Cervical and Breast Screening Flashcards
Most Cervical cancers are caused by….
oncogenic subtypes of HPV
The main HPV subtypes implicated in cervical cancer are?
16 and 18
Is there a higher or lower risk of developing cervical cancer in maori women?
Higher!
twice the incidence and upto 4x the mortality
What line should you delivery to patients when explaining what a smear is for??
” a cervical smear is to look for any abnormal cells on the surface of the cervix”
What cell type is cervical cancer, why does this matter.
Squamous cell (80%) Adenocarcinoma (20%) This is why we sample from the squamous-columnar junction, SCJ is where the squamous cells on the peripheral ectocervix meet the columnar cells from the cervical canal.
What should you do if the smear is normal but the cervix looks abnormal?
Still refer for colpscopy/ a second opinion
When does NZ cervical screening start
Starts age 25 (even if they were sexually active prior)
Even if the first smear is normal, second is done a year later to rule out a false-negative.
Then every 5 years
Continues till age 69 i (unless cervix is removed, however if it was removed due to cancer additional smears may be required)
What is the Cervical Screening Register?
The Cervical screening register is an opt-off system. Practitioners need to ask women for permission to put their name on the register, as a result their smear results will be sent from the lab to the register automatically. If women do not wish this to happen they are required to sign an opt-off form. Once registered, the woman will get a letter to give her the result of her first smear, tell her when the next smear is due and to check her personal details are correct. Thereafter she will only be contacted by the register if her smear is abnormal or her smear is more than 3 months overdue. Once part of the register, a woman will have all her cytology, histology, colposcopy, and cervical treatments recorded and these will be accessible to practitioners registered with NCSP, such as susequent smear takers, colposcopists or cytologists.
Cytological abnomalities are reported by grade:
- ASC-US:
- LSIL:
- ASC-H:
- HSIL:
- Atypical Glandular cells (AGC), Adenocarcinoma in situ (AIS),
- Suspected invasion or SCC
Histological changes are reported as:
- HPV
- CIN 1
- CIN 2
- CIN 3
- Invasive squamous cell carcinoma
- Invasive adenocarcinoma
Cytological abnomalities are reported by grade:
- ASC-US: atypical squamous cells of undetermined significance
- LSIL: low grade squamous intraepithelial lesion / HPV
- ASC-H: Atypical squamous cells, high grade abnormality cannot be excluded
- HSIL: High grade squamous intraepithelial lesion - precancerous (the laboratory may suggest changes consistent with CIN2 or CIN3)
- Atypical Glandular cells (AGC), Adenocarcinoma in situ (AIS), or Adenocarcinoma
- Suspected invasion or SCC (squamous cell carcinoma)
Histological changes are reported as:
- HPV (high risk or low risk)
- CIN 1 Cervical Intraepithelial neoplasia grade 1
- CIN 2 Cervical Intraepithelial neoplasia grade 2
- CIN 3 Cervical Intraepithelial neoplasia grade 3
- Invasive squamous cell carcinoma
- Invasive adenocarcinoma
What is Colposcopy
The cervix is examined under magnification and acetic acid and/or iodine stain is applied with biopsy of abnormal tissue.
The aim is to identify the abnormality, documet its geographical location and biopsy the worst part/are
These may need excision by LLETZ (large loop excision of the transformation zone) laser cone or cold knife cone or ablation by laser.
HPV type ___ and ___ will cause genital warts
Types 6 and 11 cause genital warts
Other typs of HPV outside of 16 and 18 that cause cervical cancer are??
31, 33, 45, 52 and 58
HPV vaccination became part of the NZ vaccination schedule in ____. The initial vaccine was Gardasil 4, which covered types _______.
From 2017, Gardasil 9 has been used. This provides more extensive coverage against high risk, pro-oncogenic HPVs. It covers ________________.
HPV vaccination became part of the NZ vaccination schedule in 2004. The initial vaccine was Gardasil 4, which covered types 6, 11, 16, and 18.
From 2017, Gardasil 9 has been used. This provides more extensive coverage against high risk, pro-oncogenic HPVs. It covers 6, 11, 16, 18, 31, 33, 45, 52, and 58.
What age ranges are subsidised for the Gardisil 9 vaccine?
What percentage of women have actually had the vaccine?
9-26 for both males and females
Only 50% have had this.
BSA stands for? What ages get it?
BreastScreen Aotearoa
Women aged 45-69
HPV 16, as will as causing cervical cancer, is associated with?
Vaginal, vulval, anus and oropharyngeal cancer
What is the HPV vaccine made up of
Synthesized Virus like particles + adjuvant (to stimulate immune response)
How many doses of the HPV vaccine are given
2 doses if 14 or under
3 doses for 15 and older
HPV 18 is particularly associated with?
Adenocarcinoma
Important activities of the NCSP are?
- maintenence of the registry
- funding
- Quality control of cytology and colposcopy services
Three main groups of cervical cytology abnormalities?
Low Grade:
- ASCUS (atypical squamous cells of uncertain significance)
- LSIL (Low grade squamous intraepithelial lesions)
High Grade:
- ASCH (atypical Squamous cells of uncertain significance possibly high grade)
- HSIL (High grade squamous intraepithelial lesions)
Glandular Abnormalities:
- AGC (atypical glandular cells)
- ACIS (adenocarinoma in situ)
Who should be referred for Colposcopy
Women who test positive for HPV 16 and 18
Women with glandular abnormalities or high grade squamous IE lesions as these have a high likelihood of having precancerous abnormalities
What happens to women with low grade squamous intraepithelial lesions?
As they have a relatively low risk of precancerous abnormality they are triaged first prior to colposcopy referral
- >30 years: hrHPV test
- means chance of CIN2/CIN3 in increased; refer
- ; repeat smear in 12 months
- <30 years: repeat smear in 12 months
When do you treat post coloposcopy and what are the treatment options?
When the abnormality is confirmed to be CIN2 or CIN3
- Treatment involves destruction/removal of the abnormal area. This normally involves the transformation zone.
- LLETZ: most common, colposcopy guided under LA with diathermy
- histological examination is performed to exclude invasive disease
- Cone biopsy: for suspected invasion, glandular abnormality or squamous abnormaltiy that extends into the endocervical canal.
