Cervical

Question 1

Low risk HPV

Answer 1

6

11

Question 2

Cervical screening

Answer 2

25-49: 3 yrly

50-64: 5 yrly

Question 3

HPV vaccination

Answer 3

Bivalent

Quadrivalent

Question 4

High risk HPV

Answer 4

16

18

Question 5

Treatment for symptomatic cervical ectropion

Answer 5

Smear
Ideally colposcopy too
Cryotherapy

Question 6

Complications of cervical ectropion

Answer 6

Columnar epithelium at greater risk of infection
Acute cervicitis: STI
Chronic cervicitis: discharge + inflammatory smear
Cryotherapy +- abx

Question 7

Cervical polyps

Answer 7

Benign tumours of endocervical epithelium
Seen mostly in women >40 yrs
Usually

Question 8

Nabothian follicles

Answer 8

Where squamous epithelium has formed by metaplasia over endocervical epithelium
Columnar cells continue to secrete = retention cysts
White swellings on ectocervix
Treatment not usually required

Question 9

CIN

Answer 9

Cervical intraepithelial neoplasia
A histological diagnosis
Dyskaryosis in the squamous epithelium
Larger nuclei with frequent mitoses
3 stages

Question 10

CIN1

Answer 10

Mild dyskaryosis

Dysplasic cells only found in the lower 1/3 epithelium

Question 11

CIN2

Answer 11

Moderate dyskaryosis

Dysplasic cells found in lower 2/3 of epithelium

Question 12

CIN3

Answer 12

Severe dyskaryosis
Displasic cells occupy full thickness of epithelium
Aka carcinoma in situ

Question 13

% women with CIN2/3 developing cervical carcinoma in 10 years if left untreated

Answer 13

33%

Question 14

In what age group is there peak incidence of CIN?

Answer 14

25-29

Question 15

Risk factors for CIN

Answer 15

Smoking
Oral contraceptive use
HIV/other immunocompromise

Question 16

Why does HPV infection predispose to carcinoma?

Answer 16

When the virus invades the cell it incorporates its viral DNA into host cell DNA
Viral proteins inactivate key tumour suppressor gene products-> cell into cell cycle
other mutations build up-> uncontrolled proliferation = carcinoma
Virus changes hide the cell from the immune system

Question 17

Why does screening only start from 25?

Answer 17

Whilst women younger than 25 may have cervical changes they are unlikely to cause cancer
Starting screening from 25 reduces the number of unnecessary recalls and colposcopy

Question 18

What method is used to examine smear tests?

Answer 18

Liquid based cytology
Inadequate sample: 2.5%
Same sample can be tested for HPV ‘HPV triage’

Question 19

CIN1 treatment

Answer 19

HPV triage
+High risk= colposcopy
+Low risk= return to 3/5yrly recall

Question 20

Smear following treatment

Answer 20

No abnormal cells + no high risk HPV = return to routine recall

Question 21

What is CGIN

Answer 21

Cervical glandular intraepithelial neoplasia
Uncommon
Adenocarcinoma or cervix and endometrium should be excluded

Question 22

Colposcopy procedure

Answer 22

Cervix inspected with surgical magnification (10-20x)
Squamocolumnar junction visualised
Acetic acid applied
Aceto White (incr protein, less glycogen)
Biopsy abnormal areas/ LLETZ

Question 23

Features of dyskaryosis

Answer 23

Anaplasia
Incr nuc:cytoplasmic ratio
Hyperchromatism

Follow up
2 smears in first year
Annual smears next 5 yrs
Return to routine schedule

Question 24

LLETZ

Answer 24

High frequency current passed through wire loop
Tissue goes for histology
Out patient procedure
Small risk cervical incompetence + stenosis

Question 25

Cone biopsy

Answer 25

Surgical excision of cervical tissue under anaesthesia
Large specimen for pathology
Associated with cervical incompetence and stenosis