Cervical cancer screening (Complete) Flashcards
What is the main aim of cervical screening?
To detect pre-malignant changes rather than to detect cancer
Who is eligible for cervical screening?
Woman and people with a cervix between the age of 25-64 years.
How frequent is cervical screening?
25-49 years: 3-yearly screening
50-64 years: 5-yearly screening
Which type of woman are exempt from cervical screening?
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)
When is the optimal time to take a cervical smear?
Mid-cycle
N.B. NHS reccomends this but limited evidence to prove this
What is tested for after cervical sample is taken?
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.)
If a person if found to be HPV negative, what is the next step of action?
Return to normal recall
If a person is found to be HPV positive what further tests are conducted?
Cytological examination
(Asseses for signs of dyskaryosis/ dysplasia)
What is dyskariosis?
Change in appearance of cervical cells
Change in cervical appearance of cells is known as?
Dyskaryosis
(AKA Dysplasia)
Cervical Dyplasia/dyskaryosis is also known as?
Cervical intraepithelial neoplasia (CIN)
What are the types of abnormal cytological findings that can be detected from cervical screening? (6)
Borderline
Mild dyskaryosis
Moderate dyskaryosis
Severe dyskaryosis
Invasive squamous cell carcinoma
Glandular neoplasia
If abnormal cytological findings are found, what are the next steps for this patient?
Colposcopy
If no abnormal findings found on cytological testing, what are next steps for patient?
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
If a patient had positive findings for HPV during 24 month follow-up screening, what is the next action to be taken?
Refer for colposcopy
What should be done for patients who have inadequate samples during a cervical screen?
Repeat test in 3 months
If this happens again then refer for colposcopy
How is CIN staged?
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.
CIN 1 is also known as?
Low-grade squamous intraepithelial lesions
CIN 3 is also known as? (2)
High-grade or severe dysplasia
Stage 0 cervical carcinoma in situ
What is the management plan for patients with CIN?
Invasive/Surgical:
Large loop excision of transformation zone (LLETZ)
Follow-up:
Test of cure (TOC) repeat cervical sample in the community after 6 months
Apart from cervical screening, what other preventative measures have been implemented to reduce rates of cervical cancer?
HPV vaccination programme
Who is eligable for HPV vaccination?
Girls and boys aged 12 to 13 years
Besides cervical cancer, what cancers/conditions is HPV linked to?
Anal cancers (85%)
Vulval and vaginal cancers (50%)
Mouth and throat cancers (20-30%)
Genital warts
What HPV serotypes are associated with cancer? (2)
16
18
What HPV serotypes are associated with genital warts? (2)
6
11
What is the name of the HPV vaccination?
Gardasil
What HPV serotypes are covered by Gardasil?
6
11
16
18
31
33
45
52
58
How many doses of Gardasil are given to children?
One dose
N.B. used to be 2 doses but recent paper suggests one dose sufficient as of september 2023
Which individuals are given >1 dosage of HPV vaccination?
GBSMS 25-45 years: Offered via sexual health clinics
Immunocompromised/HIV-positive: 3-dose course
