Cervical disease Flashcards
Causes of inadequate pap smears
- Failure to complete full 360 of cervical circumference.
- Blood/ inflammatory cells can obscure visualisation
- Atrophic changes
CIN1
- Definition
- Cancerous risk
- Management
Cervical intraepithelial neoplasm 1
- Grade 1 cervical dysplasia
- Confined to 1/3 of the epithelium
High rate of regression back to normal cells
Management
- Rescreen smear within 12 months
CIN2
- Definition/ features
- Cancer risk
- Management
Cervical intrapithelial neoplasm 2- moderate grade cervical dysplasia
- Confined to 2/3 of basal epithelial
- CIN2+ = CIN2, CIn3, adenocarcinoma in situ and cervical cancer
- Slow rate of progression to higher grade/ malignant changes
Management
- LETTZ/ Cone biopsy
- Rescreen in 6 months
CIN3
- Definition
- Cancerous risk
- Management
Severe cervical dysplasia/ carcinoma in-situ
- More than 2/3 or full thickness of basal epithelium
- If carcinoma, confined to surface of cervix
- Lesion may resolve spontaneously
Management
- LETTZ/Cone biopsy
- Rescreen in 6 months
LLETZ procedure
- Definition
- Indication
Large loop excision of the transformation zone
- Method of removing the transformation zone/ lesions of CIN from the cervix using diathermy.
- Carried out under Local anaesthetic
Indicated by CIN2/CIN3
Complications of LLETZ procedure
Cervical stenosis due to significant scarring that could occur.
- This can make follow up smear more difficult
Cervical incompetence
Increased risk of pyometra.
Increased risk of 2nd trimester miscarriage.
Incomplete excision
The commonest HPV genotypes associated with invasive cervical cancer are…
HPV 16 and 18.
- 16 is associated with the majority of squamous cell carcinomas (60%).
HPV vaccines
Cervarix
- Bilvalent HPV vaccine that immunises against types 18 and 16.
Gardasil
- Quadravalent HPV vaccine that immunises against 6, 11, 16 and 18.
- Currently used in national HPV immunisation programme
Most common cervical cancer subtypes
Squamous cell carcinoma (80%)
Adenocarcinoma (15%)
Cervical screening programme
- Age
- Re-screening time periods
- Process
- Follow ups
First invitation occurs at 24.5, up to 65.
- every 3 years up to 50, then every 5 years.
Pap smear that detects HPV virus and a sample for cytology is HPV+
HPV+ and normal cytology= rescreen in 12 months
HPV + and abnormal cytology= referral to colposcopy
Colposcopy in cervical screening
Occurs when smear shows HPV+ and abnormal cytology
Acetic acid and iodine to used to look for abnormal tissue
- White (acetic) or brown (iodine) is abnormal
CIN1 can be rescreen in 12 months.
CIN2/3 is treated with LLETZ/ cone biopsy
HPV vaccination programme
Offered to boys and girls from age 12
- Aim to offer before being sexually active
In UK programme, quadrivalent vaccine Gardasil provides immunity against HPV 6, 11, 16 and 18.
Inadequate routine pap smears must be repeated after…
At least 3 months
Routine pap smears can only occur how long post-partum?
12 weeks
Cervical cancer presentation
PV bleeding
- Post-coital
- Intermenstrual
- Post-menopausal
Dyspareunia
Pelvic pain
