Cervical cancer screening (Complete)

Question 1

What is the main aim of cervical screening?

Answer 1

To detect pre-malignant changes rather than to detect cancer

Question 2

Who is eligible for cervical screening?

Answer 2

Woman and people with a cervix between the age of 25-64 years.

Question 3

How frequent is cervical screening?

Answer 3

25-49 years: 3-yearly screening

50-64 years: 5-yearly screening

Question 4

Which type of woman are exempt from cervical screening?

Answer 4

Pregnant woman: Delayed until 3 months-post partum and only done if previous abnormal findings/missed screenings

Woman who have never been sexually active (Can opt out due to very low risk of cervical cancer)

Question 5

When is the optimal time to take a cervical smear?

Answer 5

Mid-cycle

N.B. NHS reccomends this but limited evidence to prove this

Question 6

What is tested for after cervical sample is taken?

Answer 6

High-risk HPV viruses

N.B. (The NHS has now moved to an HPV first system, i.e. a sample is tested for high-risk strains of human papillomavirus (hrHPV) first and cytological examination is only performed if this is positive.)

Question 7

If a person if found to be HPV negative, what is the next step of action?

Answer 7

Return to normal recall

Question 8

If a person is found to be HPV positive what further tests are conducted?

Answer 8

Cytological examination

(Asseses for signs of dyskaryosis/ dysplasia)

Question 9

What is dyskariosis?

Answer 9

Change in appearance of cervical cells

Question 10

Change in cervical appearance of cells is known as?

Answer 10

Dyskaryosis

(AKA Dysplasia)

Question 11

Cervical Dyplasia/dyskaryosis is also known as?

Answer 11

Cervical intraepithelial neoplasia (CIN)

Question 12

What are the types of abnormal cytological findings that can be detected from cervical screening? (6)

Answer 12

Borderline

Mild dyskaryosis

Moderate dyskaryosis

Severe dyskaryosis

Invasive squamous cell carcinoma

Glandular neoplasia

Question 13

If abnormal cytological findings are found, what are the next steps for this patient?

Answer 13

Colposcopy

Question 14

If no abnormal findings found on cytological testing, what are next steps for patient?

Answer 14

Because they are HPV positive, they would have to get a repeat screen after 12 months.

If still positive, repeat again in a years time (at 24 months)

If still positive at 24 months refer for colposcopy

Question 15

If a patient had positive findings for HPV during 24 month follow-up screening, what is the next action to be taken?

Answer 15

Refer for colposcopy

Question 16

What should be done for patients who have inadequate samples during a cervical screen?

Answer 16

Repeat test in 3 months

If this happens again then refer for colposcopy

Question 17

How is CIN staged?

Answer 17

CIN1: 1/3rd thickeness of surface layer of cervix is affecred

CIN2 — 2/3rds of the thickness of the surface layer of the cervix is affected.

CIN3: Full thickness of the surface layer is affected.

Question 18

CIN 1 is also known as?

Answer 18

Low-grade squamous intraepithelial lesions

Question 19

CIN 3 is also known as? (2)

Answer 19

High-grade or severe dysplasia

Stage 0 cervical carcinoma in situ

Question 20

What is the management plan for patients with CIN?

Answer 20

Invasive/Surgical:
Large loop excision of transformation zone (LLETZ)

Follow-up:
Test of cure (TOC) repeat cervical sample in the community after 6 months

Question 21

Apart from cervical screening, what other preventative measures have been implemented to reduce rates of cervical cancer?

Answer 21

HPV vaccination programme

Question 22

Who is eligable for HPV vaccination?

Answer 22

Girls and boys aged 12 to 13 years

Question 23

Besides cervical cancer, what cancers/conditions is HPV linked to?

Answer 23

Anal cancers (85%)

Vulval and vaginal cancers (50%)

Mouth and throat cancers (20-30%)

Genital warts

Question 24

What HPV serotypes are associated with cancer? (2)

Answer 24

16

18

Question 25

What HPV serotypes are associated with genital warts? (2)

Answer 25

6

11

Question 26

What is the name of the HPV vaccination?

Answer 26

Gardasil

Question 27

What HPV serotypes are covered by Gardasil?

Answer 27

6
11
16
18
31
33
45
52
58

Question 28

How many doses of Gardasil are given to children?

Answer 28

One dose

N.B. used to be 2 doses but recent paper suggests one dose sufficient as of september 2023

Question 29

Which individuals are given >1 dosage of HPV vaccination?

Answer 29

GBSMS 25-45 years: Offered via sexual health clinics

Immunocompromised/HIV-positive: 3-dose course