Cervical screening

Question 1

What is cervical intraepithelial neoplasia?

Answer 1

Premalignant changes to cervix
Without treatment, may progress to cancer
Asymptomatic

Question 2

What is cervical intraepithelial neoplasia triggered by?

Answer 2

Persistant infection of HPV

Question 3

What are risk factors for cervical intraepithelial neoplasia?

Answer 3

Smoking
COCP
Immunosuppression
Socio-economic factors
DES exposure

Question 4

What are common HPV types?

Answer 4

Oncogenic:
- Types 16 and 18 account for 70% of cervical cancers

Non-oncogenic:
- Types 6&11 = genital warts

Question 5

How does HPV infect?

Answer 5

Infects skin and mucosal sites through skin-to-skin contact

Sexually transmitted

Question 6

What is the national HPV vaccination programme?

Answer 6

National HPV Immunisation Programme for girls in Year 8 began in September 2008 - now girls and boys can have vaccine up to 25

Question 7

Explain the process of HPV testing

Answer 7

HPV negative – routine recall
HPV positive, no abnormal cells – 12 month follow up
HPV positive, abnormal cells – referred to colposcopy

Question 8

What is colposcopy?

Answer 8

Examination of the cervix using light source with magnification

Question 9

What can be seen on colposcopy?

Answer 9

Vulva and Anal disease
- Discolouration of skin – white patches
- Texture – lichenification, thinning
- Skin splits (fissuring)
- Ulcers or erosions
- Rashes
- Labial fusion
- Evidence of FGM

Vaginal examination
- Warts, VAIN
- Infection

Examination of cervix
- Nabothian follicles/polyps
- Past LLETZ/cone biopsy
- Obvious invasion
- Cervicitis
- Infection
- Coil threads