Cervical Cancer Screening

Question 1

What is used to screen for cancer?

Answer 1

LBC - liquid-based cytology

Question 2

How often is it done?

Age ranges used?

Answer 2

3 yrs

25-49 - 3 yrs
50-64 - 5 yrs

Question 3

Procedure - just run through it

Answer 3

1. Speculum to visualise cervix
2. Brush on small broom is inserted and sweeps in cervical os
3. Brush withdrawn and head detached into the fluid vial

Question 4

Results and management:

What is done if it normal?

What is done if it is an inadequate sample?

Answer 4

Routine recall

Repeat ASAP

Question 5

Abnormal results - further testing:

For low-grade squamous dyskaryosis

Answer 5

HPV triage by testing the original sample

If HPV +ve then refer for colposcopy and punch biopsy within 4 wks

If HPV -ve then return to routine recall

Question 6

Abnormal results - further testing:

For high-grade squamous dyskaryosis

Answer 6

Colposcopy with punch biopsy

Treat immediately if visual appearance confirms high-grade dyskaryosis

Question 7

Abnormal results - further testing:

For suspected invasive carcinoma or cervical glandular intra-epithelial neoplasia (CGIN)

Answer 7

Urgent colposcopy

Question 8

Colposcopy:

What should be avoided 1 day before and 10 days after?

What is used to stain abnormal epithelium white?

How is a biopsy taken?

Answer 8

Sex and tampon use

Acetic acid or iodine

Punch biopsy

Question 9

Confirmed CIN is treated with LLETZ. What does this stand for?

Why is it important to ask if they have had this done before in obstetrics?

Alternatives to LLETZ?

Answer 9

Large Loop Excision of the Transformation Zone

Increased irks of preterm rupture of membranes or need for c-section due to cervical incompetence

Cryotherapy
Laser
Cold coagulation
Cone biopsy