Cervical Screening and Colposcopy Flashcards
how common is cervical cancer
12th most common in scottish women
most common cancer in women under 35
276 new cases and 80 deaths in 2018
what ages does cervical cancer affect most
30-45
is cervical cancer more common in most or least deprived
most deprived
what are the points needed in order to make a screening programme feasible
Important health problem? Treatment available? Recognizable latent or early symptomatic phase? Suitable screening test available? Natural history of condition understood? Cost effective?
what are the advantages of screening programmes
Reduced disease incidence Reduced disease mortality Earlier, less radical treatment Cost-effective Overall population benefit
what does cervical screening look for
cell changes which may develop to be pre-cancerous in women who otherwise have no symptoms
If left untreated, may develop into cervical cancer
what are the symptoms of cervical cancer
unusual vaginal bleeding/ discharge
increased bleeding after sex/ between periods
dyspareunia
should women with symptoms get a screening test
no should get a diagnostic test
what is the screening programme for cervical cancer
women aged 25-49 every 3 years
women aged 50-64 every 5 years
what is the cervical cancer screening test
speculum exam
visualise the cervix
brush sample of the cells from the transformation zone of the cervix
liquid based cytology (and HPV testing starting 2020)
who is most likely to uptake screening tests
ages 50-64, least deprived
what is the formula for coverage of a screening test
(screened population/ eligible population) x 100%
what is the formula for uptake of a screening test
(screened population/ invited population) x 100%
who is at risk of not getting screening
Minority ethnic groups Immigrants Travellers Prisoners Students
what are the challenges in optimising uptake
Change of address Communication Health literacy Deprivation Accessibility Vulnerable groups
how is screening coverage and uptake increased
Promotion of screening programme
Material in variety of languages
GP incentives
Local and national initiatives
which types of HPV cause cervical cancer
16 and 18
who gets the HPV vaccine
Girls S1 to S3 and MSM 45 (through SRH)
Boys in S1
is HPV 6/11 vacinnated against
yes to protect against genital warts
do people who have had HPV vaccinations still need screening
yes vaccine doesnt prevent 30% of cervical cancers
what reproductive cancers are increased by obesity
breast
womb
ovary
what is the impact of obesity in O&G
Increased subfecundity Increased infertility Decreased effectiveness of IVF Increased risk of miscarriage Increased risk of pregnancy complications
what does smoking cessation do in O&G problems
Decreased risk of complications in pregnancy and birth
Reduced risk of stillbirth, premature birth, sudden infant death syndrome
reduced risk of developing cervical cancer
Improved prognosis following diagnosis of cervical cancer
what is the recommended dose of folic acid
400 micrograms folic acid tablet every day before pre-conception, until 12 weeks pregnant.
who gets cervical smears in scotland
25-65 year olds
3 yearly smears till age 50
5 yearly from 50 -65
what do the different results of a cervical smear need management wise
normal- routine recall
unsatisfactory repeat in 3 months
borderline or mild dyskaryosis = repear in 6 months
mod/ severe dyskaryosis or glandular abnormalities= refer to colposcopy
?invasive- urgent (2 weeks) colposcopy
what is a colposcopy
Magnified inspection of cervix and use of stains to identify abnormality can perform: -Biopsy and follow up -Biopsy and treat with cold coagulation -LLETZ (large loop excision of TZ)
what stains are used in colposcopy
Acetic acid -Acetowhite -White with abnormality shows: -Extent of lesion -Density -Mosaic -Punctation -Abnormal vessels
Iodine
Positive is brown = normal
Negative is absence of stain = abnormal
What is the test of cure for cervical dysplasia
Combined smear and HPV test after 6 months
Double negative – 3 yearly repeat smear
If positive need further colposcopic assessment
what might patients experience after a colposcopy
period like bleed ad cramping
if foul smelling/ heavy bleeding with clots then not normal
how long to colposcopy results take
4 weeks, arrive by letter
what are the treatment options for CIN
Cold Coagulation (Destructive) Hot probe which causes cells to burst LLETZ (Excisional) Electosurgical wire can cut through tissue (loop) (both performed in clinic under LA)
when can you have sex after colposcopy
when feel comfortable to
small risk of infection
does colposcopy/Tx affect fertility
no
does colposcopy affect contraception
only IUD- may need removal and reinsertion
what might LLETZ increase the risk of
late miscarriage, prematurity
should you albate suspected malignancy
no always excise
what is the chance of high grade dyskaryosis turning into cancer
50%
what causes cervical cancer
HPV (70% due to types 16 qnd 18)
what can impair immune clearance of HPV
HIV
immunocompromised
transplant
diabetics
