Cervical screening symposium Flashcards
HPV prevalence
peak age 15-25 and declines with age
30% in young women and men, 10% overall
75% lifetime risk of exposure
HPV can be linked to what kind of cancers?
CERVICAL , anus
penis, vulval, vagina
mouth, oropharynx
What is SIL?
abnormal growth of squamous cells detected on smear
What is CIN?
abnormal cells in cervix detected by biopsy and histology
primary and secondary prevention of HPV/CIN
vaccines
cervical screening
UK HPV immunisation programme
1st Sep 2008 given to girls born after 1st Sep 1990
bivalent vaccine - 16&18
Sept 2012 - quadrivalent 16,18,6,11 - genital warts
Sept 2014 - 2 dose regime
How are people invited to cervical screening?
invitation in post to book appointment for cervical screening at GP from 25 years old
Process of cervical screening
LBC
cells from transformational zone - squamocolumnar
25-64
high risk HPV
What happens if minor changes are seen in the smear?
referred to colposcopy
HPV test
molecular test on cells sampled from cervix
high risk HPV viral DNA or RNA
hybridisation, PCR
change in cervical cytology samples in 2020
currently all, will be only HPV positive
dyskariosis
abnormal cells
endocervix
columnar epithelium
exocervix
stratified squamous
Lab processing method
thin layer of cells - 50 000
PAP stain
imager picks up points of interest and screener reads
abnormal cell characteristics
increased size and nuclear:cytoplasmic ratio
variation in size, shape and outline
coarse irregular chromatin
nucleoli
Koliocytosis
cells with wrinkled nucleus and perinuclear halo
multinucleation
reflect HPV infection
HPV test and cytology difference
HPV is positive or negative with cervical cells - machine detects infection and is sensitive
cytology is human interpretation of the cells and cellular change. specific
HPV negative - what happens?
recall in 5 years
HPV positive - what happens?
cytology normal repeat in 1 year
dyskariosis –> colposcopy
colposcopy
magnification and light to see cervix
exclude obvious malignancy
acetic acid and iodine
use of acetic acid and iodine in colposcopy
identify area for biopsy
identify limits of lesion
define area to treat
Options for management - CIN
punch biopsy
return for treatment if CIN2/3
E7 protein products
prevents cell cycle arrest
E6 protein product
inhibits cell death
Low risk HPV
6,11,42,44
genital warts, infection transient, low grade CIN
High risk HPV
16,18,31,45
persistent infection and high risk of high grade CIN and cancer
How does high risk HPV –> high grade CIN?
viral DNA integrates in host cell genome
over expression of viral E6+7 proteins
deregulation of host cell cycle
CIN description
invisible to naked eye
dysplasia -squamous epithelium and abnormal change
Treating CIN
LLETZ
Thermal coagulation
laser ablation
Following up after CIN treatment
LBC at 6 months for cytology and high risk HPV
both negative - return to recall
either positive - colposcopy
cervical cancer epidemiology
2500/UK/year and 1200 death
10th most common cancer in women in Scotland
6 risk factors for cervical cancer
HPV 16&18 peak age 45-55 multiple partners early age of intercourse older partner smoker
5 symptoms of cervical cancer
PMB post coital bleeding abnormal bleeding pain discharge
Diagnosing cervical cancer
clinical, screening - aim to detect pre cancer, biopsy
Most common type of cervical cancer
squamous
stage2,3,4 of cervical cancer
2 - vagina upper 2/3
3 - lower vagina, pelvis
4 - bladder, rectum
mets of cervical cancer
lymphatic - pelvic LN
blood - liver, lungs, bone
staging by cervical cancer
EUA, PET-CT, MRI
treatment of cervical cancer
1a1: type 3 excision or hysterectomy
1b-2a: radical hysterectomy or chemo/radio
2b-4:chemo/radio
What is removed in radical hysterectomy
uterus, cervix, upper vagina
parametria
pelvic LN
ovaries conserved
chemo
5 cycles of cisplatin
radio
external beam x 20 fractions
caesium insertion
24 hours
