Cervical screening and CIN

Question 1

What age and how often are women screened?

Answer 1

⎫ Sexually active women aged 25-64

⎫ 3 yearly from 25-50 and 5 yearly until 64

Question 2

What specific group of women require annual smears?

Answer 2

HIV +ve

Question 3

What % of abnormalities are detected by screening?

Answer 3

95

Question 4

What Is CIN?

Answer 4

Cervical intra-epithelial neoplasia (CIN) is the pre-invasive phase of cervical cancer

Question 5

What is CIN 1

Answer 5

affects the lower basal third of cervical epithelium and will regress to normal in 60% within 2 years

Question 6

What is CIN 2

Answer 6

<2/3 of epithelium

Question 7

What is CIN 3

Answer 7

> 2/3 of epithelium (up to full thickness)

Question 8

What HPV strains is CIN associated w ?

Answer 8

16, 18, 31 and 33

Question 9

What are CIN 2 and 3 at higher risk of ?

Answer 9

developing into invasive squamous carcinoma of the cervix

Question 10

What is dyskaryosis?

Answer 10

Abnormal cytologic changes of squamous epithelial cells

Question 11

Explain the process of screening if borderline or mild dyskaryosis is found on a smear

Answer 11

Women w borderline or mild changes are tested for high-risk HPV
If +ve refer to colposcopy

Question 12

Explain the process of screening if mod-severe dyskaryosis is found on a smear

Answer 12

Colposcopy regardless of HPV status

Question 13

How does dyskaryosis relate to CIN?

Answer 13

Degree of dyskaryosis approximates to the severity of CIN

Question 14

What are risk factors for CIN?

Answer 14

Persistent high risk HPV infection
Multiple partners (increased exposure)
Smoking
Immunocompromise
OCP (probs due to reduced use of barrier contraceptives)

Question 15

What is the first stage in management of CIN?

Answer 15

Colposcopy

Question 16

Explain what happens in colposcopy

Answer 16

→ Woman in lithotomy position w speculum inserted
Cervix visualised, transformation zone identified and painted w 5% acetic acid
Lugol’s iodine is then
used
Punch biopsy taken

Question 17

What is acetic acid used for?

Answer 17

it is preferentially taken up by neoplastic cells

Question 18

What is lugols iodine used for?

Answer 18

not take up by neoplastic cells

Question 19

How are abnormal areas identified on colposcopy?

Answer 19

they appear white by the acetic acid

Question 20

When is LLETZ offereD?

Answer 20

if high grade CIN (>1)

Question 21

What is LLETZ

Answer 21

Large loop excision of the transformation zone

Is performed under local anaesthetic w loop diathermy

Question 22

What are the complications of LLETZ

Answer 22

o	Haemorrhage
o	Infection
o	Vaso-vagal sx
o	Anxiety 
o	Cervical stenosis
o	Premature delivery

Question 23

What is the required follow up for LLETZ

Answer 23

smear at 6m w high risk HPV testing

Question 24

What is CGIN

Answer 24

cervical glandular intraepithelial neoplasia

Question 25

What is CGIN associated w

Answer 25

high risk HPV

Question 26

Why is CGIN difficult to manage?

Answer 26

endocervical epithelium extends into the cervical canal and is therefore not completely visible at colposcopy

Question 27

What is the treatment of CGIN

Answer 27

cylindrical LLETZ, cone biopsy or hysterectomy

Question 28

When is the HPV vaccination offered?

Answer 28

12yrs

Question 29

What subtypes is HPV aimed at

Answer 29

6,11,16 and 18

Question 30

When doesn’t the HPV vaccination offer protection?

Answer 30

once the HPV infection has occurred