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reproductive system 2 > Cervical Screening Symposium > Flashcards

Cervical Screening Symposium Flashcards

1
Q

What virus is associated with cervical cancer?

A

HPV

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2
Q

What is the incidence of HPV?

A

peak prevalence 15-25yrs

  • prevalence declines with age
  • 10% overall
  • ~30% prevalence in young women
  • lifetime risk of exposure up to 80% from serological studies
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3
Q

What cancers does HPV have an association with?

A
  • Cervical
  • Anus
  • Penis
  • Vulva/vagina
  • Oropharynx
  • Mouth
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4
Q

What is a squamous intraepithelial lesion?

A

An abnormal growth of squamous cells detectable on smear

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5
Q

What are abnormal cells in the cervix detected by biopsy and histological examination classified as?

A

cervical intraepithelial neoplasia (CIN)

graded 1-3

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6
Q

What types of HPV is associated with cervical cancer in Europe?

A

Types 16 and 18

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7
Q

What are the possible outcomes of CIN1?

A
  • regression
  • remain unchanged
  • progression to CIN2, CIN 3 or cervical cancer
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8
Q

What is the UK HPV immunisation programme?

A
  • introduced in September 2008
  • offered to girls born after 1 September 1990
  • currently a 2 dose regime
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9
Q

What are the steps in the Scottish Cervical Call Recall System?

A
  • smear taker enters request details onto SCCRS database
  • vials sent to lab receipt logged on SCCRS
  • patient details received from SCCRS, vials processed, slides stained and screened
  • cytology lab results put on SCCRS database
  • woman and GP receive results
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10
Q

What is the cervical screening programme in Scotland?

A
  • women aged 25-64 years
  • 5 yearly smears
  • liquid based cytology
  • test for high risk HPV
  • if positive, triage with cytology
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11
Q

What is an HPV test?

A

molecular test on cells sampled from cervix

  • identifies high risk type HPV viral DNA or RNA
  • any high risk type leads to type specific genotyping
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12
Q

What is cervical cytology?

A

microscopic assessment of cells scraped from the transformation zone

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13
Q

What type of epithelium is found in the endocervix?

A

Columnar epithelium

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14
Q

What type of epithelium is found in the ectocervix?

A

Stratified squamous epithelium

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15
Q

What type of epithelium is find at the transformation zone of the cervix?

A

Squamo-columnar junction

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16
Q

How are cervix cells stained?

A

Stained by Papinicolaou method

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17
Q

What is dyskaryosis?

A

Abnormal cells showing the earliest signs of malignancy in its nucleus whilst retaining relatively normal cytoplasm

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18
Q

What are the nuclear features of dyskaryosis?

A
  • Increased size and nuclear:cytoplasmic ratio
  • Variation in size, shape and outline
  • Coarse irregular chromatin
  • Nucleoli
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19
Q

How is dyskaryosis graded?

A

reflects degree of underlying CIN

  • Low grade (+ borderline)
  • High grade
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20
Q

What do koilocytes reflect?

A

HPV infection

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21
Q

What does HPV test identify?

A

HPV infection (could be transient or CIN associated)

22
Q

What does cytology identify?

A

Cellular changes

  • Low grade (persisting infection/CIN1)
  • High grade (CIN2/3)
23
Q

What happens if a cervical smear is hrHPV is negative?

A

Routine recall in 5 years

24
Q

What happens if a cervical smear is hrHPV is positive?

A
  • Cytology normal; repeat test 1 year

- Dyskaryosis: refer to colposcopy

25
Q

What is colposcopy?

A
  • magnification and light to see cervix
  • exclude obvious malignancy

use of acetic acid =/- Iodine: to identify lesion limits, select biopsy site and define area to treat

26
Q

What are the options for management of dyskaryosis?

A
  • punch biopsy to make a diagnosis and can return for Treatment if CIN2/3
  • or “See and treat” at first visit
27
Q

What HPV related pathology can affect the transformation zone of the cervix?

