Cervical Screening and HPV triage Flashcards
What are the age intervals for cervical screening in the UK?
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
What may be the reasons for voluntary withdrawal from the cx screening programme?
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
What is the management of smears reported as low grade/borderline dyskaryosis?
Test for HRHPV using Hybrid Capture 2 (HC2)
If neg -> routine recall
If pos -> colposcopy
What is the management of smears reported as high grade dyskaryosis?
Refer direct to colposcopy
When should inadequate smear tests be repeated by?
> 3/12
How many inadequate smears before referral to colp?
3
See within 6/52
When in their cycle are women >40 more likely to have endometrial cells in their cervical smear sample?
Up to Day 12
What is the follow up following treatment for CIN?
Regardless of margins - 6/12, community based
If negative/LG/borderline - HRHPV and referral to colp if positive
If HG/?invasive - straight to colp
What is the follow up following treatment for CGIN?
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
Under what circumstances should women be seen within 2/52 of referral in colp clinic?
- HG dyskariosis, moderate or severe
- ?invasive squamous cell carcinoma
- ?glandular neoplasia of endocervical or non-endocervical or non-specific type
Otherwise 6/52
What is the advice for women following outpatient treatment colposcopically?
- 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
What is DySIS?
Dynamic spectral imaging system
Digital video colposcopy that gives quantitative measurement of acetowhitening
When may ablative techniques for CIN be suitable?
TZ visualised entirely No glandular abnormality No invasive disease No major discrepancy between cytology and histology Exceptional circs if >50
What % of CIN1 will regress over 22 months?
> 50%
What are the recommended depths of excision for TZs?
Type 1 - >7mm (ideally <10mm if repro age)
Type 2 - 10-15mm
Type 3 - 15-22mm
What is the management of CIN3 that extends to the margins on excision?
No routine excision providing:
- No glandular abnormality
- No invasive disease
- <50yo
TOC at 6/12
Repeat excision if >50
What is the managment of incompletely locally excised microinvasive squamous 1a cancer?
Repeat excision even if hysterectomy planned to exclude further invasive disease (ie needs radical)
What is the management of incompletely excised CGIN?
Further attempt at conservative excision can be attempted
MDT
What is the colposcopic management of women exposed to DES in utero?
Initial colp - if normal routine cervical screening
If abnormality/stigmata seen - for yearly colp (?for life)
What is the follow up of women treated for CIN1, 2, 3?
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
What is the follow up for conservative mangement of stage 1a cervical cancer?
Cytology 6, 12 months
Annual cytology for 9 years
Routine recall to 65
(ie no HPV testing yet)
What is the follow up for hysterectomy with no CIN in specimen and on routine recall?
No further vault cytology
What is the follow up for hysterectomy with no CIN in specimen and not on routine recall?
Vault cytology 6/12 then ceased if negative
What is the follow up for hysterectomy with completely excised CIN in specimen?
Vault cytology 6 and 18 months
What is the follow up for hysterectomy with incompletely excised CIN in specimen?
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
What is the management of a woman who has been called to routine cervical screening and is pregnant?
Defer until postnatal
What is the management of a woman who is found to have abnormal cytology and is pregnant?
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
What is the management of women who have had treatment for CIN and are pregnant when due follow up colp/cytology?
If untreated CIN1 - delay until postnatal
If following CGIN or unclear margins for CIN2/3 don’t delay
When should cervical biopsy be taken in pregnancy?
If invasive disease suspected clinically or colposcopically (caution re: risk of haemorrhage 25%)
When should women have smears if in renal failure on dialysis?
Shortly after diagnosis
Within previous year if undergoing transplantation
What is the cervical screening for women who are HIV positive?
Annual cytology with initial colposcopy if possible
Treatment as per national screening
What type of virus is HPV?
double strnded DNA
