Cancer Flashcards
what does the NHS cervical screening test for ?
HPV first system , i.e. a sample is tested for high-risk strains of human papillomavirus (hrHPV) first and cytological examination is only performed if this is positive.
What do you do if an hrHPV results is negative?
return to normal recall, unless
* the test of cure (TOC) pathway: individuals who have been treated for CIN1, CIN2, or CIN3 should be invited 6 months after treatment for a test of cure repeat cervical sample in the community
* the untreated CIN1 pathway
* follow-up for incompletely excised cervical glandular intraepithelial neoplasia (CGIN) / stratified mucin producing intraepithelial lesion (SMILE) or cervical cancer
follow-up for borderline changes in endocervical cells
what is your next step if you have a positive hrHPV following a smear test?
samples are examined cytologically
Cervical cancer screening: postive HPV plus abnormal cytology
**colposcopy **
this includes the following results:
* borderline changes in squamous or endocervical cells.
* low-grade dyskaryosis.
* high-grade dyskaryosis (moderate).
* high-grade dyskaryosis (severe).
* invasive squamous cell carcinoma.
* glandular neoplasia
Cervical screening: hrHPV +ve but cytologically normal
the test is repeated at 12 months
Cervical screening:
1st hrHPV +ve but cytologically normal
repeated test after 12 months –> HPV -ve
next step?
if the repeat test is now hrHPV -ve → return to normal recall
Cervical screening:
1st hrHPV +ve but cytologically normal
repeated test after 12 months –> HPV +ve and normal cytology
next step?
further repeat test 12 months later
Cervical screening:
1st hrHPV +ve, cytologically normal
repeat test 12 months hrHPV +ve, cytologically normal
Further repeat at 12 months:
hrHPV -ve at 24 months →
return to normal recall
Cervical screening:
1st hrHPV +ve, cytologically normal
repeat test 12 months hrHPV +ve, cytologically normal
Further repeat at 12 months:
if hrHPV +ve at 24 months →
colposcopy
Cervical screening: sample is inadequate
repeat the sample within 3 months
if two consecutive inadequate samples then → colposcopy
Cervical screening:
individuals who’ve been treated for CIN1, CIN2, or CIN3
The follow-up of patients who’ve previously had CIN is complicated but as a first step, individuals who’ve been treated for CIN1, CIN2, or CIN3 should be invited 6 months after treatment for a test of cure repeat cervical sample in the community.
Treatment of CIN
Large loop excision of transformation zone (LLETZ) is the most common treatment for cervical intraepithelial neoplasia.
- LLETZ may sometimes be done during the initial colposcopy visit or at a later date depending on the individual clinic.
- Alternative techniques include cryotherapy.
staging of ovarian cancer
