Cervical Screening

Question 1

Which type of cancer is most commonly linked to HPV?

Answer 1

Cervical cancer

Question 2

Which other cancers are associated with HPV?

Answer 2

Penis
Vulva/vagina
Anus
Mouth
Oropharynx

Question 3

How is HPV transmitted?

Answer 3

Close physical contact, often penetrative sex

Question 4

What age group are more likely to get HPV?

Answer 4

Young people, approx. 15-20

->90% of people clear the HPV infection by their own immune system

Question 5

Which two types of HPV are the oncogenic types?

Answer 5

HPV 16
HPV 18

Question 6

What is done for the primary prevention of HPV?

Answer 6

HPV immunisations

->started in 2008, boys included in 2019

Question 7

Who is offered HPV vaccine?

Answer 7

Secondary children aged 12-13

Question 8

What is one risk factor for cervical cancer?

Answer 8

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

Question 9

What test is used for cervical screening?

Answer 9

SMEAR tests

Question 10

Which part of the cervix needs to be tested for HPV in a SMEAR test?

Answer 10

Transformation zone

->this is the are that there are changes seen from HPV to precancer

Question 11

If there are any minor changes in a SMEAR test, which further test may be carried out?

Answer 11

Colposcopy - test to take a closer look at the cervix

Question 12

How often are SMEARS taken?

Answer 12

Every 5yrs from age of 25-64

Question 13

What technique is used in smear tests>

Answer 13

Liquid based cytology

Question 14

Dyskaryosis?

Answer 14

Abnormal cytology of the cervix

Question 15

What are some of the nuclear features of dyskaryosis?

Answer 15

Increased size, increased nucelar:cytoplasmic ratio
Variation in size/shape
Coarse irregular chromatin

Question 16

Which type of cell reflects HPV infection?

Answer 16

Koliocytes

Question 17

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?

Answer 17

Repeat test in one year

Question 18

What should be done if there is dyskaryosis on a smear test sample?

Answer 18

Refer to colposcopy

Question 19

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

Answer 19

B.

Question 20

What happens in colposcopy?

Answer 20

Magnification and light to see the cervix

Question 21

What does a colposcopy allow for?

Answer 21

Exclusion of obvious malignancy
Use to acetic acid +/- lodene to identify limits of lesion, select biopsy site and define an area to treat

Question 22

What will be done if colposcopy is done and the cervix looks normal?

Answer 22

Discharged back to have smear repeated in community

Question 23

What will be done if colposcopy is done and there is low grade changes?

Answer 23

May also be discharged and get another smear in a year

But if unsure, small punch biopsy may be done

Question 24

What will be done if colposcopy is done and high grade changes were seen?

Answer 24

Punch biopsy to make diagnosis and then offer treatment

Question 25

List the low risk types of HPV

Answer 25

6, 11, 42, 44

Question 26

What may be seen in those with low risk HPV?

Answer 26

Genital warts
Low grade CIN

->often transient and resolve

Question 27

List the high risks types of HPV.

Answer 27

16, 18

-> 21 and 45 but less so

Question 28

What may be seen in those with high risk types of HPV?

Answer 28

Persistent infection
Increased risks of high grade CIN and cancer

Question 29

How does HPV cause high grade CIN?

Answer 29

Persistent infection

->viral DNA integrates into host cell genome. Over expression of viral E6 and E7 proteins leading to deregulation of host cell cycle

Question 30

CIN?

Answer 30

Cervical intraepithelial neoplasia

->disorganised proliferation of abnormal cells in squamous epithelium (dysplasia)

Question 31

CIN 1?

Answer 31

Low grade dysplasia- will regress

Question 32

CIN 2?

Answer 32

Moderate dysplasia- may regress

Question 33

CIN 3?

Answer 33

Severe dysplasia- unlikely to regress. Precursor of invasive cancer

Question 34

Treatment of CIN 2/3?

Answer 34

Excuse transformation zone of cervix
Ablate the transformation zone of cervix

Question 35

Why is important to follow up patients after treatment of CIN?

Answer 35

They are at a higher risk of cervical cancer

Question 36

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

Answer 36

Reduce risks of cervical cancer

->by detecting high risk HPV and cervical dyskaryosis