Cervical Cancer Screening Flashcards
types of HPV that cause cervical cancer
16 and 18
who gets a HPV vaccine
all boys and girls ages 12-13
put the following cancer sites in order of % of cases caused by HPV
a) penis
b) vulva/vagina
c) cervix
d) mouth
e) anus
f) oropharynx
cervix, anus, penis, vulva/vagina, oropharnyx and mouth
% of cervical cancers caused by HPV
> 99%
who recieves cervical screening
women 25-49 every 3 years
women 49-65 every 5 years
in what circumstances would you screen a women >65 y/o
if she had not been screened since 50 y/o or if she had a recent smear that required follow up
method of cervical sampling
Liquid-Based Cytology - brush swept around squamocolumnar junction and snapped off in a pot of liquid
how is HPV tested for
by hybridisation and PCR
how is dyskaryosis identified
on cytology with the cells stained by PAP method
what do abnormal cells on smear look like
big with bigger nuclei with coarse and irregular chromatin
low grade dyskaryosis = CIN _
1
high grade infection = CIN _
2 or 3
what is CIN
cervical intraepithelial neoplasia - a pre-cancerous state
how does HPV cause cervical cancer
disrupts host cell cycle by overexpression of proteins E6 and E7
what cells seen on cytology indicate HPV infection
koilocytes - wrinkled nuclei with perinuclear halo
next steps if someone has mild dyskaryosis
HPV test
if +ve then colposcopy
if -ve then back to routine screening
next steps with moderate dyskaryosis
colposcopy within 2 weeks
next steps with severe dyskaryosis
colposcopy within 2 weeks
recall following treatment for CIN 1, 2 and 3
cytology 6 months later
someone who had CIN 2 returns for a repeat cytology 6 months after treatment. What results would require a colposcopy
HPV +ve or dyskaryosis
what happens on colposcopy
observe for obvious malignancy
apply acetic acid +/- iodine to show up lesion
take punch biopsy of lesion
treatment of dyskaryosis
LLETZ
thermal coagulation
laser ablation
true/false only CIN 2 and 3 should recieve treatment
true - CIN 1 is likely to regress
what is the likelihood of dyskaryosis recurring following treatment
5% in 3-5 years
