Cervical screening

Question 1

what is the abnormal growth of squamous cells detectable on a smear called?

Answer 1

squamous intraepithelial lesion (SIL). Abnormal cells in the cervix detected by biopsy and histological examination are classified as cervical intraepithelial neoplasia (CIN). Graded 1 to 3 according to the proportion of cervix affected.

Question 2

outline the UK HPV immunisation programme

Answer 2

2 dose regime of 16/11/18/6 Quadrivalent vaccine

Question 3

what age is it started at?

Answer 3

25

Question 4

Taking Screening Sample - how is this taken?

Answer 4

5 yearly smears , Liquid Based Cytology (LBC), Test for high risk HPV, If positive; triage with cytology

Question 5

what is a HPV test?

Answer 5

Molecular test on cells sampled from cervix, Identifies high risk type HPV viral DNA or RNA, Any high risk type →→type specific genotyping, Works on LBC samples,

Technology: Hybridisation, PCR

Question 6

what is a cervical cytology sample?

Answer 6

Microscopic assessment of cells scraped from the transformation zone, Look for abnormal cells (dyskaryosis), indicate that woman has underlying cervical intraepithelial neoplasia - CIN

Question 7

what are the 2 components of the cervical canal?

Answer 7

endocervix - columnar epithelium, ectocervix - squamous epithelium

Question 8

The majority of cells present are

Answer 8

mature squamous cells,

Question 9

what method is the slide stained by

Answer 9

The slide is then stained by the Papanicolaou method for viewing under the microscope.

Question 10

where are women reffered after a abnormal smear is detected?

Answer 10

for a colposcopy

Question 11

Dyskaryosis has what features?

Answer 11

abnormal cells, Nuclear features: increased size and nuclear:cytoplasmic ratio, variation in size, shape and outline, coarse irregular chromatin, nucleoli

Question 12

what do Koilocytes reflect?

Answer 12

HPV infecition

Question 13

how do HPV tests and cytology differ?

Answer 13

HPV - cervical cells, machine, indentifies infection which could be transient or CIN associated, sensitive.
Cytology - cervicl cells, human interpretation, indentifies cellular chhanges (low grade - persisting infection/CIN1, high grade - CIN 2/3), specific.

Question 14

what happens if +ve hrHPV?

Answer 14

if cytology is normal repeat the test in 1 year BUT if the cytology shows dyskaryosis then refer to colposcopy

Question 15

what is a Colposcopy?

Answer 15

Colposcopy is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix as well as the vagina and vulva. Many pre-malignant lesions and malignant lesions in these areas have discernible characteristics that can be detected through the examination.

Question 16

what is it used for and how is it done?

Answer 16

excluding obvious malignancy, magnificaiton and light to see the cervix, use of acetic acid/ iodene to identify areas to treat, identify limits of the lesion, select the biopsy site. PUNCH BIOPSY DONE TO MAKE A DIAGNOSIS. Return for tx if CIN2/3

Question 17

what is the action of HPV in the transformation zone?

Answer 17

infects the basal layer, utilises the host for replication, as the host cell matures different viral genes are expressed.

Question 18

describe the histology of HPV infection of koliocytosis

Answer 18

cells wit wrinkled nuclei and periuclear halo. Multinucleation

Question 19

which are low risk HPV types?

Answer 19

6, 11, 42, 44 - geital warts ad low grade CIN, ofte trasient ad resolve.

Question 20

which are high risk HPV types?

Answer 20

16, 18, 31, 45, persistent infection increases the risk of developing high grade CIN and more cancer.

Question 21

how does HPV cause high grade CIN?

Answer 21

persistent infection, viral DNA integrates into the host cell genome, overexpressio of viral e6 ad e7 protein, deregulation of the host cell cycle.

Question 22

histology of CIN3

Answer 22

Neoplastic cells or undifferentiated cells fill full thickness of epith here , no normal differentiated cells seen

Question 23

summarise what CIN is…

Answer 23

Disorganised proliferation of abnormal cells in squamous epithelium (dysplasia), Lack of maturation, variation in cellular size and shape, nuclear enlargement, irregularity, hyperchromasia, cellular disarray, CIN 1: low grade dysplasia–will regress, CIN 2: moderate dysplasia – may regress, CIN 3: severe dysplasia – unlikely to regress, Precursor of invasive cancer, it is invisible to the naked eye.

Question 24

how is CIN treated?

Answer 24

LLETZ, Thermal Coagulation, Laser ablation