invitation at 25 years age
- Three yearly until 49 years age
- Five yearly until 64 years age
HPV subtypes associated with genital warts
6 and 11 can cause genital warts in more than 90% cases
HPV subtypes associated with cervical cancer
High risk: 16 and 18 cause 70 % of cervical cancer
Over 95% of cervical SCCs associated with high risk HPV types (16,18,31,33,45);
Cervical smear results classification
- Normal
- Borderline nuclear abnormality (BNA) • Low grade (Mild)
- High grade (Moderate and Severe)
- High grade ? Invasion
- Glandular changes
Smear test - what are Koilocytes?
HPV infected cells- vacuoles in cytoplasm
Smear test - what is dyskaryosis?
MILD: Cells with slightly increased nuclear cytoplasmic ratio
MODERATE: increased nuclear cytoplasmic ratio
SEVERE: markedly increased nuclei with mitotic figures
Colposcopy: What does Acetowhite area indicate?
increased nuclear activity
Colposcopy: What does iodine negative area indicate?
less cytoplasmic glycogen
What is a LLETZ procedure?
Large loop excision of Transformation Zone
Cervical Intraepithelial Neoplasia GRades
CIN:Is a Histological Term
• CIN 1 : Abnormal cells affecting the lower one-third of the epithelium
• CIN 2: Abnormal cells affecting the lower (Basal ) two-thirds of the epithelium
• CIN 3 : Abnormal cells affecting > than two- thirds and up to full thickness
• CGIN: Cervical Glandular Intra-epithelial Neoplasia- precursor to adenocarcinoma.
Treatment of High Grade CIN
Excision therapy- recommended, as disease excised
Ablative therapy- Not recommended- risk of residual disease