Cervical Cancer/Smear Counselling

Question 1

What are the risk factors for cervical carcinoma?

Answer 1

• Multiple partners
• Early age 1st intercourse
• HPV infection (Type 16 & 18)
• Smoking
• Immunocompromised

Question 2

What are the clinical features of cervical carcinoma?

Answer 2

• Asymptomatic* (often picked up on smear)

BLEEDING

• Postmenopausal
• Post-coital
• Intermenstrual
• Pregnancy
• Offensive blood stained vaginal discharge

ADVANCED SIGNS

• Urinary/bowel change
• Haematuria
• Loss of weight
• Back ache

Question 3

What is the epidemiology of cervical cancer?

Answer 3

• Worldwide 2nd most common form in females after breast

- 9:100,000 diagnosed in UK (lower numbers due to screening program)

Question 4

How is cervical cancer investigated?

Answer 4

• Smear
• Colposcopy
• Staining

Question 5

Who is eligible for cervical smear screening?

Answer 5

Ages 25-49yrs = every 3 years

50-64 = every 5 years

May have more monitoring depending on smear results

Question 6

What advice is given before cervical smear test?

Answer 6

• Can have smear test at GP, family planning, GUM clinic or antenatal clinic
• Speculum is a device that will be inserted inside vagina - it has two small plastic arms that will be used to open up vagina
• A small sample of cells from the cervix will be scraped by a brush and these will be sent off to be examined for abnormalities
• Should book an appointment mid-menstrual cycle
• May not need contacting after if results are normal

Question 7

What results may occur from a smear test?

Answer 7

• 9/10 results = normal
• 1/20 mild changes
• 1/100 moderate changes
• 1/200 severe changes
• May need repeat smear

Borderline = cell changes but near normal and probably will go back to normal = repeat smear inn 6 months

Cervical erosion = cells normally inside cervix seen on outside = can cause bleeding but usually resolves by self

ABNORMAL (NB: CIN carcinoma in situ - potential to become cancerous but not yet)
CIN1 = mild
CIN2 = moderate
CIN3 = severe dyskaryosis

Question 8

How are abnormal smear results managed?

Answer 8

MILD

• Colposcopy OR
• Repeat smear in 6 month then need x3 normal 6 month smears one after another before surveillance stops

MODERATE/SEVERE
-Treatment (can do so during colposcopy)

Question 9

What advice is given before a colposcopy procedure?

Answer 9

• Uses a microscope to examine the cervix and biopsies can be taken
• Simple analgesia before procedure can help
• Speculum used to view the cervix
• Acetic acid = rapidly dividing cells appear white
• Iodine solution = normal cells are brown & dysplastic cells appear yellow

Question 10

What treatments can be given during colposcopy?

Answer 10

Excision or ablation (>90% success)

CIN2/3 usually treated by large loop excision of transformation zone
-Complications: bleeding, infection, cervical stenosis/incomplete

Question 11

When is colposcopy contraindicated?

Answer 11

Menstruation, sex/tampon vaginal medications w/i 24h

Question 12

How is cervical cancer managed?

Answer 12

Stage 1a:

• Cone biopsy (saves fertility)
• Simple hysterectomy

Stage 1b
-Total hysterectomy removing lymph nodes, ovaries, radiotherapy and chemotherapy

Stage II to IV
-Usually chemoradiotherapy

Question 13

Who is eligble for the HPV vaccination?

Answer 13

• All girls aged 12-13yrs up to 18 years
• More effective if given before sexual activity
• Immunocompromised also recommended

-Provides immunity for at least 6 years

Question 14

Which strains does HPV vaccination protect against?

Answer 14

HPV 16 & 18

>99% effective

Question 15

What are the side effects of HPV vaccination?

Answer 15

Soreness at injection site
Myalgia
Headache
Tiredness/dizziness

Urticaria (rare)