Cervical Screening Flashcards
What age group is invited for cervical screening?
25-64
What does a smear test consist of?
a speculum examination and a collection of cells from the cervix using a small brush - these cells are then stored for liquid-based cytology
What are smear test samples originally tested for?
HPV
If a smear is HPV positive, what is the next step in investigation?
cytology
How often are women aged 25-49 invited for a cervical screening?
every 3 years
How often are women aged 50-64 invited for cervical screening?
every 5 years
Give 5 exceptions to the cervical screening invitation protocol:
1) women with HIV are screened annually
2) women over 65 may request a smear test if they have not had one since aged 50
3) women with previous CIN may require additional screening
4) certain groups of immunocompromised women may have additional screening e.g. those of dialysis or who have had organ transplants
5) pregnant women due a routine smear test should wait until 12 weeks post partum
If a smear test is HPV positive with abnormal cytology, what is the next step in screening?
colposcopy
What is colposcopy?
inserting a speculum and using a colposcope to magnify the cervix to allow visual examination of the epithelial lining of the cervix
What does CIN stand for?
cervical intraepithelial neoplasia
What two stains are used during colposcopy?
1) acetic acid
2) iodine
What is the effect of acetic acid staining in colposcopy?
acetic acid causes abnormal cells to appear white due to their increased nuclear material
What is the effect of Schiller’s iodine test in colposcopy?
iodine will stain healthy cells a brown colour while abnormal areas will not stain
What does LLETZ stand for?
large-loop excision of the transformation zone
What is LLETZ?
a procedure to remove abnormal epithelial tissue of the cervix using a loop of wire with an electrical current
Why should patients with recent LLETZ avoid intercourse and tampons?
LLETZ can cause bleeding and abnormal discharge several weeks after the procedure
Other than cervical cancer, name 6 cancers that can be caused by HPV:
1) anal
2) vulval
3) vaginal
4) penis
5) mouth
6) throat
True or false: HPV is transmitted sexually
true
What two strains of HPV are responsible for around 70% of cervical cancers?
HPV type 16 and 18
Describe how HPV increases risk of cancer:
HPV produces proteins E6 and E7 which inhibit tumour suppressor genes P53 and pRb respectively
Give 4 risk factors for HPV infection:
1) not using condoms
2) early sexual activity
3) increased number of sexual partners
4) sexual partners who have had more patients
Who is the HPV vaccine recommended for?
Males and females 11-12 to 26 years old, preferably before they become sexually active
What HPV vaccine does the NHS currently use?
Gardasil
What 4 strains of HPV does the Gardasil vaccine protect against?
1) type 6
2) type 11
3) type 16
4) type 18
What does type 16 and type 18 HPV cause?
genital warts
When is CIN diagnosed?
colposcopy
Describe CIN 1:
mild dysplasia - affects 1/3 of the thickness of the epithelial layer, likely to return to normal without treatment
Describe CIN 2:
moderate dysplasia - affects 2/3 of the thickness of the epithelial layer, likely to progress to cancer if left untreated (required LLETZ)
Describe CIN 3:
severe dysplasia - very likely to progress to cancer if untreated (also known as cervical carcinoma in situ)
What is CIN?
Cervical intraepithelial neoplasia (CIN), also known as cervical dysplasia, is the abnormal growth of cells on the surface of the cervix that could potentially lead to cervical cancer
