Cervical Screening Flashcards

1
Q

What is the main aim of cervical cancer screening?

A

Detect pre malignant changes rather than to detect cancer

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2
Q

Who is screened and how often?

A

All women between 25 and 65
First invitation: age 25
Every 3 years from 25 to 50
Every 5 years from 50-65

After 65 selected patients only

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3
Q

How is cervical screening performed?

A

Explain nature and purpose of test
Visualise cervix with speculum - are there any suspicious areas? If so continue with smear, indicate on referral form, refer for colposcopy under 2ww
Cells collected from cervix - the transformation zone with a brush, which is put in a liquid (liquid based cytology)

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4
Q

How are cytology results classified?

A
Normal
Inadequate (repeat smear)
Borderline changes 20-30% CIN II-III
Mild dyskaryosis 30% CIN II-III
Moderate dyskaryosis 50-75% CINII-III
Severe dyskaryosis 80-90% CIN II-III
Suspected invasion
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5
Q

What should be done if borderline or mild dyskaryosis?

A

HPV test
If positive refer for colposcopy
If negative routine recall

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6
Q

What should be done if moderate or severe dyskaryosis?

A

Refer to colposcopy

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7
Q

What should be done if suspected invasion?

A

Urgent colposcopy

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8
Q

What is the process in Scotland?

A

Women from ages 20-60 screened every 3 years

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9
Q

What is colposcopy?

A

Examination of the cervix by a colposcope - a binocular microscope which magnifies by 6-40x

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10
Q

Describe the colposcopy process

A

Woman in the lithotomy position
Bivalve speculum inserted in vagina
Once cervix visualised, the transformation zone identified and painted with 5% acetic acid - this is preferentially taken up by neoplastic cells
Aceto-white areas identify abnormal areas and this enable punch biopsy to be taken to gain histological diagnosis
Iodine also used - not taken up by neoplastic cells

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11
Q

If there is strong uptake of acetic acid, what can be done?

A

See and treat - perform definitive treatment in same appointment without waiting for biopsy result

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12
Q

Does colposcopy detect adenocarcinoma?

A

No (it usually lies in the endocervical canal)

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13
Q

Can a pregnant woman have a colposcopy?

A

Yes but not a LLETZ

Should wait until 12 w post partum until definitive treatment

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14
Q

How is a Large Loop Excision of the Transformation Zone (LLETZ) performed?

A

In the colposcopy clinic under local anaesthetic using loop diathermy

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15
Q

What features are suggestive of CIN or invasion?

A

Abnormal vascular pattern

Abnormal staining of tissue

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16
Q

How is CIN treated?

A

LLETZ
After this treatment, woman should have smear at 6 months with high risk HPV testing
If negative can return to 3 yearly smears

17
Q

If left untreated, what percentage of CINII-III will progress to cervical cancer?

A

20-30%

18
Q

What complications of LLETZ are there?

A
Haemorrhage
Infection
Vasovagal symptoms 
Anxiety
Cervical stenosis 
Small risk of cervical incompetence and premature delivery
19
Q

When is HPV vaccine offered in UK and to whom?

A

All 12-13 year olds in school year 8
Helps protect against cervical cancer, some mouth and throat cancers, some cancers of anal and genital area and genital warts
Second dose offered 6-12 months after first

20
Q

What percentage of cervical cancers are caused by high risk type HPV?

A

99.7%

21
Q

What does the vaccination programme currently use?

A

Gardasil vaccine - protects against HPV 6,11,16,18