Cervical CA screening

Question 1

________ is the fourth most common cause
of cancer death in women worldwide, especially in
developing countries.

Answer 1

Cervical cancer

Question 2

It is the most common cancer
in women in Eastern and Middle Africa, and the _______
most common in Australian women

Answer 2

12 th

Question 3

Australia has
the second lowest incidence of cervical cancer in
the world as a result of the success of the _______

Answer 3

National

Cervical Screening Program introduced in 1991

Question 4

The most common cervical cancer is ________ accounting for 80% of cases

Answer 4

squamous
cell carcinoma (SCC),

Question 5

________ is less common and more difficult

to diagnose because it starts higher in the cervix.

Answer 5

Adenocarcinoma

Question 6

Cervical cancer almost exclusively occurs in women
who have been sexually active, due to exposure to
_________

Answer 6

human papillomavirus (HPV).

Question 7

Of the genital HPV types, 15 are
classified as ‘high risk’, as they are associated
with _________

Answer 7

anogenital cancer (including squamous and
adenocarcinoma of the cervix).

Question 8

HPV _________ are responsible for around 70% of invasive cervical cancers and 50% of high-grade lesions

Answer 8

16 and 18

Question 9

Most cervical HPV infections are cleared or suppressed by __________

Answer 9

cell-mediated

immunity within 1–2 years of exposure.

Question 10

The focus of attention is the__________ where columnar cells lining the endocervical
canal undergo metaplasia to squamous cells in
the region of the squamocolumnar junction.

Answer 10

transformation zone

Question 11

It is important clinically to realise that this transformation
zone can extend with progressive metaplasia of
columnar epithelium and so the squamocolumnar
junction may recede into the ________

Answer 11

endocervical canal

Question 12

________ represent an acute HPV infection of the transformation zone.

Answer 12

Low-grade squamous intraepithelial lesions (LSILs)

Question 13

T or F

HSILs may return to normal, persist or eventually
progress to invasive cervical cancer

Answer 13

T

Question 14

The average duration between HSILs and cancer is between _________

Answer 14

10 and 15 years.

Question 15

Current cervical screening uses ________

Answer 15

cytology from the
Papanicolaou smear, or Pap test, as the screening
tool

Question 16

Cervical CA screening

• Commence cervical screening at _________after first sexual intercourse, whichever is later

• Perform every 2 years and cease at ______ in
those who have had two normal Pap tests within
the last 5 years

Answer 16

18–20 years or 2 years

70 years

Question 17

Screen women over 70 years if _______

Answer 17

they request it or

if they have never had a Pap test

Question 18

Women with postcoital or persistent

intermenstrual bleeding require a ______

Answer 18

diagnostic Pap
test and referral for colposcopy irrespective of
the resul

Question 19

Screening in particular groups

Hysterectomy . Cervical screening is still required if
__________

Answer 19

the cervix was not completely removed.

Question 20

vaginal vault Pap tests are indicated if there is a
1
2
3

Answer 20

1. history of gynaecological dysplasia or malignancy, or
2. exposure to diethylstilboestrol in utero, as well as in
3. immunosuppressed women.

Question 21

Screening in particular groups

Pregnancy. If due, cervical screening is still
recommended and can be safely performed until
________

Answer 21

24 weeks gestation

Question 22

T or F

Pap tests have been associated
with an increased rate of miscarriage in the first and
second trimesters

Answer 22

False

have not

Question 23

Postmenopausal women. If not taking hormone

replacement therapy, postmenopausal women may benefit from a _______

Answer 23

short course of topical vaginal oestrogen

before their Pap test

Question 24

Special attention should be focused on screening the
following women:

• \_\_\_\_\_\_\_\_\_
(mortality of cervical cancer five times that of
other women in Australia)
• Women from \_\_\_\_\_\_\_
• Women in\_\_\_\_\_\_
• Lesbian and bisexual women
• Women with disabilities

Answer 24

Aboriginal and Torres Strait Islander women

non-English-speaking backgrounds

rural and remote areas

Question 25

What are the smear taking instruments

Answer 25

— Ayer’s spatula, wooden or plastic
— Cervex sampler broom
— Cervex-Brush Combi
— endocervical brush

Question 26

pregnancy—avoid use of the ____ and ____

Answer 26

endocervical brush and the Cervex-Brush Combi

Question 27

The __________provides better exposure
of the vulva but requires more manipulation of
the patient.

Answer 27

Sims exaggerated left lateral

position

Question 28

cervix is situated in the _______

Answer 28

upper sixth of the anterior vaginal

wall (not in the apex of the vagina).

Question 29

A__________ is normal in most premenopausal women and was formerly incorrectly called an erosion.

Answer 29

cervical ectropion

Question 30

A woman treated for HSIL should have a ______

Answer 30

colposcopy

and cervical cytology at 4–6 months after treatment

Question 31

three-dose schedule of the quadrivalent HPV vaccine

that protects against:

Answer 31

HPV types 16 and 18 (high risk for cervical cancer) and types 6 and 11 (which cause genital warts).

Question 32

Currently, the HPV vaccine (Gardasil®)
is administered through the National Immunisation
Program to __________

Answer 32

males and females aged 12–13 years

Question 33

Women who have been immunised still require

cervical screening because ________

Answer 33

the vaccine does not

prevent all HPV types that cause cervical cancer

Question 34

Negative smear—no endocervical cells_______
Negative smear—inflammatory cells ______
Unsatisfactory smear________

Answer 34

Repeat in 2 years.
Repeat test in 2 years.
Repeat smear in 6–12 weeks (allows regeneration of cells).

Question 35

Low-grade epithelial lesion

Possible LSIL and definite LSIL

Answer 35

Repeat Pap test at 12 months. If the woman is 30+ years,

and has no negative cytology in previous 2–3 years, refer for colposcopy or repeat the test in 6 months

Question 36

High-grade epithelial lesion

Possible HSIL and definite HSIL______

Glandular abnormalities including adenocarcinoma in situ ____________
Invasive squamous cell carcinoma or adenocarcinoma ___________
Inconclusive—raising possibility of high-grade disease ____________

Answer 36

Refer for colposcopy.

Refer to a gynaecologist.

Refer to appropriate specialist gynaecologist or unit.

Refer for colposcopy and possible biopsy

Question 37

Pending policy approval, in 2017 it is anticipated
that the cervical cancer screening test will transition
from the 2-yearly Pap test to ________

Answer 37

5-yearly HPV DNA

testing

Question 38

prior to HPV vaccination,
the role of HPV DNA testing was limited as a
screening tool because ________

Answer 38

as many of 25% of women aged <30 were likely to test positive for oncogenic viruses.