Cervical Screening and HPV triage

Question 1

What are the age intervals for cervical screening in the UK?

Answer 1

24.5 - first invitation
25-49 every 3 years
50-64 every 5 years
65+ as per abnormal results. If no adequate screening >50, on request

Invitations sent out 6/52 before due

Question 2

What may be the reasons for voluntary withdrawal from the cx screening programme?

Answer 2

1 low risk ie never sexually active
2 difficult/distressing sample taking eg disability
3 no benefit to screening eg terminally ill
4 unable to give adequate sample eg fgm - ?refer gynae

Question 3

What is the management of smears reported as low grade/borderline dyskaryosis?

Answer 3

Test for HRHPV using Hybrid Capture 2 (HC2)
If neg -> routine recall
If pos -> colposcopy

Question 4

What is the management of smears reported as high grade dyskaryosis?

Answer 4

Refer direct to colposcopy

Question 5

When should inadequate smear tests be repeated by?

Answer 5

> 3/12

Question 6

How many inadequate smears before referral to colp?

Answer 6

3

See within 6/52

Question 7

When in their cycle are women >40 more likely to have endometrial cells in their cervical smear sample?

Answer 7

Up to Day 12

Question 8

What is the follow up following treatment for CIN?

Answer 8

Regardless of margins - 6/12, community based
If negative/LG/borderline - HRHPV and referral to colp if positive
If HG/?invasive - straight to colp

Question 9

What is the follow up following treatment for CGIN?

Answer 9

Complete excision:

• TOC 6 and 18 months if cytology and HPV neg then 3 year recall
• Refer to colp if either cytology or HPV pos
• If no abnormality at colp and re-excision declined cytology at 6,12 months then yearly for 9 years

Question 10

Under what circumstances should women be seen within 2/52 of referral in colp clinic?

Answer 10

• HG dyskariosis, moderate or severe
• ?invasive squamous cell carcinoma
• ?glandular neoplasia of endocervical or non-endocervical or non-specific type

Otherwise 6/52

Question 11

What is the advice for women following outpatient treatment colposcopically?

Answer 11

• No tampons/sex 4/52
• No swimming 2/52
• Normal activities e.g. light exercise, driving OK
• May have temporary change in menstrual pattern following LLETZ
• Single Rx <10mm depth not associated with increased PTL/PPROM
• No increase in infertility but may be increase in T2 miscarriage

Question 12

What is DySIS?

Answer 12

Dynamic spectral imaging system

Digital video colposcopy that gives quantitative measurement of acetowhitening

Question 13

When may ablative techniques for CIN be suitable?

Answer 13

TZ visualised entirely
No glandular abnormality
No invasive disease
No major discrepancy between cytology and histology
Exceptional circs if >50

Question 14

What % of CIN1 will regress over 22 months?

Answer 14

> 50%

Question 15

What are the recommended depths of excision for TZs?

Answer 15

Type 1 - >7mm (ideally <10mm if repro age)
Type 2 - 10-15mm
Type 3 - 15-22mm

Question 16

What is the management of CIN3 that extends to the margins on excision?

Answer 16

No routine excision providing:

• No glandular abnormality
• No invasive disease
• <50yo

TOC at 6/12
Repeat excision if >50

Question 17

What is the managment of incompletely locally excised microinvasive squamous 1a cancer?

Answer 17

Repeat excision even if hysterectomy planned to exclude further invasive disease (ie needs radical)

Question 18

What is the management of incompletely excised CGIN?

Answer 18

Further attempt at conservative excision can be attempted

MDT

Question 19

What is the colposcopic management of women exposed to DES in utero?

Answer 19

Initial colp - if normal routine cervical screening

If abnormality/stigmata seen - for yearly colp (?for life)

Question 20

What is the follow up of women treated for CIN1, 2, 3?

Answer 20

6/12 TOC

• If neg/borderline/LG and HPV neg 3 yr recall (then 5 yrs if >50 and negative then)
• If HPV pos -> colp
• If HPV unavailable repeat cytology 3/12
• HG -> colp

Question 21

What is the follow up for conservative mangement of stage 1a cervical cancer?

Answer 21

Cytology 6, 12 months
Annual cytology for 9 years
Routine recall to 65
(ie no HPV testing yet)

Question 22

What is the follow up for hysterectomy with no CIN in specimen and on routine recall?

Answer 22

No further vault cytology

Question 23

What is the follow up for hysterectomy with no CIN in specimen and not on routine recall?

Answer 23

Vault cytology 6/12 then ceased if negative

Question 24

What is the follow up for hysterectomy with completely excised CIN in specimen?

Answer 24

Vault cytology 6 and 18 months

Question 25

What is the follow up for hysterectomy with incompletely excised CIN in specimen?

Answer 25

As if cervix in situ:
CIN1 - cytology 6, 12, 24 months
CIN2/3 - cytology 6, 12 months then yearly for 9 years
Until 65 or 10 years after treatment

Question 26

What is the management of a woman who has been called to routine cervical screening and is pregnant?

Answer 26

Defer until postnatal

Question 27

What is the management of a woman who is found to have abnormal cytology and is pregnant?

Answer 27

Colposcopy in late T1/early T2 (if prev colp abnormal don’t delay)
If colp referral for LG and pos HPV can be deferred til 3/12 postnatal

Question 28

What is the management of women who have had treatment for CIN and are pregnant when due follow up colp/cytology?

Answer 28

If untreated CIN1 - delay until postnatal

If following CGIN or unclear margins for CIN2/3 don’t delay

Question 29

When should cervical biopsy be taken in pregnancy?

Answer 29

If invasive disease suspected clinically or colposcopically (caution re: risk of haemorrhage 25%)

Question 30

When should women have smears if in renal failure on dialysis?

Answer 30

Shortly after diagnosis

Within previous year if undergoing transplantation

Question 31

What is the cervical screening for women who are HIV positive?

Answer 31

Annual cytology with initial colposcopy if possible

Treatment as per national screening

Question 32

What type of virus is HPV?

Answer 32

double strnded DNA