Cervical Screening Flashcards
What is the main aim of cervical cancer screening?
Detect pre malignant changes rather than to detect cancer
Who is screened and how often?
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
How is cervical screening performed?
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)
How are cytology results classified?
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
What should be done if borderline or mild dyskaryosis?
HPV test
If positive refer for colposcopy
If negative routine recall
What should be done if moderate or severe dyskaryosis?
Refer to colposcopy
What should be done if suspected invasion?
Urgent colposcopy
What is the process in Scotland?
Women from ages 20-60 screened every 3 years
What is colposcopy?
Examination of the cervix by a colposcope - a binocular microscope which magnifies by 6-40x
Describe the colposcopy process
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
If there is strong uptake of acetic acid, what can be done?
See and treat - perform definitive treatment in same appointment without waiting for biopsy result
Does colposcopy detect adenocarcinoma?
No (it usually lies in the endocervical canal)
Can a pregnant woman have a colposcopy?
Yes but not a LLETZ
Should wait until 12 w post partum until definitive treatment
How is a Large Loop Excision of the Transformation Zone (LLETZ) performed?
In the colposcopy clinic under local anaesthetic using loop diathermy
What features are suggestive of CIN or invasion?
Abnormal vascular pattern
Abnormal staining of tissue