Cervical Screening Flashcards
What is the peak prevalence of HPV infection?
15 -25yrs
What areas are mostly affected by HPV infection?
Cervix Oropharynx Vulva/vagina Anus Mouth Penis
What type of HPV are girls immunised against?
16 and 18
How many doses are given of the HPV vaccine?
3
What age range is offered cervical screening and what are the time intervals between smears?
Women aged 25-64
3 yearly smears up to 50
5 yearly from 50
What type of test is used to analyse cervical smears?
Liquid based cytology
What are cytologist looking for in cervical smears?
Detection of abnormal squamous cells
What is the sating method used for cervical smears?
Papinicolaou
What features should be present in normal cervical cytology?
Squamous epithelial cells
Small, uniform size and shape, fine regular chromatin evenly distributed
What features are found in abnormal cervical cytology?
Increased size and nuclear: cytoplasmic ratio
Variation in size, shape and outline
Coarse irregular chromatin
What is the cytology management of a low grade dyskaryosis?
Repeat in 6 months
What is the cytology management of a high grade dyskaryosis?
Refer to colposcopy
What are the management options at the time of colposcopy?
Punch biopsy for diagnosis
Return for treatment if CIN2/3
What is the transformation zone?
Glandular lining cells of exposed endocervical epithelium transformed into squamous cells
Why is associated with the transformation zone?
Site of HPV infection
How does HPV virus take host in the body?
Infects basal layer cells
Utilises host by replication
As host cells matures, different viral genes expressed
What is koliocytosis?
Cells with wrinkled nucleus and perinuclear halo
Mulitnucleation
What is cervical intraepithelial neoplasia?
Abnormal proliferation of cells in squamous epithelium, invisible to naked eye
What are the risk factors for CIN?
HPV, particularly types 16 and 18 Early age at first intercourse Multiple sexual partners Prolonged oral contraceptive use Smoking STDs Immunodifficiency
What is squamous carcinoma of the cervix?
Malignant change in squamous cells of transformation zone of cervix
What are the treatment options for cervical squamous carcinoma?
LLETZ
Cold coagulation
Laser ablation
What is the follow-up after treatment of CIN?
LBC 6 months for cytology and high risk HPV
What are the risk factors associated with cervical cancer?
HPV related (16 and 18) Multiple partners Early age at first intercourse Older age of partner Smoking
What are the symptoms of cervical cancer?
Abnormal vaginal bleeding Post coital bleeding Intermenstrual bleeding/ PMB Discharge Pain
What is removed during a radical hysterectomy?
Uterus, cervix, upper vagina
Parametria
Pelvic nodes
What are the treatment options available for cervical cancer?
Radiotherapy
Chemotherapy
Caesium insertion
What type of chemotherapy is used for cervical cancer?
5 cycles of cisplatin
