Cervical Screening

Question 1

What age group is invited for cervical screening?

Answer 1

25-64

Question 2

What does a smear test consist of?

Answer 2

a speculum examination and a collection of cells from the cervix using a small brush - these cells are then stored for liquid-based cytology

Question 3

What are smear test samples originally tested for?

Answer 3

HPV

Question 4

If a smear is HPV positive, what is the next step in investigation?

Answer 4

cytology

Question 5

How often are women aged 25-49 invited for a cervical screening?

Answer 5

every 3 years

Question 6

How often are women aged 50-64 invited for cervical screening?

Answer 6

every 5 years

Question 7

Give 5 exceptions to the cervical screening invitation protocol:

Answer 7

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

Question 8

If a smear test is HPV positive with abnormal cytology, what is the next step in screening?

Answer 8

colposcopy

Question 9

What is colposcopy?

Answer 9

inserting a speculum and using a colposcope to magnify the cervix to allow visual examination of the epithelial lining of the cervix

Question 10

What does CIN stand for?

Answer 10

cervical intraepithelial neoplasia

Question 11

What two stains are used during colposcopy?

Answer 11

1) acetic acid
2) iodine

Question 12

What is the effect of acetic acid staining in colposcopy?

Answer 12

acetic acid causes abnormal cells to appear white due to their increased nuclear material

Question 13

What is the effect of Schiller’s iodine test in colposcopy?

Answer 13

iodine will stain healthy cells a brown colour while abnormal areas will not stain

Question 14

What does LLETZ stand for?

Answer 14

large-loop excision of the transformation zone

Question 15

What is LLETZ?

Answer 15

a procedure to remove abnormal epithelial tissue of the cervix using a loop of wire with an electrical current

Question 16

Why should patients with recent LLETZ avoid intercourse and tampons?

Answer 16

LLETZ can cause bleeding and abnormal discharge several weeks after the procedure

Question 17

Other than cervical cancer, name 6 cancers that can be caused by HPV:

Answer 17

1) anal
2) vulval
3) vaginal
4) penis
5) mouth
6) throat

Question 18

True or false: HPV is transmitted sexually

Answer 18

true

Question 19

What two strains of HPV are responsible for around 70% of cervical cancers?

Answer 19

HPV type 16 and 18

Question 20

Describe how HPV increases risk of cancer:

Answer 20

HPV produces proteins E6 and E7 which inhibit tumour suppressor genes P53 and pRb respectively

Question 21

Give 4 risk factors for HPV infection:

Answer 21

1) not using condoms
2) early sexual activity
3) increased number of sexual partners
4) sexual partners who have had more patients

Question 22

Who is the HPV vaccine recommended for?

Answer 22

Males and females 11-12 to 26 years old, preferably before they become sexually active

Question 23

What HPV vaccine does the NHS currently use?

Answer 23

Gardasil

Question 24

What 4 strains of HPV does the Gardasil vaccine protect against?

Answer 24

1) type 6
2) type 11
3) type 16
4) type 18

Question 25

What does type 16 and type 18 HPV cause?

Answer 25

genital warts

Question 26

When is CIN diagnosed?

Answer 26

colposcopy

Question 27

Describe CIN 1:

Answer 27

mild dysplasia - affects 1/3 of the thickness of the epithelial layer, likely to return to normal without treatment

Question 28

Describe CIN 2:

Answer 28

moderate dysplasia - affects 2/3 of the thickness of the epithelial layer, likely to progress to cancer if left untreated (required LLETZ)

Question 29

Describe CIN 3:

Answer 29

severe dysplasia - very likely to progress to cancer if untreated (also known as cervical carcinoma in situ)

Question 30

What is CIN?

Answer 30

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