Cervical Screening and Colposcopy Flashcards
What is cervical check and how does it work?
- Irish national screening programme for cervical cancer
- Women aged 25-60
- Aged 25-45 = smear every 3yrs
- Aged 45-60 smear every 5yrs
Define CIN
Pre-cancerous lesion which occurs at the TZ of squamous columnar junction
Screening picks up these pre-cancerous changes
What is HPV?
- Common virus that can affect the cells of the cervix and 80% of adults will have it at some point in their lives
- Usually spread by direct skin to skin contact during vaginal, anal or oral sex with someone infected
- Asymptomatic, most people never know they are infected
- Normally cleared by person’s own immune system
- Smoking reduces body’s ability to clear the virus
How many oncogenic subtypes of HPV are there and which are the most common?
- 15 oncogenic genotypes
- Types 16+18 = 70% cervical cancers
- Types 16, 18, 31 and 33 = 81% cervical cancers
What is the vaccine available for HPV and what subtypes does it vaccinate against?
- Gardasil vaccine
- Types 6, 11, 16 and 18
List the secondary risk factors for cervical cancer
- Smoking
- COCP
- Multiparity
- Immunosuppression
- STIs (Chlamydia)
Explain no abnormality detected (NAD) smear result
In the sample taken, no abnormal cells were detected at this time
Explain unsatisfactory/inadequate smear result
Lab was unable to read the sample which may be because there were not enough cells to analyse or because they were obscured by blood/discharge/lubricant
Woman must wait for 3mths from date of last smear test so that enough cells are present for repeat test
Explain atypical squamous cells of undetermined significance (ASC-US) smear result
- Test has found some minor changes in the cells of the cervix that may be referred to as borderline
- Some cells from outer cervix cannot definitely be described as normal
- Will result in HPV test for types of HPV associated with cervical cancer
- If HPV negative, routine recall
- Refer to colposcopy if HPV positive
Explain atypical squamous cells - cannot exclude HSIL (ASC-H) smear result
- Cervical cells do not appear normal
- May be abnormal changes which are high grade
- Referral to colposcopy for further assessment
Explain indeterminate HPV test smear result
- Any HPV test not processed for technical reasons generates an automatic referral to colposcopy recommendation
Explain atypical glandular cells (AGC) smear result
- Some cells in inner lining of cervix appear abnormal
- Requires referral to colposcopy as higher risk of cancer
Explain low grade squamous intraepithelial lesion (LSIL) smear result
- Found some mild changes to cells of cervix
- NOT CANCER - cells can often return to normal
- HPV test for types associated with cervical cancer
- HPV negative, routine recall
- HPV positive, colposcopy referral
Explain high grade intraepithelial lesion (HSIL) smear result
- Moderate to severe abnormal changes in the cervix
- Needs further investigation
- Does not mean woman has cancer
- Refer to colposcopy
Explain broken/damaged/expired vial or sample smear result
- Smear test could not be processed and will need to be repeated no earlier than 3mths from the date of the last smear test
List the indications for referral to colposcopy
- 3 consecutive unsatisfactory smears
- Any 3 smear tests that are not normal in the past ten years
- ASC-US of LSIL with positive HPV test
- HSIL
- ASC-H
- AGC
- Suspicious cervix
What is the time frame for smears in post-colposcopy surveillance?
Smear test in 1yr
What is the time frame for a post-hysterectomy vault smear?
Repeat in 6mths
Define colposcopy
A method of examination that magnifies and illuminates the cervix in order to identify precancerous lesions
How is the procedure performed?
- Lithotomy position - cervix visualised using speculum
- Colposcope focused on the cervix to demonstrate area of abnormality
- Acetic acid applied - abnormal cells stained white
- Iodine applied - normal cells stain brown , columnar epithelium unstained, CIN stains yellow
- Specific areas for biopsy identified and biopsies taken
- +/- treatment LLETZ (large loop excision of transformation zone)
What advice should be given to the patient after LLETZ/biopsy?
Avoid sex, tampons and baths for 4-6wks after
What types of biopsy/ procedures can be done?
- LLETZ
- Punch biopsy
- Cone biopsy
List the advantages of colposcopy
- Quick
- See and treat
- Done in OPD
List the disadvantages of colposcopy
- Can be an unpleasant procedure
- Anxiety related to procedure
- Anxiety related to precancerous lesions
- Risk of bleeding/infection
- Maybe overtreatment (??)
