Cervical Screening Flashcards
Which type of cancer is most commonly linked to HPV?
Cervical cancer
Which other cancers are associated with HPV?
Penis
Vulva/vagina
Anus
Mouth
Oropharynx
How is HPV transmitted?
Close physical contact, often penetrative sex
What age group are more likely to get HPV?
Young people, approx. 15-20
->90% of people clear the HPV infection by their own immune system
Which two types of HPV are the oncogenic types?
HPV 16
HPV 18
What is done for the primary prevention of HPV?
HPV immunisations
->started in 2008, boys included in 2019
Who is offered HPV vaccine?
Secondary children aged 12-13
What is one risk factor for cervical cancer?
Smoking
->interestingly, while genetics can increase chances if it runs in the family, this isn’t as much as other cancers as it tends to be caused by HPV infection
What test is used for cervical screening?
SMEAR tests
Which part of the cervix needs to be tested for HPV in a SMEAR test?
Transformation zone
->this is the are that there are changes seen from HPV to precancer
If there are any minor changes in a SMEAR test, which further test may be carried out?
Colposcopy - test to take a closer look at the cervix
How often are SMEARS taken?
Every 5yrs from age of 25-64
What technique is used in smear tests>
Liquid based cytology
Dyskaryosis?
Abnormal cytology of the cervix
What are some of the nuclear features of dyskaryosis?
Increased size, increased nucelar:cytoplasmic ratio
Variation in size/shape
Coarse irregular chromatin
Which type of cell reflects HPV infection?
Koliocytes
Like previously mentioned, normal smears are repeated every five years.
However, how often is a smear repeated if the patient is positive for HPV but the cytology is normal?
Repeat test in one year
What should be done if there is dyskaryosis on a smear test sample?
Refer to colposcopy
A women gets an invitation to book a colposcopy appointment, What would be the most likely reason for this:
A. Her HPV test is positive
B. She has high risk HPV and low grade dyskaryosis
C. She has low grade dyskaryosis or BNA on cytology
D. Her smear test was unsatisfactory or failed
E. Her smear taker thought her cervix looked abnormal
B.
What happens in colposcopy?
Magnification and light to see the cervix
What does a colposcopy allow for?
Exclusion of obvious malignancy
Use to acetic acid +/- lodene to identify limits of lesion, select biopsy site and define an area to treat
What will be done if colposcopy is done and the cervix looks normal?
Discharged back to have smear repeated in community
What will be done if colposcopy is done and there is low grade changes?
May also be discharged and get another smear in a year
But if unsure, small punch biopsy may be done
What will be done if colposcopy is done and high grade changes were seen?
Punch biopsy to make diagnosis and then offer treatment
List the low risk types of HPV
6, 11, 42, 44
What may be seen in those with low risk HPV?
Genital warts
Low grade CIN
->often transient and resolve
List the high risks types of HPV.
16, 18
-> 21 and 45 but less so
What may be seen in those with high risk types of HPV?
Persistent infection
Increased risks of high grade CIN and cancer
How does HPV cause high grade CIN?
Persistent infection
->viral DNA integrates into host cell genome. Over expression of viral E6 and E7 proteins leading to deregulation of host cell cycle
CIN?
Cervical intraepithelial neoplasia
->disorganised proliferation of abnormal cells in squamous epithelium (dysplasia)
CIN 1?
Low grade dysplasia- will regress
CIN 2?
Moderate dysplasia- may regress
CIN 3?
Severe dysplasia- unlikely to regress. Precursor of invasive cancer
Treatment of CIN 2/3?
Excuse transformation zone of cervix
Ablate the transformation zone of cervix
Why is important to follow up patients after treatment of CIN?
They are at a higher risk of cervical cancer
What is the aim of cervical screening?
A. Detect cervical dyskaryosis
B. Reduce the risk of cervical cancer
C. Detect CIN
D. Prevent cervical cancer
E. Reduce high risk HPV infections
Reduce risks of cervical cancer
->by detecting high risk HPV and cervical dyskaryosis
