Cervical CA screening Flashcards
________ is the fourth most common cause
of cancer death in women worldwide, especially in
developing countries.
Cervical cancer
It is the most common cancer
in women in Eastern and Middle Africa, and the _______
most common in Australian women
12 th
Australia has
the second lowest incidence of cervical cancer in
the world as a result of the success of the _______
National
Cervical Screening Program introduced in 1991
The most common cervical cancer is ________ accounting for 80% of cases
squamous cell carcinoma (SCC),
________ is less common and more difficult
to diagnose because it starts higher in the cervix.
Adenocarcinoma
Cervical cancer almost exclusively occurs in women
who have been sexually active, due to exposure to
_________
human papillomavirus (HPV).
Of the genital HPV types, 15 are
classified as ‘high risk’, as they are associated
with _________
anogenital cancer (including squamous and adenocarcinoma of the cervix).
HPV _________ are responsible for around 70% of invasive cervical cancers and 50% of high-grade lesions
16 and 18
Most cervical HPV infections are cleared or suppressed by __________
cell-mediated
immunity within 1–2 years of exposure.
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.
transformation zone
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 ________
endocervical canal
________ represent an acute HPV infection of the transformation zone.
Low-grade squamous intraepithelial lesions (LSILs)
T or F
HSILs may return to normal, persist or eventually
progress to invasive cervical cancer
T
The average duration between HSILs and cancer is between _________
10 and 15 years.
Current cervical screening uses ________
cytology from the
Papanicolaou smear, or Pap test, as the screening
tool
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
18–20 years or 2 years
70 years
Screen women over 70 years if _______
they request it or
if they have never had a Pap test
Women with postcoital or persistent
intermenstrual bleeding require a ______
diagnostic Pap
test and referral for colposcopy irrespective of
the resul
Screening in particular groups
Hysterectomy . Cervical screening is still required if
__________
the cervix was not completely removed.
vaginal vault Pap tests are indicated if there is a
1
2
3
- history of gynaecological dysplasia or malignancy, or
- exposure to diethylstilboestrol in utero, as well as in
- immunosuppressed women.
Screening in particular groups
Pregnancy. If due, cervical screening is still
recommended and can be safely performed until
________
24 weeks gestation
T or F
Pap tests have been associated
with an increased rate of miscarriage in the first and
second trimesters
False
have not
Postmenopausal women. If not taking hormone
replacement therapy, postmenopausal women may benefit from a _______
short course of topical vaginal oestrogen
before their Pap test
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
Aboriginal and Torres Strait Islander women
non-English-speaking backgrounds
rural and remote areas
What are the smear taking instruments
— Ayer’s spatula, wooden or plastic
— Cervex sampler broom
— Cervex-Brush Combi
— endocervical brush
pregnancy—avoid use of the ____ and ____
endocervical brush and the Cervex-Brush Combi
The __________provides better exposure
of the vulva but requires more manipulation of
the patient.
Sims exaggerated left lateral
position
cervix is situated in the _______
upper sixth of the anterior vaginal
wall (not in the apex of the vagina).
A__________ is normal in most premenopausal women and was formerly incorrectly called an erosion.
cervical ectropion
A woman treated for HSIL should have a ______
colposcopy
and cervical cytology at 4–6 months after treatment
three-dose schedule of the quadrivalent HPV vaccine
that protects against:
HPV types 16 and 18 (high risk for cervical cancer) and types 6 and 11 (which cause genital warts).
Currently, the HPV vaccine (Gardasil®)
is administered through the National Immunisation
Program to __________
males and females aged 12–13 years
Women who have been immunised still require
cervical screening because ________
the vaccine does not
prevent all HPV types that cause cervical cancer
Negative smear—no endocervical cells_______
Negative smear—inflammatory cells ______
Unsatisfactory smear________
Repeat in 2 years.
Repeat test in 2 years.
Repeat smear in 6–12 weeks (allows regeneration of cells).
Low-grade epithelial lesion
Possible LSIL and definite LSIL
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
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 ____________
Refer for colposcopy.
Refer to a gynaecologist.
Refer to appropriate specialist gynaecologist or unit.
Refer for colposcopy and possible biopsy
Pending policy approval, in 2017 it is anticipated
that the cervical cancer screening test will transition
from the 2-yearly Pap test to ________
5-yearly HPV DNA
testing
prior to HPV vaccination,
the role of HPV DNA testing was limited as a
screening tool because ________
as many of 25% of women aged <30 were likely to test positive for oncogenic viruses.
