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Reproductive > Cervical Screening Symposium > Flashcards

Cervical Screening Symposium Flashcards

1
Q

How common is HPV infection?

A

Human Papilloma Virus

  • peak prevalence 15-25yrs
  • prevalence declines with age
  • 10% overall
  • ~30% prevalence in young women
  • lifetime risk of exposure up to 75% from serological studies
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2
Q

What is the basis of the HPV immunisation program?

A

After Sept 2014,

  • 2 dose regime
  • Helps protect them against cervical cancer, which is the most common cancer in women under 35 in the UK
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3
Q

What is cervical screening and what is the role?

A
  • Method of detecting abnormal cells on the cervix
  • [aka the smear test]
  • Detect cervical dyskaryosis
  • Reduce the risk of cervical cancer
  • Detect CIN
  • Prevent Cervical Cancer
  1. Smear is taken
  2. Smear taker enters request details onto SCCRS database (Scottish Cervical Call Recall System)
  3. Vials sent to lab receipt logged on SCCRS
  4. Patient details received from SCCRS, vials processed, slides stained and screened
  5. Cytology lab results put on SCCRS database
  6. SCCRS creates colposcopy referral
  7. Woman and GP receive results
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4
Q

When do women get the smear test?

A
  • Women aged 25-64 years
  • 3 yearly smears up to age 50
  • 5 yearly from 50
  • Liquid Based Cytology (LBC)
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5
Q

What is found via cervical cytology?

A
  • Microscopic detection of abnormal squamous cells that are suggest underlying cervical intraepithelial neoplasia
  • Identify women that have no abnormality and those requiring further investigation
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6
Q

What is normal cytology of the cervix?

A
  • Squamous epithelial cells
  • Other cells present (glandular etc)
  • Benign nuclear features: small, uniform size and shape, fine regular chromatin
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7
Q

What is abnormal cytology of the cervix?

A

Abnormal = DYSKARYOSIS

  • Abnormal cells may be few
  • Nuclear features:
    • increased size and nuclear/cytoplasmic ratio
    • variation in size shape and outline
    • coarse irregular chromatin
    • nucleoli
  • Graded low or high grade dyskaryosis - reflects degree of underlying CIN (Cervical Intraepithelial Neoplasia)
  • Low grade (+ borderline nuclear abnormality) = 8%
  • High grade = 1.4%
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8
Q

What does low grade dyskaryosis reflect?

A
  • usually indicates HPV infection/CIN 1
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9
Q

What does the presence of Koilocytes reflect?

A
  • Productive HPV infection
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10
Q

What does high grade dyskaryosis represent?

A

Underlying CIN3

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11
Q

What is cytology management when:

Normal?

Low grade dyskaryosis?

High grade dyskaryosis?

A

Normal: routine, 3 yearly

Low grade: repeat in 6 months

High grade: refer to colposcopy

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12
Q

What is colposcopy and what occurs at the first visit?

A
  • Counselling

What is it?

  • Magnification and light to see cervix
  • Exclude obvious malignancy
  • Use of acetic acid =/- Iodene:
    • Identify limits of lesion
    • Select biopsy site
    • Define area to treat
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13
Q

What are the options for management post colposcopy?

A
  • Punch biopsy to make a diagnosis
  • Return for Treatment if CIN2/3
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14
Q

What occurs histologically in the transformation zone?

A
  • Glandular lining cells of exposed endocervical epithelium transformed into squamous cells! (squamous metaplasia)
  • Site of HPV infection
  • Also the site of precancerous changes
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15
Q

What are the effects of HPV infection?

A
  • Infects basal layer cells
  • Utilises host for replication
  • As host cell matures, different viral genes expressed
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16
Q

What is CIN??

A

Cervical intraepithelial neoplasia

  • Abnormal proliferation of cells in squamous epithelium = cervical intraepithelial neoplasia (CIN)
  • Precursor of invasive cancer
17
Q

What dictates if CIN is 1, 2 or 3?

A

CIN1: Undiff cells only occupy lowest 1/3 of epith and surface cells can mature to big flat cells

CIN2: Undiff cells occupy 2/3 of thickness and only top layers show maturation to medium size cells

CIN3: Neoplastic cells or undifferentiated cells fill full thickness of epith here , no normal differentiated cells seen

18
Q

Aetiology/RF for CIN?

A
  • Almost all are associated with HPV particularly types 16 and 18
  • Early age at first intercourse, multiple sexual partners, prolonged oral contraceptive use
  • Cigarette smoking, STD’s, immunodeficiency
  • Persistant infection
  • Viral DNA > integration in host cell genome> overexpression of viral E6 and E7 proteins> deregulation of host cell cycle
19
Q

What can happen to CIN?

A
  • May regress or persist
  • A minority (20-30%) of CIN 3 progress to invasive cancer over 10 - 20 years if untreated
20
Q

What is squamous carcinoma in the cervix?

A
  • Malignant change in squamous cells of transformation zone of cervix
  • Abnormal cells invade the underlying tissues
21
Q

What is the management of CIN?

A
  • LLETZ
  • Cold Coagulation
  • Laser ablation
22
Q

What is the follow up management after CIN treatment?

A
  • Confirm treatment is effective
  • Prevent invasive cancer: recurrent disease after 3-5 years, detect occasional cancer
  • To reassure the woman
  • Follow-up LBC at 6 months for cytology and high risk HPV: if both negative then return to recall, if either positive then return to colposcopy
23
Q

What are the RF for cervical cancer?

A
  • Peak age 45-55 years
  • HPV related (16 & 18)
  • Multiple partners
  • Early age at first intercourse
  • Older age of partner
  • Cigarette smoking
24
Q

Symptoms of cervical cancer?

A
  • Abnormal vaginal bleeding
  • Post coital bleeding
  • Intermenstrual bleeding/PMB
  • Discharge
  • (Pain)
25
Q

How is the diagnosis made for cervical cancer?

A
  • Clinically
  • Screen detected
  • Biopsy
26
Q

How is the staging of cervical cancer carried out?

A
  • EUA (especially rectal) [examination under anaesthetic)
  • PETR -CT
  • MRI
27
Q

What is involved in a radical histerectomy?

A

Removal of:

  • Uterus, cervix, upper vagina
  • Parametria
  • Pelvic nodes
  • Ovaries conserved
28
Q

What are the management options for cervical cancer?

A
  • Radiotherapy- External Beam x 20 fractions
  • Chemotherapy- 5 cycles of cisplatin
  • Caesium Insertion (24 hours)
  • Stage 1a1:
    • Excision biopsy (Cone/SWETZ)
  • Stage 1b - 11a:
    • Radical hysterectomy or
    • chemo-radiotherapy
  • Stage 11b - 1V:
    • Chemo-Radiotherapy
29
Q

What are the cure rates of cervical cancer?

A

1a: 99%
1b: 85%
11a: 75%
11b: 60%
111b: 33%

1V: 15%

Reproductive (34 decks)

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