Cervical Cancer Screening

Question 1

types of HPV that cause cervical cancer

Answer 1

16 and 18

Question 2

who gets a HPV vaccine

Answer 2

all boys and girls ages 12-13

Question 3

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

Answer 3

cervix, anus, penis, vulva/vagina, oropharnyx and mouth

Question 4

% of cervical cancers caused by HPV

Answer 4

> 99%

Question 5

who recieves cervical screening

Answer 5

women 25-49 every 3 years

women 49-65 every 5 years

Question 6

in what circumstances would you screen a women >65 y/o

Answer 6

if she had not been screened since 50 y/o or if she had a recent smear that required follow up

Question 7

method of cervical sampling

Answer 7

Liquid-Based Cytology - brush swept around squamocolumnar junction and snapped off in a pot of liquid

Question 8

how is HPV tested for

Answer 8

by hybridisation and PCR

Question 9

how is dyskaryosis identified

Answer 9

on cytology with the cells stained by PAP method

Question 10

what do abnormal cells on smear look like

Answer 10

big with bigger nuclei with coarse and irregular chromatin

Question 11

low grade dyskaryosis = CIN _

Answer 11

1

Question 12

high grade infection = CIN _

Answer 12

2 or 3

Question 13

what is CIN

Answer 13

cervical intraepithelial neoplasia - a pre-cancerous state

Question 14

how does HPV cause cervical cancer

Answer 14

disrupts host cell cycle by overexpression of proteins E6 and E7

Question 15

what cells seen on cytology indicate HPV infection

Answer 15

koilocytes - wrinkled nuclei with perinuclear halo

Question 16

next steps if someone has mild dyskaryosis

Answer 16

HPV test
if +ve then colposcopy
if -ve then back to routine screening

Question 17

next steps with moderate dyskaryosis

Answer 17

colposcopy within 2 weeks

Question 18

next steps with severe dyskaryosis

Answer 18

colposcopy within 2 weeks

Question 19

recall following treatment for CIN 1, 2 and 3

Answer 19

cytology 6 months later

Question 20

someone who had CIN 2 returns for a repeat cytology 6 months after treatment. What results would require a colposcopy

Answer 20

HPV +ve or dyskaryosis

Question 21

what happens on colposcopy

Answer 21

observe for obvious malignancy
apply acetic acid +/- iodine to show up lesion
take punch biopsy of lesion

Question 22

treatment of dyskaryosis

Answer 22

LLETZ
thermal coagulation
laser ablation

Question 23

true/false only CIN 2 and 3 should recieve treatment

Answer 23

true - CIN 1 is likely to regress

Question 24

what is the likelihood of dyskaryosis recurring following treatment

Answer 24

5% in 3-5 years

Question 25

what is the likelihood of dyskaryosis recurring following treatment

Answer 25

5% in 3-5 years

Question 26

next steps when HPV is +ve but no dyskaryosis

Answer 26

recall after 1 year