Cervical Screening

Question 1

What is the peak prevalence of HPV infection?

Answer 1

15 -25yrs

Question 2

What areas are mostly affected by HPV infection?

Answer 2

Cervix 
Oropharynx 
Vulva/vagina 
Anus 
Mouth 
Penis

Question 3

What type of HPV are girls immunised against?

Answer 3

16 and 18

Question 4

How many doses are given of the HPV vaccine?

Answer 4

3

Question 5

What age range is offered cervical screening and what are the time intervals between smears?

Answer 5

Women aged 25-64
3 yearly smears up to 50
5 yearly from 50

Question 6

What type of test is used to analyse cervical smears?

Answer 6

Liquid based cytology

Question 7

What are cytologist looking for in cervical smears?

Answer 7

Detection of abnormal squamous cells

Question 8

What is the sating method used for cervical smears?

Answer 8

Papinicolaou

Question 9

What features should be present in normal cervical cytology?

Answer 9

Squamous epithelial cells

Small, uniform size and shape, fine regular chromatin evenly distributed

Question 10

What features are found in abnormal cervical cytology?

Answer 10

Increased size and nuclear: cytoplasmic ratio
Variation in size, shape and outline
Coarse irregular chromatin

Question 11

What is the cytology management of a low grade dyskaryosis?

Answer 11

Repeat in 6 months

Question 12

What is the cytology management of a high grade dyskaryosis?

Answer 12

Refer to colposcopy

Question 13

What are the management options at the time of colposcopy?

Answer 13

Punch biopsy for diagnosis

Return for treatment if CIN2/3

Question 14

What is the transformation zone?

Answer 14

Glandular lining cells of exposed endocervical epithelium transformed into squamous cells

Question 15

Why is associated with the transformation zone?

Answer 15

Site of HPV infection

Question 16

How does HPV virus take host in the body?

Answer 16

Infects basal layer cells
Utilises host by replication
As host cells matures, different viral genes expressed

Question 17

What is koliocytosis?

Answer 17

Cells with wrinkled nucleus and perinuclear halo

Mulitnucleation

Question 18

What is cervical intraepithelial neoplasia?

Answer 18

Abnormal proliferation of cells in squamous epithelium, invisible to naked eye

Question 19

What are the risk factors for CIN?

Answer 19

HPV, particularly types 16 and 18 
Early age at first intercourse 
Multiple sexual partners 
Prolonged oral contraceptive use 
Smoking 
STDs 
Immunodifficiency

Question 20

What is squamous carcinoma of the cervix?

Answer 20

Malignant change in squamous cells of transformation zone of cervix

Question 21

What are the treatment options for cervical squamous carcinoma?

Answer 21

LLETZ
Cold coagulation
Laser ablation

Question 22

What is the follow-up after treatment of CIN?

Answer 22

LBC 6 months for cytology and high risk HPV

Question 23

What are the risk factors associated with cervical cancer?

Answer 23

HPV related (16 and 18)
Multiple partners 
Early age at first intercourse 
Older age of partner 
Smoking

Question 24

What are the symptoms of cervical cancer?

Answer 24

Abnormal vaginal bleeding 
Post coital bleeding 
Intermenstrual bleeding/ PMB 
Discharge 
Pain

Question 25

What is removed during a radical hysterectomy?

Answer 25

Uterus, cervix, upper vagina
Parametria
Pelvic nodes

Question 26

What are the treatment options available for cervical cancer?

Answer 26

Radiotherapy
Chemotherapy
Caesium insertion

Question 27

What type of chemotherapy is used for cervical cancer?

Answer 27

5 cycles of cisplatin