A
  • HPV infection
  • precancerous changes cervical intraepithelial neoplasia (CIN)
  • cervical carcinoma
28
Q

How does HPV infection affect the transformation zone of the cervix?

A
  • infects basal layer cells
  • utilises host for replication
  • as host cell matures, different viral genes expressed
29
Q

What does the E7 protein product do?

A

Prevents cell cycle arrest

30
Q

What does the E6 protein product do?

A

Inhibits cell death

31
Q

What is koilocytosis?

A

cells with wrinkled nucleus and perinuclear halo

multinucleation

32
Q

What are the low risk types of HPV?

A

6, 11, 42, 44, others

genital warts and low grade CIN

often transient and resolve

33
Q

What are the high risk types of HPV?

A

16, 18, 31, 45, others

persistent infection increases risk of developing

high grade CIN and (more rarely) cancer

34
Q

How does HPV cause high grade CIN?

A

persistent infection

  • viral DNA integrates into host cell genome
  • overexpression of viral E6 and E7 proteins
  • deregulation of host cell cycle
35
Q

How does CIN present histologically?

A
  • disorganised proliferation of abnormal cells in squamous epithelium (dysplasia)
  • lack of maturation
  • variation in cellular size and shape
  • nuclear enlargement
  • irregularity
  • hyperchromasia
  • cellular disarray
36
Q

What is CIN a precursor of?

A

Invasive cancer

37
Q

How is CIN treated?

A

excise of transformation zone of cervix
- LLETZ

ablate transformation zone of cervix

  • thermal ablation
  • laser ablation
38
Q

Why is CIN followed up after treatment?

A

to confirm treatment was effective

to prevent invasive cancer

to reassure woman treatment has worked

39
Q

How is CIN followed up after treatment?

A

follow-up LBC at 6 months for cytology and high risk HPV

  • both negative – return to 3 year recall
  • either positive – return to colposcopy
40
Q

What is the incidence of cervical cancer?

A
  • 2500 cases per year in UK
  • 1200 deaths
  • 10th commonest cancer in women in Scotland
  • Good cure rate if detected early
  • BUT major cause of death in in women in developing countries
41
Q

What are the risk factors for cervical cancer?

A
  • peak age 45-55 years
  • HPV related (16&18)
  • multiple sexual partners
  • early age at first intercourse
  • older age of partner
  • cigarette smoking
42
Q

What are the symptoms of cervical cancer?

A
  • abnormal vaginal bleeding
  • post coital bleeding
  • intermenstrual bleeding/PMB
  • discharge
  • (pain)
43
Q

How is cervical cancer diagnosed?

A
  • clinical
  • screen detected
  • biopsy
44
Q

What is the histology of cervical cancer?

A

tumour cells from epithelium invade into underlying stroma

  • majority squamous carcinoma (80%)
  • adenocarcinoma (endocervical) rising in relative incidence
45
Q

What is stage 1A cervical cancer?

A

Invasive cancer identified only microscopically

46
Q

What is stage 1B cervical cancer?

A

Clinical tumours confined to the cervix

47
Q

How can cervical cancer spread?

A

Local

  • Stage 2: Vagina (upper 2/3),
  • Stage 3: lower vagina, pelvis,
  • Stage 4 bladder, rectum

Metastases

  • Lymphatic: pelvic nodes
  • Blood: liver, lungs, bone
48
Q

How is cervical cancer staged?

A
  • PET-CT

- MRI

49
Q

How is cervical cancer treated?

A
  • excision of cervical TZ
  • radical hysterectomy
  • chemo-radiotherapy
50
Q

What is a radical hysterectomy?

A

removal of

  • uterus, cervix, upper vagina
  • parametria
  • pelvic nodes

ovaries conserved in pre-menopausal women

reproductive system 2 (35 decks)

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