Cervical Screening Flashcards

1
Q

What percentage of cervical cancers are HPV-related?

A

> 99%

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2
Q

What other cancers can be caused by HPV than cervical?

A
  • Penis
  • Vulva/vagina
  • Anus
  • Mouth
  • Oropharynx
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3
Q

How are HPV immunisations given in the UK?

A

The UK HPV immunisation schedule currently involves a quadrivalent vaccine against HPV 16, 18, 6 and 11. This increased in 2012 from a bivalent vaccine against HPV 16 and 18

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4
Q

How are screening samples for cervical cancer taken?

A
  • Women aged 25-64 years
  • 5 yearly smears
  • Liquid Based Cytology (LBC)
  • Test for high risk HPV
  • If positive; triage with cytology
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5
Q

What is abnormal cytology of the cervix known as?

A

Dyskaryosis

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6
Q

What are the cytological features of dyskaryosis?

A
  • Increased size and nuclear:cytoplasmic ratio
  • Variation in size, shape and outline
  • Coarse irregular chromatin
  • Nucleoli
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7
Q

What steps need to be taken after cervical screening testing?

A
  • Negative- recall at routine five years
  • Positive for hrHPV but normal cytology- repeat test after one year
  • Dyskaryosis- refer for colposcopy
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8
Q

What is involved in colposcopy?

A
  • Magnification and light to see cervix
  • Exclude obvious malignancy
  • Use of acetic acid =/- Iodene to identify the limits of lesion, select the biopsy site or define area to treat
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9
Q

What are the options for management during colposcopy?

A
  • Punch biopsy to make a diagnosis
  • Return for Treatment if CIN2/3
  • “See and treat” at first visit
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10
Q

How does HPV infection affect the cervix?

A

HPV infects the basal layer of the transformation zone, utilising the host for reception. As the host cell matures, different viral genes are expressed

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11
Q

What are the high risk types of HPV?

A

16, 18, 31 and 45

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12
Q

How does HPV infection cause CIN?

A

HPV causes high risk CIN as a result of persistent infection causing the following processes:
•Viral DNA integrates into host cell genome
•Overexpression of viral E6 and E7 proteins
•Deregulation of host cell cycle

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13
Q

How is CIN graded?

A
  • CIN 1: low grade dysplasia–will regress
  • CIN 2: moderate dysplasia – may regress
  • CIN 3: severe dysplasia – unlikely to regress
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14
Q

How is CIN treated?

A

LLETZ, thermal coagulation or laser ablation

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15
Q

Why should treatment of CIN be followed up?

A
  • Confirm effectiveness of treatment
  • Prevent invasive cancer
  • Reassure patient
  • Increased risk of cervical cancer
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